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Maternal and Child Health in Bangladesh

"Most health activists agree that the emphasis on reducing fertility rates by increasing contraceptive use and promoting sterilization have led to the development of lop-sided health policy."
Since the International Conference on Population and Development held in Cairo in 1994, Nafis Sadiq, its Director General, has convinced States and Governments that maternal mortality and morbidity can be reduced dramatically by increasing contraceptive use and thus preventing 500,000 maternal deaths world-wide due to unsafe abortions.

that there is a need to ensure that women do not have to resort to unsafe and illegal abortions, there is considerable disagreement among women health activist as to the primary cause of such deaths and more importantly what should be done about it. Moreover, this argument is now being used by organizations and individuals to once again promote methods of sterilization and contraception that are experimental and very unsafe from the point of view of health of poor women in third world countries. A case in point is Bangladesh. So far there have been four five-year plans for Population and Health; the term of the fourth plan ends this year. A mid-term review was conducted by donor countries in 1995. This report, while praising the overall efforts to reduce fertility rates, by better contraceptive distribution and increased rates of sterilization, very clearly sounds the alarm bell for maternal and child health. They note that maternal mortality has increased despite the reduction in fertility rates. For example maternal mortality rates increased from 234/100,000 births in 1993 to 2290/100,000. Ironically the Government of Bangladesh attributed this to increase use of hospital services.

Moreover the report noted that maternal morbidity during the first six weeks after birth, 70% of women had symptoms and this was exceptionally high. While infant mortality rates have improved for under five year olds, down from 188/1000 to 149/1000, the morbidity rates continue to be high. Poverty-related and nutrition-related diseases are rampant and the mission noted that there has been no significant improvement in the nutritional status of people. The statistics on health status are the greatest indictment of the lop-sided policies followed by Governments that focus on birth control and neglect

primary health care. In the case of Bangladesh, anemia remains unchanged (70% of the population), children suffer from stunted growth (65% children), muscle wasting is significant (17% children), low birth weight is common (35-50%) and night blindness due to vitamin A deficiency continue to be high (1.7% of the population). Tuberculosis, Malaria, Kala Azar have either increased or remain unchanged. If similar studies were done in other countries of South Asia, we will no doubt find a similar statistics. The mission noted that "Bangladesh has a maternal health crisis that needs to be addressed urgently"

Most health activists agree that the emphasis on reducing fertility rates by increasing contraceptive use and promoting sterilization have led to the development of lop-sided health policy. The shift in emphasis has a great deal to do with how International aid is provided. For example when all development projects are perceived to be tied to family

planning, the focus necessarily shifts from primary health to birth control. Undoubtedly the problems of improving the health status of the citizens of a large populous country like Bangladesh pose many challenges but it requires development of rational health policies and programs that focus on improving the health of all sectors of society; the gap between rural and urban health care facilities need to be reduced. Globalization and privatization of many institutions pose a further threat as to how health care will be delivered in the future in poor countries that already have a two-tiered system, one for the rich and the other for the poor. Will there be the political will to swallow the bitter pill of no profits for the health and future of citizens of Bangladesh and other countries of South Asia? As international development partners the challenge of organizations like CERAS, is to assist the NGOs seeking an alternative to the current trends in women's health.

- Shree Mulay, Director, McGill Centre for Research and Teaching on Women

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