BANGLADESH (Plan International): Shruti Bagum was only 14 years old when she got married. Both she and her new husband lived in the remote village of Amjhol in Lalmonirhat District, Bangladesh, and he worked as a day labourer.
The marriage didn’t last long, breaking down after only three years. Shruti was subjected to almost constant mental and physical torture by her husband. A few months after they split, Shruti married again, this time to a 40 year old man by the name of Fazlul Haque. She soon became pregnant for the first time.
“I was just a child and my health was not good because I was malnourished. During this time I had no one with whom I could share my feelings, not even my husband. I always felt nervous about my pregnancy.”
Shruti received no antenatal care of any sort. Her baby was delivered at home by an untrained traditional birth attendant who forced the process causing Shruti’s uterus to collapse. She gave birth to a dead child and she only narrowly survived herself, suffering extensive bleeding.
Within a year of this experience, Shruti Bagum was pregnant once again, but this time she had access to more skilled support in the shape of Jobeda, the community health worker for Eco-Social Development Organisation – a partner organisation of Plan International.
Jobeda asked Shruti to join the local women’s group and attend the learning sessions they organise. After consenting to do this, Shruti told Jobeda what her problems were. The community health worker advised her to attend her nearest Family Welfare Centre in order to receive proper antenatal care. Having followed this advice she was told that she suffered from anaemia and they identified exactly what her uterine problem was. She was also advised to have regular antenatal check-ups and to take iron tablets and vitamin supplements.
Her husband and her mother-in-law, however, were against her visiting the Family Welfare Centre on a regular basis. Her mother-in-law argued that, “I have a son but I didn’t take all these medicines. If you take so many tablets, your child will grow bigger inside your tummy and it will be difficult for you during delivery. Maybe you will need a caesarean (C-section) and that will cost us money.”
The community health worker and health officials from the local government attempted to remonstrate with both Shruti’s husband and her mother-in-law, but to no avail. Shruti’s health deteriorated and Jobeda called in the support of the local health officials, and community leaders responsible for managing the village’s development and the local clinic, in order to convince Shruti’s husband to admit her to the Upazila Sub-District Health Complex.
He agreed and, thankfully, this prompt action saved the life of both mother and child. Shruti explains, “My third baby was born without any problems at all. I thank sister Jobeda for her constant care and her sound advice.”
Shruti is now 29 years old and is living with her 51 year old husband and her two children. She advises other pregnant women from her village to have their babies delivered at the hospital and make use of antenatal care services. People listen and now most women in the district choose to deliver at the Family Welfare Centre or Upazila Health Complex.
Shruti Bagum’s story is echoed across Bangladesh. The decline in maternal mortality in the country as a whole over the last decade is a major public health achievement. Maternal mortality has declined as much as 40% according to the second Bangladesh maternal mortality and health care survey conducted in 2010. In 2001 only 9% of mothers gave birth using proper medical facilities. By 2010 that figure had increased to 23%.
A case that mirrors that of Shruti Bagum is that of Farida Akther from Bansbari village in Gazipur district. She married at the age of 17 and became pregnant within a year. As with Shruti, Farida had no antenatal care throughout her pregnancy. She simply trusted in good luck charms such as tabij (amulets) and pani pora (holy water) to counter the minor problems she encountered. Her baby boy ended up being born prematurely, delivered with the help of a traditional birth attendant, and he died after only half an hour of life.
Two years later Farida was pregnant again. She had some problems, including swelling in her legs for which she took traditional herbal remedies. One day after the delivery pains started, her family brought her to hospital, but it was too late to save her from giving birth to another dead baby.
Shortly after this Farida received a household visit from Nurunnahar, a Plan community nutrition worker. Nurunnahar listened carefully to her story and then spoke to both Farida and her family in order to convince them of the wisdom of Farida attending the local women’s group sessions. Here, Farida learned of the importance of antenatal care, good diet and rest during pregnancy.
Soon Farida was pregnant once again. This time she followed Nurunnahar’s advice and went for regular antenatal checkups at her local family welfare centre where she was well looked after. She delivered another baby boy normally at a private hospital. Although she is now the proud mother of a healthy son, she is reflective about the past.
“I lost two children purely through ignorance. I don’t want any other woman to suffer what I have suffered and I am deeply grateful to sister Nurunnahar.” Farida’s husband, Rashid adds, “Nurunnahar really opened my eyes. She showed me how to properly care for my wife during her pregnancy. Every husband should learn how to be helpful and careful when their wife is pregnant.”
It was hard to wean Farida’s mother-in-law from her traditional ways. “I believed in traditional culture and I was superstitious. I did not allow my son’s wife to go outside for a health check-up. As a result I lost my two grandsons. By her third pregnancy I had realised my mistake and allowed her to take antenatal care.”
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