Every year, a recent WHO report shows, 529,000 women worldwide die in childbirth and pregnancy. For over 20 years, the international community has pledged itself to improving maternal health. But until recently there has been very little progress. Now, in the Millennium Development Goals, 189 countries have renewed their commitment to reduce maternal mortality by 75 per cent by 2015.

In Bangladesh, 50 women die during pregnancy or in childbirth every day, but the government is determined to cut its maternal mortality rate – bringing it down from 20,000 to 5,000 a year over the next decade.

In 1999, Majuda Begum, wife of Belal Hussain went into labour with her fourth child. Belal had no money to take her to the hospital. He left his three children with their mother and went in search of money. Half an hour later, when he came back to the slum, his wife was already dead. The child was never born. In the four years since Majuda’s death, more than 80,000 women have died during pregnancy or in childbirth in Bangladesh.

In developed countries, WHO statistics show that a mother’s risk of dying from pregnancy-related causes is one in every 2800. In Bangladesh, the risk is one in every 59. The tragedies of maternal mortality don’t end with the death of individual women. The families they leave behind, especially the children, go on suffering the consequences.

Before Majuda's death, Belal used to work in a factory. After her death, he re-married and had two more children. But then he suffered a stroke that left him paralysed waist down – and his family life deteriorated.

Sunita Mukarjee, UNFPA Representative, Bangladesh, says: "If a mother dies, what happens to her new baby, what happens to her siblings, what happens to her community, on whom some charge will be levied? What happens to her husband, how does he proceed with his life? who looks after the children?"

Apart from the tragedy of the maternal deaths, there is also the continuing problem of maternal morbidity – ongoing health problems usually caused by the trauma of immature women giving birth. In Bangladesh alone, the UN Population Fund estimates six million women suffer from maternal morbidities – such as fistula.

Dr Sayeba Akhter operating.

Professor Sayeba Akhter of Dhaka Medical College Hospital explains: "For one woman who dies, 15 or more women suffer from many disabilities like obstetric fistula that means a hole in the bladder or rectum, there may be prolapse of the uterus, uterus descends and hangs outside, there may be chronic pelvic pains, the woman suffers from pains, they cannot work properly, they cannot stay with their husband because they have difficult intercourse and sometimes, that leads to family breakdown even. And due to infections, the women become infertile."

Often, affected women become outcasts, like Rina. By the age of 14 she was pregnant and had obstructed labour and ruptured her vagina. Her first baby died. Like many young girls whose pelvic bones are under developed, obstructed delivery left Rina damaged. Rina developed fistula and lost control of her bowel and bladder movements. She’s already had six operations but is still not cured.

"My husband’s family were very unkind to me. They said things like 'what use is this wife? She can’t make a family, she’s can’t do anything, what good is she to us?'"

Rina’s mother has had to sell most of her land and livestock to pay the costs of Rina’s treatment. With the family’s funds running out, Rina has given her youngest daughter up for adoption. The family has learned the hard way… Rina's sister, Mukta is already 20 but after the problems her sister faced, she refuses to get married young.

Rina says wistfully: "I do wonder what it would be like if I were a man. And I know that if I were a man I would never treat a woman like this. Since I’ve been treated this way, I’m sure I would never treat another woman like this."

Joy Phumaphi, WHO.

Joy Phumaphi, WHO’s Assistant Director General For Family And Community Health, comments: "In some of the developing countries it’s a part of the culture, it’s a part of the underdevelopment of women, the inequities that exist, the early marriages for young girls that are still underdeveloped, whose bodies are not yet ready to give birth. These are the issues that have to be addressed."

Religious leaders say that religion should be no barrier to women’s rights. Mullah Mohammad Abbas Uddin, of the Islamic Research Cell of the Family Planning Association of Bangladesh, says: "Men cannot, without the help of women, create or administer a nation, a community or a family. Quite similarly, women cannot perform their duties without the assistance of men. But together they can make, a home, a society or a country, beautiful, fruitful and functional. For this reason men have a lot of responsibilities towards women."

Joy Phumaphi says it is more a women’s empowerment issue than a health issue: "There’s a very close link between empowering women and reducing the number of women who die during childbirth. An educated woman will know what to do during pregnancy and post pregnancy to protect herself and the baby. Empowering women to ensure that they have a say over what happens to their bodies will ensure that they plan their families properly, they don’t get married before their bodies are ready for marriage and they are not sexually violated."

Economic opportunities also empower women. More than a million women under the age of 25 now work in garment industries in Bangladesh – and a quarter of them are unmarried. Opportunities like these are helping to break the cycle of poverty and maternal mortality in Bangladesh.

Rina and her daughter.

One thing Rina is sure about – her own daughter will be better off than she was. "I hope my daughter does well and develops herself. I hope that I can educate her and she can possibly become a nurse or even a doctor. These are my dreams…. Just because I am uneducated does not mean that I want my daughter be uneducated. That’s all that I want."

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