Written by This project is needed to address the poor state of maternal and newborn health (MNH) in Bogra district in northern Bangladesh. Bangladesh is a densely populated country of almost 150 million people, 35% of whom live in rural areas. Bangladesh ranks 146th among nations on the HDI (UNDP, 2011). Despite impressive economic growth rates of around 6-7% in recent years Bangladesh remains a poor country with 26% of the population living below the poverty line (World Bank, 2010). Bangladesh is on track to meet both MDGs 4 and 5 but at current rates of progress this achievement will miss out newborns and the poorest women. Bangladesh has the sixth largest number of newborn deaths globally with around half of under-5 deaths occurring in the first month of life (Countdown 2015). Despite impressive reductions in maternal mortality the national MMR remains high at 194/ 100,000 (Bangladesh Maternal Mortality Survey, 2011).There are significant inequities in coverage of and access to maternal health interventions such as antenatal care visits and skilled birth attendance and, despite government efforts, 68% of deliveries are still performed at home (Countdown 2015, 2013 Update). Located in northern Bangladesh in Rajshahi Division, Bogra district has a total population of 3,400,874 and the majority (2,730,486 people) live in rural areas. The female literacy rate, at only 45%, is below the national average of 49% (Population and Housing Census 2011). Administratively Bogra is organised into 12 upazilas (sub-districts), 110 unions and 2,618 villages. This project will be implemented in three unions of two upazilas covering a total population of 96,985 (PCP household survey, 2011). We will focus on Bogra for the following reasons:
- The district is acutely affected by poor MNH compared to national averages: the NMR (35/ 1,000 live births) is higher than the national average (26/ 1,000 live births); the proportion of births attended by medically trained personnel (26% NIPORT 2011; national average 32% BDHS2011), institutional deliveries (24% ibid.; 29% ibid.) and post natal care visits by trained health personnel (14%, ibid.; 27% ibid.).
- Despite the existence of two medical college hospitals, one district hospital, four Maternal and Child Welfare Centres,11 upazila health complexes, 38 union sub-centres, 61 union health and family welfare centres, 358 community clinics and two NGO clinics utilisation of health facilities in the district is still low. This is due to a lack of awareness and knowledge among women and their families about good MNH care and the benefits of skilled medical MNH care, distance to travel to appropriate health facilities, high out of pocket payments, lack of trained health staff and inadequate supplies of medicines andequipment and other logistical problems, poor referral systems, lack of ownership and weak accountability and communication skills of health staff.
- We have been operating successfully in partnership in Bogra since 2002 (with data going back to 2004) and have strong systems and community presence in place.
- There are no other initiatives for stimulating PLA-based community mobilisation for MNH in the area.
Health is intricately connected to broader poverty and the health of women and children is critically important to almost every area of human development and progress. Poor maternal health contributes directly to poverty – if mothers are unhealthy or die the whole family economy suffers due to medical expenses, loss of earnings/production, children are less likely to attend schooland have reduced future economic prospects. Patriarchy and gender inequality are important determinants of many MNH problems with Bangladesh ranking low on the Gender Equity Index. Poor people’s health must be improved to address poverty and improving health contributes to economic development. This project will address MDGs 3, 4 and 5 by improving the beneficiaries’ knowledge, empowering women to seek skilled MNH care and changing MNH behaviour at community level.