Traditional Birth Attendants and Neonatal Care in Bangladesh

The following blog was posted originally on Women & Children First Blog.

The road leading to the village of Dighalkandi in Bangladesh is a pretty scene. Lush green paddy fields with farmers getting ready for plantation season, school children dressed in uniforms sitting under trees and chatting to friends.

But behind this picturesque scene is a community largely without access to professional medical care, where giving birth is a moment to fear death. Though Bangladesh has more than halved child mortality since 1985, of every 1,000 children born, 54 still die before their fifth birthday– and most of these deaths occur in the first month. About 85% of births in Bangladesh occur at home and only around 18% of women give birth with a skilled attendant. Though the Bangladesh Government actively encourages mothers to use local health facilities, the lack of skilled staff and adequate health facilities, together with the persistent challenge of social norms about gender and family roles, have kept the vast majority of mothers out of the delivery room.

Because so many deliveries take place at home, and because of the shortage of professionally trained birth attendants, Traditional Birth Attendants (TBAs) continue to play a major role in the community. Women and Children First recognises that to help save lives now, we cannot ignore TBAs but need instead to work with them, and support them in playing the most effective role they can. They are not an alternative to professionally trained staff, but can play a vital complementary role in keeping mothers and babies alive.

Bina Begum (here seen in an orange saree), is the TBA of Dighalkandi village in Bogra district. When I meet her, she is having a lively chat with some of the mothers from the village. Bina tells me that she has attended three training courses on Essential Newborn Care organised by our partner – the Perinatal Care Project (PCP). The courses have taught her to: provide counselling and support for mothers to encourage exclusive breastfeeding; ensure that babies are kept warm and with the mother after birth – especially important for low-birth weight babies; ensure hygiene through clean cord care and hand-washing; advise parents on the importance of immunisation; and recognise danger signs, treat some infections and refer more complicated cases to professionally trained medical staff.

The women tell me about how Bina has helped them with their children - at the delivery, as newborns, and as they start to walk. Bina smiles and says she likes going to the trainings which help her make more of a difference. And the mothers say that they are very grateful for Bina’s advice on how to look after their children.

Countries with more comprehensive healthcare systems, like Sri Lanka, Thailand, or Vietnam, have fewer child deaths than Bangladesh. This is not an alternative model to professionally trained staff. But by helping TBAs to learn new skills, organisations like PCP are helping mothers and children survive and thrive. Bina isn’t a doctor, or a nurse, or a midwife. But she is a life saver, and a hero to the village. And to us.