Maternal Care in BangladeshBack in 1972, Fazlé Hasan Abed started a small organization called the Bangladesh Rehabilitation Assistance Committee (BRAC). Originally dedicated to helping refugees after Bangladesh’s war for independence against Pakistan, the organization has since grown to serve 11 countries across Asia and Africa. One of the key focuses of BRAC is poverty alleviation and includes categories such as improving maternal care in Bangladesh.

BRAC’s Strategies for Poverty Reduction

BRAC engages several strategies to combat poverty, such as social enterprises. Social enterprises are self-sustaining cause-driven business entities that create social impact by offering solutions to social challenges and reinvesting surplus to sustain and generate greater impact. Some social enterprises include those seeking to promote access to fisheries, give people access to jobs in the silk industry and businesses that give seed access to farmers.

BRAC also prioritizes social development. These initiatives refer to BRAC’s on-the-ground programs. Social development efforts aim to build communities up by attempting to foster long-term development through the promotion of microfinance and gender equality and by eradicating extreme poverty.

The third focus of BRAC is investments. BRAC seeks to invest in local companies in order to create as much social impact as possible. This includes initiatives to expand affordable internet access for all and a range of other financial support services.

Finally, the organization founded a tertiary education institution called Brac University. The University, located in Bangladesh, aims to use its liberal arts curriculum in order to try and advance human capital development and help students develop solutions to local problems.

The BRAC Manoshi Maternal Care Initiative

Founded in 2007, the Manoshi program is specifically tailored to serve mothers and newborns by providing accessible care. There are a couple of unique methods that make this maternal healthcare initiative especially effective in reaching its goals of improving maternal care in Bangladesh.

One-third of people in Bangladesh live under the poverty line and a greater part of this group live in slums, making it difficult to access and afford necessary healthcare. Manoshi focuses primarily on empowering communities, particularly women, in order to develop a system of essential healthcare interventions for mothers and babies.

Manoshi’s Focal Areas for Community Development

  • Providing basic healthcare for pregnant and lactating women, newborns and children under 5
  • Building a referral system to connect women with quality health facilities when complications arise
  • Creating women’s groups to drive community empowerment
  • Skills development and capacity building for healthcare workers and birth attendants
  • Connecting community organizations with governmental and non-governmental organizations to further their goals

The main methods used in the Manoshi project to achieve desired outcomes are social mapping, census taking and community engagement.

Manoshi’s Impact on Maternal Care in Bangladesh

BRAC projected that improvement in healthcare access would cause neonatal mortality to decline by 40-50% and the most recent data from the Manoshi program shows just that. Manoshi’s data shows that from 2008 to 2013, both the maternal and neonatal death rates dropped by more than half. From 2007 to 2011, the percentage of births at health facilities increased from 15% to 59%, while national averages only increased from 25% to 28%, suggesting that mothers served by Manoshi have more access to resources and facilities for safe deliveries. Prenatal care also increased from 27% to 52% in the same years.

With the substantial impact of organizational programs like Manoshi prioritizing the wellbeing of women and children, advancements with regard to maternal care in Bangladesh will hopefully only continue upward.

– Thomas Gill
Photo: Flickr

Neonatal Mortality
The United Nations plans to combat under-five mortality with its Sustainable Development Goal (SDG) 3.2, which aims to “end preventable deaths of newborns and children under five years of age.” The project, if successful, will help to fight neonatal mortality as well.

The 17 SDGs are launching following the commencement of the U.N.’s Millennium Development Goals (MDGs) in 2015 with a 2030 target date. The MDGs were able to save approximately six million children worldwide, which was a 53% reduction in under-five mortality.

There is still room for progress. Neonatal mortality comprised 45% of deaths among children under five in 2015 and continued to be a significant component of under-five deaths. As a result, as part of SDG 3.2, the U.N. aims to lower neonatal mortality to as low as 12 per 1,000 births.

The neonatal mortality rate was highest in the World Health Organization’s Regions of Africa. This region was where over one-third of under-five child deaths occurred in the neonatal period. A recent study that appeared in Geospatial Health determined the significant factors that contributed to neonatal mortality in East and West Africa and outlined ways in which the SDGs can help.

The study identified home birthing as a major risk factor for neonatal mortality in East Africa. Another risk was maternal exposure to unprotected water sources. Both of these factors largely contributed to the correlation between home births and neonatal mortality. This correlation is because these people face exposure to unclean water, which can lead to an infection of either the umbilical cord or the intestinal tract.

The SDG Goal Six aims to tackle the problem of unsafe and inaccessible water. By 2030, the U.N. hopes to “achieve universal and equitable access to safe and affordable drinking water for all.”

One common explanation for the high neonatal mortality rates in East Africa has been a lack of education for women. SDGs 4.1 and 4.5 intend to ensure all boys and girls free, quality primary and secondary education. This policy will help eliminate any gender disparities in education.

Home births were a risk factor for neonatal mortality in West Africa, too. The study found that 48.6% of mothers had home deliveries. Other significant risk factors included mothers who did not intend to have another child or who only completed primary education.

The study suggests improving prenatal care, including family planning education, and ensuring access to at least secondary education. SDG 4.3 seeks to make technical vocational training more accessible, and SDG 3.87 aims to create maternity health care systems that include “universal access to sexual and reproductive health-care services.”

If the U.N. has the same success for the SDGs that they did with the MDGs, they could save millions of more lives and drastically reduce neonatal mortality.

Lauren Mcbride

Photo: Flickr

The winning team in Northwestern University’s 4th Annual Global Health Case Competition proposed a sustainable, long-term health plan in the form of a “birth kit” to reduce neonatal mortality in Nigeria.

Every day, nearly 2,300 Nigerian children under the age of five lose their lives. According to UNICEF, essential medical care during childbirth and the weeks following would have prevented most of these deaths.

Neonatal mortality in Nigeria constitutes a quarter of deaths among children under five. A majority of these deaths occur within the first week after birth and are caused by birth asphyxia, infection and premature birth.

On Feb. 18, 2017, Northwestern conducted its annual health case competition. For the fourth year, the university invited students to propose solutions to a 21st-century global health challenge to raise awareness and encourage innovative thinking. The 2017 competition included six teams consisting of five students each from different schools.

The 2017 case centered around neonatal mortality in Nigeria and the implementation of chlorhexidine, an inexpensive and effective antiseptic gel. Severe infection and sepsis, an immune response to bacterial infection in the bloodstream, are two of the leading causes of neonatal death in Nigeria. The students’ assignment involved integrating chlorhexidine into “Nigeria’s healthcare institutions, culture, and maternal care regime.”

The winning team’s three-year implementation plan centers around a “birth kit,” which includes the chlorhexidine gel and other materials essential for home births. The umbilical cord is a common entry point for infectious diseases, so the gel would be used to sanitize and protect mothers and their newborns. Sustainability was the team’s focal point. They proposed a partnership with a nonprofit to help cooperatively create a demand for the birth kit, then slowly normalize chlorhexidine in Nigeria’s childcare culture.

Courtney Zhu, a member of the winning team and a sophomore studying journalism and global health, said, “From this experience, I gained insight into the mechanism of tackling modern health challenges, and realized just how valuable collaboration is in a multidimensional field like global health.”

Madison O’Connell

Photo: Flickr