University of Iowa

Essential care absent in impoverished world

November 8th, 2015

Commentary by Will Story for the Iowa City Press-Citizen.

Four years ago I spent the summer interviewing men and women in a rural area of northern Bangladesh about their experiences during the birth of their youngest child.  Working with a research institution in Bangladesh as well as a community organization based in the rural villages, I had the opportunity to hear dozens of birth narratives.  Men and women described harrowing tales of travelling three to four miles by rickshaw to a small hospital to receive emergency care and others who delivered their child on a dirt floor at home with the help of an untrained traditional birth attendant and other close family members. As I recall these stories, I can’t stop thinking about one family in particular. And we never even met them.

We set off down a narrow dirt path surrounded by rice paddies in search of the home of a woman who recently gave birth in a local hospital.  After walking for over three miles and crossing two rivers by boat, we finally found someone who knew who we were looking for.  The man we met proceeded to tell us that the woman no longer lived in this village.  Two weeks after giving birth and returning home, her baby died.  He continued to explain that her sister recently died during childbirth as well.  The family decided to move to the capital city to remove themselves from the painful memories in their village and to find work.

Unfortunately, this story is all too common in Bangladesh and many low-income countries in South Asia and sub-Saharan Africa.  Around the world, 800 women and 7,700 newborns still die each day from complications during pregnancy, childbirth, and in the postnatal period and 99% of these deaths happen in developing countries like Bangladesh. Whether a woman or her child dies during or after childbirth depends largely on their access to timely and competent obstetric care.  Although facility-based deliveries are on the rise in Bangladesh, over 70% of children are born at home and only 27% of children in rural Bangladesh receive a postnatal check-up within two days after birth, the most vulnerable time in a child’s life.

In order to ensure that mothers and children are getting the care they need in resource-poor areas, they must have access to appropriate care as close to their home as possible.  One successful strategy to address this need is the training of community-level health workers to provide home-based counseling for pregnant women and their families to address social and cultural barriers to facility-based childbirth as well as provide basic newborn care and referrals for sick newborns.

A great example of this work was the development of an easy-to-use eToolkit, or digital library, to train field workers on a number of health-related topics, including maternal and newborn health.  This program was led by the Bangladesh Knowledge Management Initiative, which is directed by UI College of Public Health alumna Rebecca Arnold who helped develop and implement this project based on the skills and expertise she gained while completing her Master’s Degree in the Department of Community and Behavioral Health.  Currently, the department is partnering with organizations in Bangladesh and India to explore how to best engage families and communities to improve access to and use of maternal and newborn care.

I invite you to join me, 2015 International Impact Award winner Rebecca Arnold, my public health colleague Edith Parker, and three current students of the college for a WorldCanvass discussion of global health issues and efforts underway to address them.  WorldCanvass, produced by UI International Programs, takes place at 5 p.m. Tuesday at FilmScene, 118 East College St.  WorldCanvass is free and open to the public.

William Story is an assistant professor in the Department of Community and Behavioral Health at the University of Iowa College of Public Health.