The rapid urbanization of Bangladesh means we are now faced with unprecedented health challenges, particularly amongst the urban slum population, where access to healthcare and utilization is particularly low. Physical and financial challenges, fear of the hospital environment, and disrespectful and abusive behaviour create barriers to seek care from professional healthcare providers, despite the presence of health facilities. Maternal health remains in a dismal situation, with 86 percent of slum women giving birth at home, attended by unskilled birth attendants in 2007.
It is imperative to improve maternal, neonatal and child health status in urban slums of Dhaka city corporations, and that is why in 2007 BRAC initiated Manoshi – primary health care to reach out to women and children offering culturally appropriate, medically proven maternal and child health services at the community. To address women’s health, we trained female community health workers to visit houses to identify women of reproductive age and ensure family planning.
The first step to addressing the problems of maternal health is to detect pregnant women, and provide health and nutrition education and basic antenatal check-ups at home and ensure comprehensive antenatal check-up from medically trained providers. In response to women’s wants and needs, we also need to continue to establish delivery centers within the slums close to women’s home, so that we can provide safe and dignified delivery services and facilitate timely referral to higher-level facilities if complications arise. The solution to the lack of access to proper healthcare facilities can only be found in community health workers who pay visits to homes after childbirth and provide postnatal care.
Over the years, Manoshi has expanded to all major cities in Bangladesh, reaching seven million slum dwellers by 2014. As a result, from 2007 to 2011, the proportion of women in the targeted slums having four or more antenatal care visits increased from 27 percent to 52 percent, and there has been an increase in facility based deliveries from 15 percent to 65 percent.
However, unnecessary referrals to hospitals are still happening, along with a sharp rise of caesarean sections. To stop this, we upgraded delivery centers to maternity centers and brought trained midwives to attend childbirth with basic emergency obstetric services. In few months, there has already been a 41 percent reduction of referrals to hospitals during childbirth at maternity centers compared to delivery centers. More importantly, Manoshi’s contribution to reduction of maternal and newborn mortality rate is immense in urban slums due to timely and congenial medical, social and financial support for health care.
To deal with the health issues of mothers and newborn babies in urban slums, there is a need for respectful maternity care maintaining quality, dignity and cultural appropriateness in provision of services, referral support for comprehensive care, and building of trust between community and health systems.
Dr Kaosar Afsana is Director of BRAC Health, Nutrition & Population Programme
