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Bangladesh Maternal Health Programs Save Lives, Educate Mothers, and Build Bright Careers
HOPE Midwifery Institute and MedGlobal offer high-quality training for midwives while caring for displaced and refugee women, and others living in poverty.
The young midwife’s pregnant patient was convulsing – the onset of severe eclampsia – in the middle of a cyclone in Cox’s Bazar, Bangladesh.
“There was no electricity, no senior doctor, no communications,” Mahabubara Belee Sikder, a midwife at Bangladesh’s HOPE Midwifery Institute, recalled.
She monitored her patient’s vital signs and attended her until help was available. “Both mother and baby survived,” she recalled, relieved.
Sikder received her midwifery education and training at the HOPE Midwifery Institute, which was founded in 2013 and has rapidly become a competitive and much sought-after program for hopeful midwives. The institute, which trains midwives to work amid the Bangladeshi and Rohingya refugee women of Cox’s Bazar, builds on a growing national and global awareness of the importance of accessible, high-quality, and compassionate maternal health care.
Many hopeful midwives who apply to the program are inspired by their own families, said Sarmin Nesa, vice principal of the institute.
“They see their mother and the babies…not getting enough service during their deliveries,” she explained. “This is the most important thing they share with us, that they would see their mothers’ and [infant siblings’] many challenges.”
A HOPE midwife poses with a young patient. (Courtesy photo)
The HOPE Foundation for Women and Children of Bangladesh, of which the midwifery institute forms a part, operates a hospital in Cox’s Bazar. The group also operates a separate field hospital located within the area’s Rohingya refugee camps and a new primary and maternal care facility on Moheshkhali Island that is designed to bring healthcare access and reduce maternal mortality. The latter facility aims to serve the approximately 600,000 community members living on nearby islands where perinatal care and skilled birth attendance are difficult to access.
The organization offers mental health services and surgery to repair fistula – a debilitating, complex injury caused by prolonged labor without appropriate care – as well as burns and cleft palates. The setting is challenging, demanding that midwives care both for Bangladeshi women, many living in poverty, and for Rohingya refugees, displaced from their native Myanmar by violence and often living in makeshift shelters.
For many midwives, that challenge is appealing, Nesa said: “They want to save the mothers’ and babies’ lives.”
Refugee mothers are often unwilling to go to a facility for care or delivery, Nesa said. HOPE midwives conduct door-to-door visits, offering information and services to pregnant women. They deliver babies both at facilities and at women’s homes. They screen women for potential complications, so they can be referred to specialty care if needed.
This contact with patients informs the midwives’ approach, Nesa explained: “They are building trusting relationships,” often with patients who have no experience with maternal healthcare and don’t know what to expect.
HOPE midwives are trained to handle emergent situations, such as stabilizing hemorrhage and keeping patients with eclampsia safe until help can arrive. Nesa said a strong focus on respect, communication, and professionalism helps student midwives handle difficult situations. As an example, she described how a woman experiencing a difficult labor kicked a student midwife, who calmly counseled her patient, helping her to relax and deliver her baby safely. After the delivery, Nesa checked in with the student midwife to ask if she was injured or needed support.
Students at the HOPE Midwifery Institute benefit from a combination of classroom and hands-on learning. (Courtesy photo)
“No, ma’am,” she recalled the young woman saying, “I saved their lives, and I delivered the baby.”
“The normal process”
Medglobal’s Bangladesh maternal health facility is located in the Somitipara neighborhood of Cox’s Bazar, where it serves primarily Bangladeshi women who were displaced to the area after a destructive 1991 cyclone. The clinic is consistently over capacity, and a health outpost in one of the camps sees as many as 400 patients per day.
Still, encouraging women to seek maternal health care is often a multi-step process, explained Dr. Rahana Parvin, MedGlobal’s clinical coordinator in Bangladesh.
“This community is not well educated” about health issues, she said. Many of the women approached by a midwife initially feel that, “if you got pregnant, there’s no need to do anything. This is the normal process.”
MedGlobal Bangladesh midwives work over time to cultivate trust in patients in Cox’s Bazar and encourage them to receive maternal healthcare. (Courtesy photo)
The organization has responded by getting creative: Mother’s Clubs educate girls and women of reproductive age about healthy pregnancy and maternal healthcare. Women who are willing to give birth in a health facility receive a neonatal kit filled with supplies for their babies. A hotline provides counseling to women experiencing worrying symptoms, and midwives call patients who are due for delivery daily to check in.
Dr. Parvin explained that inadequate nutrition and sanitation, as well as poor living conditions, affect many of their patients’ health. “The living style is really very poor,” she said of her patients. MedGlobal bears all costs associated with maternal healthcare – including transfer to a hospital and a staff escort for patients who have obstetric emergencies – to ensure patients receive the treatment and monitoring they need.
Shipan Akter, a MedGlobal midwife, said that saving the lives of mothers and newborns is her greatest motivation. She’s also acutely aware that the high-quality care and support that MedGlobal provides isn’t always available to women in Bangladesh.
“I work with the hope that one day, every mother in our society will have access to safe childbirth,” she said.
“A famous and popular job”
For the midwives who train and work in these communities, their profession is an opportunity to serve others and protect lives – but it’s also a valued and desirable career path for many women in Bangladesh.
Sanjida Kawsar Tania, a student midwife at HOPE, said she appreciates learning evidence-based treatments for managing emergencies like post-partum hemorrhage and eclampsia. “I get some difficult cases…when I do night shift duty,” she explained.
In addition, Tania said the institute offers a supportive environment, with senior midwives offering advice and teaching new skills to students in training.
“I feel very proud to be a student of HOPE’s midwifery program,” she said.
A new mother cuddles with her infant with the help of a MedGlobal Bangladesh midwife. (Courtesy photo)
Akter, who has worked as a midwife with MedGlobal for four years, explained that the organization has helped her build her career as well as care for vulnerable women. “Working here has been a very important chapter of my life,” she said. “It has provided me not only with the opportunity to serve patients but also to enhance my professional skills through training and hands-on experience.”
Maternal and other health needs in Bangladesh continue to be high. Cuts to public aid, ongoing displacement, and inability to access or afford healthcare have all increased the demand for support. Years after the 2017 genocide that forced many to flee Myanmar, Rohingya refugees threatened by violence and instability have continued to arrive in Bangladesh. There, their movements are restricted to within the camps, giving them limited opportunities to earn a living or build new skills, and increasing their need for humanitarian aid.
Nesa explained that Bangladesh’s government employs midwives in communities across the country. At HOPE Midwifery Institute, student midwives receive a combination of classroom education and practical skill-building that will allow them to work in a private or government hospital. About 90% of graduates secure government jobs after completing their certification exams, and HOPE-trained midwives oversee more than 1,000 births per year in the organization’s own facilities.
HOPE midwifery students describe an atmosphere of support and mentorship at the Cox’s Bazar training program. (Courtesy photo)
“Nowadays midwifery is a very famous and popular job” in Bangladesh, she said.
Since 2009, Direct Relief has provided the HOPE Foundation for Women and Children of Bangladesh with 58 shipments of material medical aid, totaling $14.8 million in value. That support includes 94 full midwife kits and 40 resupply kits, enabling 6,700 safe births. The organization has supported MedGlobal Bangladesh with five shipments of medical aid totaling $2.3 million in value. Additional maternal healthcare support to Bangladesh is planned for later this year.
In total, Direct Relief has also provided 21 fistula repair modules to HOPE and other partners in Bangladesh, supporting about 1,200 obstetric fistula repair surgeries, and 45 perinatal kits to treat life-threatening conditions affecting women and infants, including eclampsia, premature birth, infection, and neonatal respiratory distress. More than $664,000 worth of prenatal vitamins, and $1.18 million in total grant funding for healthcare needs, including maternal health, has also been provided to partner health organizations in Bangladesh.
Holland Bool contributed reporting to this story.
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