Read Day 1 here.
We got up early to beat the infamous Dhaka traffic and headed Northeast to Narshingdhi to visit a few CARE projects that focus on educating and involving the families of pregnant women as well as the community to prevent maternal deaths in this region.
Since one of the delays in women accessing emergency care in time is her own family in too many cases, this program includes the entire household. A community health worker meets with the family to educate everyone about how to care for the pregnant mother, informing them about her nutrition needs, signs of complications, the need to save some money in the event of an emergency, and the importance of group participation in caring for the mother throughout her pregnancy. The family structure in Bangladesh is somewhat unique in that when a woman marries she leaves her parents' home to live with her in-laws. For example, in the family we visited, the pregnant woman, Mahmuda, was joined by her husband, her one year-old Khadija, her mother in law, sister in law, and the sister of her mother in law. If all of these family members are aware of the danger signs in labor, they can ensure that she gets to a health facility equipped to receive and care for her.
This is a community that has suffered the losses of too many women in pregnancy and so has organized itself to make a change. We joined a meeting in the community where an elected group of leaders and committee members hold frequent meetings where they come together with traditional birth attendants to collect information about girls and women in the community and track who is pregnant, who has delivered and who is most vulnerable.
This program was created to promote community engagement and participation. We sat with them around their hand-drawn map of their district where each mother is given a locator number and they mark her status on the map and track each delivery. Parked next door was a rickshaw ambulance the community had purchased to help with emergency transport and they also have a collection to benefit those who may require further help in an emergency.
After the meeting we spoke with a few moms who had benefited from the community's group activities. We spoke with Nipa, who is 6 months pregnant with her second child. During her first birth she labored for 6 hours before the community decided she and a traditional birth attendant should board the rickshaw ambulance and head to the hospital.
In the evening, we were fading fast, but we were excited to meet with representatives of D.Net- the local NGO that has pioneered use of mobile technology to scale up access to health information and services. These will be the folks leading the implementation of the MAMA (Mobile Alliance for Maternal Action) initiative, which was recently launched by Hillary Clinton as a partnership between USAID, Johnson & Johnson, UNF, mHealth Alliance and Babycenter. MAMA will scale up the sort of innovation we saw in Manoshi where cell phones and texting are helping health workers reach more women. The goal is to reach 500,000 women in three years with health information across the country and we were excited to hear about their plans to get started.
It was exciting to reflect not only on how much has happened since I was last here but to imagine where this technology will lead us and how it will impact maternal health.