COMMENTATOR (COMM): Previously on Life…

Dr. NAFIS SADIK, Former Director of UN Population Fund:
While a lot has been done on so many fronts – the rights of women have not been addressed, they’re not educated, informed about their own health and you know reproductive matters…

HILDE FRAFJORD JOHNSON, Minister for International Development, Norway:
To educate girls and educate women is the best investment in purely economic terns that one can do in any poor country…

EVELINE HERFKENS, Director of the Millennium Campaign, UNDP:
...in the real world many developing countries are incorporating again in their national millennium development goal reports the issues of reproductive health.

BELAL:
Aha! A mother is a mother. She is the most important person in a child’s life… the most important. There is no one else like her. Just a few days before she died she had said that I should take care of the children, educate them and guide them this is what she told me. My wife was very attached to my children and me. She loved us a lot.

COMM:
It was two in the morning 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.

BELAL:
When my wife died, I wasn’t at home. I only came home half an hour after her death. My eldest son asked me, “Dad, won’t you take mom to the hospital?” and I answered, “son, we don’t have the money for a hospital, but do one thing, take her to the clinic instead”. But he said that he couldn’t move her. I said to him “ I’ll tell you what, I’ll go and try to get the money, I’ll be back in half and hour, nothing will change by then, I’ll be back in half and hour and we’ll take her.”

COMM:
In the four years since Majuda’s death, according to the World Health Organization, more than 80,000 women have died during pregnancy or in childbirth in Bangladesh... that’s 50 mothers dying every day.

Like many developing countries, Bangladesh faces problems - poverty, over population and the lack of health and education services, particularly women’s health services. Despite all these odds, Bangladesh is determined to cut its maternal mortality rate – bringing it down from 20,000 to 5,000 a year over the next decade. The question is - will it be able to deliver?

Every year, according to the World Health Organization, 529,000 women worldwide die in childbirth and in pregnancy. For over 20 years, governments, UN agencies and NGOs have pledged to bring down the number of women dying. Maternal mortality rate is considered one of the most important indicators of a nation’s development. Now, in the Millennium Development Goals, 189 countries have renewed their commitment in 2000 to reduce maternal mortality by 75% by 2015.

JOY PHUMAPHI, Assistant Director General for Family and Community Health, World Health Organisation:
Right now you will find that the pursuits, the development, the promotion of the millennium development goals is a priority for a lot of development partners. And this is because we now appreciate that without addressing maternal mortality reduction and strengthening systems to support this essential element of human health, we are not going to achieve sustainable development in affected countries.

COMM:
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 Bangladesh Health Ministry is acutely aware of the problems.

Prof. MIZANUR REHMAN, Director General of Health Services:
In my country, 130 million people, thickly populated country, so in the delivery or the labour in the country we are still trying to go up but still there is a lot of problems. Still moreover 90% of deliveries happen at home and they are not nicely attended to. So we are trying to fine up this delivery system.

COMM:
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.

BELAL:
After I got married again, in the beginning, she loved my children a lot. Now she has started causing trouble with them. For want of peace and quiet, my daughter has left the house and I have started taking my son with me.

COMM:
Belal now supports his family by begging. His younger son Faruq accompanies him while he begs. Belal's loyalties are constantly divided between his two families.

SUNITA MUKARJEE, UNFPA Representative, Bangladesh:
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? Now the richer people maybe able to afford better health care and maybe somebody to take care of the children, but the poor people, they just get in to worse poverty and it becomes a vicious circle.

COMM:
The death of Belal’s first wife Majuda has had a profound effect on his children. Belal's 13-year old daughter is now a housemaid and seldom returns home. His 15-year-old son, Masud, collects scrap and works full time.

With their education cut short, their chances for better a future remain bleak.

SUNITA MUKARJEE, UNFPA Representative, Bangladesh:
Maternal mortality, I mean just imagine if our mothers died at birth, what would our lives have been? A nation cannot progress with mothers dying in large numbers. 99% of maternal deaths take place in developing countries, and most of them are preventable.

COMM:
A few kilometres down the road, in the heart of the city, is the Dhaka Medical College Hospital, one of the best hospitals in Bangladesh.

Because 90 per cent of births traditionally happen at home, the Bangladeshi women who do end up here are emergency cases, rushed into the obstetric ward when things go wrong. Often though it’s too late.

One in six maternal deaths are caused by eclampsia. Eclampsia - or fits – is caused by high blood pressure, but is easily preventable if detected early. With the majority of Bangladeshi births taking place at home, by the time women are brought to the Eclampsia unit of the hospital, most lose their babies, many die and others suffer permanent brain damage or paralysis.

While maternal mortality is a key development indicator in poor countries, maternal morbidities – the disabilities that result from birth complications, are often overlooked. A recent WHO report shows that more than 50 million women worldwide suffer from poor reproductive health and maternal morbidities. In Bangladesh alone, the UN Population Fund estimates six million women suffer from maternal morbidities – such as fistula.

PROF. SAYEBA AKHTER, Dhaka Medical College Hospital:
For one woman who dies, 15 much 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.

COMM:
Dr. Sayeba Akhter has done more than 250 operations on women with obstetric fistula. Today is 22-year old Munira's first operation.

PROF. SAYEBA AKHTER:
When I talk about the maternal morbidities, maternal morbidity is not a physical or medical problems only… there is also lots of social impact. It has impact on social and psychological health of the women, and whenever a woman has maternal morbidities, she cannot continue the proper family life. She becomes the outcast of the family.

COMM:
One such outcast is twenty-two year old Rina. Over the past eight years, she and her four-year old daughter have become familiar figures at the Dhaka Medical College Hospital. Rina was married when she was 13. By the age of 14 she was pregnant and had obstructed labour and ruptured her vagina. Her first baby died. Rina developed fistula and lost control of her bowel and bladder movements. She’s already had six operations but is still not cured. Like many young girls whose pelvic bones are under developed, obstructed delivery left Rina damaged.

RINA:
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?” But it was only my husband’s family that was like this.

COMM:
After her obstetric fistula, Rina had two more children but her husband disowned her. Now, whenever she is not at the hospital in Dhaka, she lives with her mother in a village in Naushindi district, three hours from Dhaka,

RINA:
Childhood was the best time for me. Before I was married, I was happy. Since I got married it’s all been downhill.

COMM:
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.

Breaking with tradition in the village is difficult. Cultural norms often require early marriage and result in teenage pregnancy. Government figures show that 58% of girls below the age of 19 are either pregnant or mothers. And UN figures show that it’s teenage girls who face three times more risk of maternal mortality and morbidity than women in their 20s.

JOY PHUMAPHI, Assistant Director General For Family And Community Health, WHO:
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.

RINA:
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.

COMM:
It’s cultural practices - like the social pressures for early marriage of girls – that are the root cause for the high maternal mortality rate in South Asia, as well as for some of the lowest levels of education, health and nutrition for girls and women. Religious leaders are aware of the issues and say that religion should be no barrier to women’s rights.

MULLAH MOHAMMAD ABBAS UDDIN, Islamic Research Cell of Family Planning Association of Bangladesh:
I think the rights given to women in Islam supersedes the rights given to them by any other religion that I am aware of. ‘Men and Women complete one another and make each other whole.’ 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.

COMM:
Bangladesh has made significant progress recently in reducing maternal mortality. According to UN Population Fund, the number of women dying in childbirth has almost halved in the last 13 years – from 60 to 32 out of every ten thousand deliveries.

One of the Government’s first steps has been to focus on empowerment of women and to invest heavily in girls' and adolescent education. Primary and secondary enrolment of girls went up dramatically. For the first time ever, more girls than boys now attend both primary and secondary school.

And in the rural areas, the Government’s also training skilled birth attendants and community midwives to perform safer deliveries and teaching them to refer complicated cases to health facilities.

JOY PHUMAPHI:
Over the last ten years, maternal mortality reduction has not reduced. We are continuing to lose a woman to maternal mortality at the rate of one per minute. This is unforgivable. Because of the interventions that are required to save these women’s lives are available and they are known to the global health community. They are easy to implement and they can become a pivotal part of any health system, no matter how poor the country. It’s a question of priorities, even for the developing economies… so that I believe that it is feasible, it is possible, if the countries want it badly enough.

COMM:
For Rina and her family, it’s all come too late.

RINA:
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. Maybe I can’t achieve them. At the moment, I can’t even educate her but I will try my best and I’m doing all that I can. Maybe I can make her a nurse. If she can pass her matriculations, she could be a nurse. Just because I am uneducated does not mean that I want my daughter be uneducated. That’s all that I want.

COMM:
But Rina also tries to make sure that other women don’t have to go through what she went through. Rina's neighbour, 18-year old Rashida, was married last year. She is now five months pregnant. But like other women in the village, Rashida has not been for antenatal checkup. Yet according to UNICEF 15 out of every 100 women risk complications giving birth. Rina’s had a long day trying to convince Rashida's family to take her for a check-up. When Rina first visited this district hospital, it had no emergency obstetric care facilities. Last year, the government established an emergency unit as well as a maternal and child welfare clinic.

JOY PHUMAPHI:
It has taken a long time for governments in developing countries to appreciate the important link between investing in health care and maternal mortality reduction and development because development is normally associated with human capital that is technical or that is of a high level such as the training of the engineers, doctors. Whereas in actual fact, what contributes to economic development and to the gross domestic product of a country and therefore determines the economy is how productive individuals in the economy are, no matter at what level they are.

COMM:
In Bangladesh’s rapidly expanding towns and cities, the Government’s using a different approach. They’re trying to change a culture of risky home birth and women’s reluctance to attend ante-natal clinics. Instead, they’re taking health services to the communities themselves – especially in the slums.

Prof. MIZANUR RAHMAN, Director General, Health Services:
Though we have got the facilities in the districts and the Dhaka city, in the big cities we have got the facilities. But due to their ignorance and due to the stigma they don’t like to sometimes come. So this thing we have to go for awareness particularly the mother in law and the husband they have got these stigmas, they don’t like to come. This is the things.

COMM:
Every day, sister Sumanti Biswas examines patients in slums across the city. Many come for reproductive health care. With volunteers and massive media campaign, community awareness about maternal health is slowly increasing. But there is still a long way to go.

JOY PHUMAPHI:
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.

COMM:
One of the effects of globalization is that there are now more job opportunities for women. More than a million women under the age of 25 now work in garment industries in Bangladesh – a quarter of them are unmarried. Opportunities like these are empowering women economically and are helping to break the cycle of poverty and maternal mortality in Bangladesh.

SUNEETA MUKARJEE:
As long as there is no gender equality or there is not full gender equality, women will not get the same right to health as men get or as they deserve. Safe motherhood is a human right and every woman is authorized to this right. No woman should die if that can be prevented while she is bringing another person to the world.

BELAL:
I still often remember my wife and when I do, I go to the Azimpur graveyard. I buried her at Azimpur. Whenever I think about my wife, I go to Azimpur in a rickshaw. I just go to visit her grave and then I come back. When anyone talks about clinics then I think about her...

END

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