Community clinics must be adequately equipped

The community level health facilities should be equipped with proper labour rooms, smooth supply of electricity and water, and accommodation for midwives posted there to provide the locality with quality mother and child care, speakers said at a roundtable yesterday.

They also identified the need for quality teachers at nursing institutes countrywide, imparting midwifery education to young women, who after obtaining the midwifery license, would be posted to upazila health complexes and union-level sub-centres.

The recommendations came at the roundtable on the role of professional midwives in providing health services to mothers and children. Prothom Alo and United Nations Population Fund (UNFPA) jointly organised the event at the daily newspaper's office in the capital.

"Over 5,000 women die every year due to pregnancy related complications in Bangladesh," said Dr SAJ Md Musa, special adviser to the representative (maternal health) UNFPA, in his presentation.

He said that out of all deliveries in the country only 38 percent happen at institutional facilities such as hospitals and only 42 percent take place at the presence of skilled birth attendants.

Though the maternal mortality rate has decreased considerably over the years, it is still far from the Millennium Development Goals' target.

Giving examples of countries including Afghanistan, Sri Lanka and Malaysia, Musa pointed out that packaged maternal care provided by professional midwives specialised and trained on ante-natal, post-natal and pregnancy related care, could play a significant role in reducing maternal and infant mortality.

The government has already created 3,000 midwifery posts, four in upazila health complexes and one in union sub-centres, said Farida Banu, national programme officer at UNFPA, noting that at sub-centres it would not be possible for one midwife to provide service 24/7.

"Already 600 nurse midwives after completion of an international standard six-month training, have been posted to some of the community level health facilities," said Nelofar Farhad, director of the Directorate of Nursing Services.

Suraiya Begum, registrar of Bangladesh Nursing Council, said the first batch of 602 students graduated recently after completion of the three-year midwifery programme, of whom 597 passed the licensing test.

Students can study midwifery in 38 government and 13 private institutions in the country, she added.

Mafuza Begum, who is currently studying midwifery at Mymensingh Medical College, said that midwives' entire focus remains on mother and child care while nurse midwives conduct the midwifery function apart from other nursing services. So nurse midwives often cannot provide quality care as she has to remain busy with other tasks.

Samsun Nahar, principal of Nursing Institute, Mitford Hospital, said in big hospitals it is very difficult for midwifery students, who are required to conduct at least 20 deliveries, to reach patients, compete with medical students, interns, doctors and nurses.

Habib-a-Millat, member of the parliamentary sub-committee on safe motherhood and safe delivery, said child marriage is a major cause of maternal mortality in the country.

Mohammad Wahid Hossain, director general of the Directorate of Family Planning, said family welfare visitors and assistants, who used to provide door to door services in remote villages, could be used to inform people of the midwifery services available at union sub-centres and upazila heath complexes.

"What would you do with logistic support if there is no caring hand for the patients?" said Health and Family Welfare Minister Mohammad Nasim, urging the new midwifery graduates present at the discussion, to work sincerely at their postings.

He also assured that the government would address the needs in this field step by step.

Abdul Quayum, associate editor of Prothom Alo, moderated the discussion.