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Expecting Life for Mothers

by Ekram Kabir
**8As far as the situation in Bangladesh is concerned, awareness has to be so created that the problem of 'motherhood' is not seen just as a problem of the 'woman' concerned, but everybody around the woman is involved in it***
LACK of maternal care leaves about 28.000 women in Bangladesh dead every year at childbirth and in post-delivery period, according to an estimate made Jointly by Obstetrical and Gynaecological Society of Bangladesh and the UN Children's Fund. Maternal mortality may not be new in the country, but the staggering statistics implies to insufficient care for mothers.
"Safe Motherhood doesn't merely end in being a woman pregnant and giving birth to a child; it's in fact more than that in terms of her rights to survival and to choose." says Dr. Yasmin Ali Haque, a project officer at Dhaka UNICEF, specialising in health and nutrition.
Stretching on the point. Dr. Haque says: "Safe Motherhood means creating the circumstances within which a woman
is, first, enabled to choose whether she will become pregnant. and then, if she does, it has to be ensured that she receives care for prevention and treatment of pregnancy-related complications, and has access to trained birth assistance, emergency obstetric care, if she needs it. and receives care after giving birth to a child."
"These are all very important so that a woman can avoid death or disability from com-Elication of pregnancy at child-irth,” she emphasises.
Bangladesh has one of the
highest maternal mortality rates in the world which is five times higher than Sri Lanka's and Vietnam's, and about ten times higher than Malaysia's. "Once a woman develops complications. she needs a special type of care' known as emergency obstetric care (EOC) without which she may die, and unfortunately enough, in majority of the cases, women fail to avail this particular care due to various socio-economic and family-related reasons; and only one in 20 women with complications in Bangladesh can get to a facil-
ity where emergency obstetric care is available." says Dr. Haque.
The prime complications that cause maternal deaths in Bangladesh are haemorrhages (heavy loss of blood), abortion (spontaneous or induced), eclampsia (convulsions), and puerperal sepsis (infections) and obstructed labour. It is now known all over the world that all pregnant women are risk-prone to serious obstetric complications, and if the access to emergency obstetric services is not available to them and the
prevailing state of the system is not improved, then maternal deaths will continue to rise. One in six women globally develops these fatal complications due to the absence of proper nutrition during pregnancy.
In the context of Bangladesh, this means that while attaining the national goal of reducing maternal mortality is now a must, it is an imperative to focus on EOC services at all levels. And weighing the gravity of women’s poor health status, the government has decided to observe May 28 beginning from this year as 'Safe Motherhood Day'. Prime Minister Sheikh Hasina will officially announce it and zoom in on its importance on the day.
As the chips had been down for too long. May 28 is unlikely to be a hobby-horse like observing a host of already existing days in a mundane manner Instead. it. is expected to be a crash prograrhme all over the country, by engaging all concerned professionals, to ensure EOC services at every tier of the country's healthcare system. Evaluating women's contribution to the country's socio-eco-
Bangladesh cannot afford to experience a deplorable number of its women dying every year in absence of care.
Meanwhile, a question may arise: "Do all women who develop complications die as a result?" "No” says Dr. Haque, adding: "But many who do survive suffer with disability and pain for the rest of their lives." She cites 'fistula' as an obvious example: when it occurs, a woman is soon made undesirable by her husband.
Fistula occurs when tissues of the birth canal are deadened by prolonged labour and days of pressure from the baby's skull. Within days and weeks after the birth, the dead tissue falls away, leaving holes which allow leakage from the bladder and rectum. In this state, urine and faeces bypass the muscles that normally control the flow, and the woman becomes incontinent. As such, without an op-
eration to repair the fistula, she will remain so all her life feeling miserable to the extreme, both mentally and physically.
There are some traditional factors, resulting out of ignorance, which help unsafe motherhood to take root. "Many girls are married off too early and are made pregnant even before their own bodies are fully grown and ready to bear children." says the UNICEF project officer. Besides, a woman will run the risk when soon after giving birth to a child she has no choice but to resume sexual relations, regardless of the pain it causes; thus she needs obstetric care very badly. But most of the time, the social taboos fail to understand and overlook that after childbirth, a woman bruised and battered, needs time to recuperate.
Apart from the fact that Bangladesh has a fairly comprehensive health services infrastructure which to an extent is much better than other similar countries, most women with complications fail to get the care they need in time.
According to Dr Yasmin, it happens because of three kinds of delay; Delay in seeking care tiiat resuits in either not getting to the facility or reaching there when its too late; delay in reaching to an EOC facility due to the problems of distance, transportation and lack of preparation for emergencies; and delay in starting treatment because there are problems of availability of trained personnel. medicine and necessary equipment. All these delays take place because often proper value — at individual, family and social levels — is not put on a woman's life, both as a human being and as a mother.
As far as the situation in Bangladesh is concerned, awareness has to be so created that the problem of 'motherhood' is not seen Just as a problem of the woman' concerned, but everybody around the woman is involved in it. It can also be looked at in this way — implications for children are too significant to be omitted, that is. concentrating on women more as protectors of children, rather than women as women. The physical and emotional cost is beyond measure when women die at childbirth leaving their children mother-