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Meeting Millennium Development Goals



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Nabonita (left) and other pregnant women are now at less risk in Bangladesh

As part of a series assessing whether Bangladesh is on track to meet the UN Millennium Development Goals (MDGs) by 2015, the BBC's Alastair Lawson reports on the battle to improve maternal health.

Nabonita Hassan is seven months pregnant and lives in the Mogh Bazaar slum area of Bangladesh.

Her pregnancy and her low income means that she is one of the millions of people the MDGs are designed to help.

Goal four is to reduce child mortality and goal five is to improve maternal health.

UN figures show that as with primary education, Bangladesh has made remarkable progress in dealing with maternal mortality.

A survey by the UN children's fund (Unicef) shows that the maternal mortality ratio has been reduced from 440 deaths per 100,000 child births in 1997 to 320 per 100,000 live births in 2001.

'Childbirth complications'

In 2006 it was estimated to be 290 per 100,000 live births, but that figure may rise because of recent floods and cyclones.

Nabonita Hassan being checked by maternal nurse
At no time has it been safer for women to be pregnant in Bangladesh

Even so, signs of the the progress made over recent years are all too evident in Mogh Bazaar.

"Today only about 3% of women die because of pregnancy and childbirth complications," says Fetema Akhtar, a midwife and paramedic who works in the slum for the Bangladesh Rural Advancement Committee (Brac), a Unicef partner organisation.

"The situation is so much better today, and it is a source of great pride to us that there are far fewer deaths.

"But I think it is important to point out that what has been going on in Mogh Bazaar - with Brac joining Unicef to address the problem - is not the same in other slums in different parts of the country. There the statistics are far worse."

Campaigners say that if the success story of Mogh Bazaar is to be replicated in those other slum areas, the key is to provide women-only health-related services.

In a conservative country like Bangladesh, mothers-to-be are known to feel uncomfortable about going to see a doctor if there are men present.

"We serve only women coping with pregnancy and childbirth," says Ms Akthar, "and I have no doubt that has contributed towards our success and the success of similar projects elsewhere in the country.

"There are now a host of other organisations working to attend other patients."

Foetal complications

The figures relating to maternal mortality seem to back up her argument.

THE EIGHT MILLENNIUM DEVELOPMENT GOALS
Inhabitants of Mogh Bazar slum
Eradicate extreme hunger and poverty
Achieve universal primary education
Promote gender equality and empower women
Reduce child mortality
Improve maternal health
Combat HIV/Aids, malaria and other diseases
Ensure environmental sustainability
Develop a global partnership for development

The country is more or less on track to meet the MDG target of 143 maternal deaths per 100,000 live births by 2015.

Progress in this area is vital because the health of women is a crucial factor in the health of children. Gender discrimination leaves women particularly vulnerable to disease and death.

Translated into real numbers, the figures reveal that of 2.5 million women who become pregnant each year, an estimated 370,000 develop foetal complications, which the health facilities in the country are unable to handle.

Increasing access to emergency obstetric care is a key element in reducing maternal mortality.

The vast majority of babies are still born at home. Only 8.6% of births take place in hospitals or local health centres and only 11.8% of deliveries were assisted in 2001 by doctors, midwives, nurses or family welfare visitors.

The remaining 88.2% were attended by relatives or other people, of whom only 11.9% were trained by traditional birth attendants.

Maternal malnutrition, infections during pregnancy, anaemia and repeated pregnancies still result in thousands of low birth-weight babies.

That rate is among the highest outside sub-Saharan Africa.

Nutrition initiatives

The nutritional status of women in Bangladesh is also alarming. The body mass index of 52% of women of reproductive age is less than 18.5 - this means they are dangerously underweight.

Slum child
Nabonita's child will live in one of the most densely populated countries

They are also very stunted, a problem compounded by a high prevalence of iron deficiency anaemia (more than 50%) and Vitamin A deficiency (more than 2.8% suffer from night blindness).

The poor nutritional status of female children at birth is made worse because their mothers do not have access to basic medical services while at the same time they are are suffering from high workloads and lack of rest.

All this results in poor health and low birth-weight babies, who tend to go on to be more malnourished in childhood and beyond. This vicious cycle has been repeated for centuries.

Campaigners argue that reducing the rate of maternal deaths is not possible solely through health and nutrition initiatives.

"Maternal mortality is an indicator of the overall situation of women in a society, so a more comprehensive social development approach is needed," the Unicef report says.

"This means nurturing a socio-cultural movement that addresses the reduction of maternal mortality as a woman's right and also enhances women's self esteem and status."

Nabonita Hassan gave birth to a baby boy and has now moved out of Mogh Bazaar to return to her village.



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