Reaching the unreached

Bilkis Begum, 44, is a housewife and community birth attendant who provides voluntary midwifery service to the poor and deprived women of her community of Madhab Bagan village under Durgapur Union. Her husband, Md. Abdul Latif ,55, is a day laborer. Bilkis is a mother of two sons. The eldest Mehedi Hasan, 22, is working as disaster management facilitator (DMF) at Durgapur Area Office of World Vision Bangladesh and the youngest Ariful Hasan,18, a registered child in the sponsorship programme.

In a training session of traditional birth attendants (TBAs) led by Durgapur Area Development Programme of World Vision Bangladesh, community midwife Bilkis Begum realized for the first time that the tactics she had used to hasten birth were inappropriate.

“I’m glad that I came here [to the training]. Earlier I did not have the proper technical knowledge to handle the tragic circumstances that might leave risk to pregnant mothers and the newborns,” she says.“I now know that I can prevent the complications that mothers face during pregnancy and delivery. I am as well well-known about the five warning signals of risk deliveries.”

As a part of small group of trainees, she also learned clinical skills including how to perform antenatal exam, proper hand washing, managing critical circumstances andpre- and post-natal care for mothers and their babies. 

That was just one of many essential lessons for Bilkis and other midwives enrolled in a special training program for traditional birth attendants. Organised by Durgapur Area Development Programme, the training aimed at building capacity, strengthening health systems and preventing the needless deaths of women and newborns across the communities.

Through this competency-based training, they have learnt how to avoid tragedies and provide exceptional care for clean deliveries and support to women giving births and their babies to reduce maternal and newborn deaths.

Bilkis Begum, 44, is a housewife and community birth attendant who provides voluntary midwifery service to the poor and deprived women of her community of Madhab Bagan village under Durgapur Union is now a Higher Secondary School Certificate (HSC) candidate.

Bilkis has a long inheritance of midwifery as a profession, starting from her mother and two elder sisters, and she always dreamed of becoming a midwife too. She wanted to learn how to take care of the women and children of her village, but except of having some traditional midwifery tactics, she did not have any sound technical knowledge about safe delivery as well as pre- and post-natal care.

“I feel sorrow that mothers continue to die due to prolonged labor and excessive bleeding when prevention and treatment is simple, All I could do was traditional medical techniques that I knew from my mother and sisters’, Bilkis says.

In 2010, she got an opportunity to expand her knowledge and skills in maternal and child health by attending a three-day training course on safe delivery and newborn care organized by Durgapur Area Development Programme. Last year, she also received another three-day refreshertraining for the TBAs offered by the ADP.

“Most of the deliveries I do here happen at home. I they can get more comprehensive care there. Even if people in these rural communities prefer to deliver at home, I always encourage and take women to give birth at government health centers so that I could provide the necessary support at low cost during any emergency and they could get more comprehensive care there,” says Bilkis.

“I am happy to do this, because I always want to help people rather to be caused any harm by me. I do not take any money from them, rather I accept whatever they give me happily like shari, perfumed oil and soap,” she replies.

Besides voluntary midwifery service, Bilkis also addresses several areas of concern, such as use of safe clean water and sanitation, immunization, health checkups and healthy nutrition practices. She is also involved with other interventions of the ADP like WASH, Disaster Preparedness and training on cattle rearing. Since 2009, she was a member of WATSAN committee of her village and now is also working as an active member of disaster management committee.

The impact that a trained TBA can have on the health of women and children in Durgapur Union’s community is reflected in Rawsan Ara, a woman who was attendant by Bilkis Begum having trouble while delivering her third child.

Rawsan Ara was examined by Bilkis, who found that there was malpresentation of the fetus—a common issue during delivery where the baby is not aligned for an easy exit from the birth canal. Bilkis immediately took her to Uttaran Medical Clinic, a private health center in Mymensingh District. She gave birth to two healthy baby boys—one of whom was delivered by Bilkis Begum on the way to the clinic — who likely might have died in childbirth.

‘The midwife told me I was going to have twins’, says 30-year-old Rawsan Ara, now a mother of four children. I was worried too because I did not quite know how I was going to feed this twins. But the midwife assured me I have enough breast milk to feed them. She also told me not to give them any food other than breast milk until they are six months old.”

Rowsan Ara’s twins are now three weeks old, and she continues to feed them with her breast milk only.

“I could not believe I could actually do it, feed them with breast milk only,”she explains.  Rawsansays that she did not breastfeed her elder two children exclusively for the first six months from the time of their birth.

“World Vision has become able to bring about a perceptible change in the health status of this community by making a well-trained traditional birth attendant a powerful resource in preventing unnecessary deaths of women and children. During the period, the access to maternal and child health services improved’, Bilkis says. ‘Pregnant women are aware of receiving health checkups. Women giving births in health facilities and children receiving immunization have also been increased. The rate of maternal and infant deaths has also been reduced significantly’.

‘The community mothers are now able to understand about the maternal and child care issues and receive the updated care by skilled health personnel. The community has now turned to the change of reducing the preventable deaths of women and children,” she adds.

‘Thanks to the training I received from World Vision. The trainings were all the perfect foundations for my future as a midwife,” says Bilkis with a smile.

Bilkis is now enthusiastic and satisfied in her long-awaited career, fulfilling her dreams of providing essential care to the mothers and their newborn children of her community.

“To me, there is no great service rather than serving people in the society. So, until the last day of mine to leave this world, I want to involve with the social work because people of my community love me, respect me and inspire me every day to continue my work,” she replied.

With passion and persistence, Bilkis overcame many obstacles that face Bangladesh’s women, like lack of education, and became a midwife in her village and is admired by all. She has the trust of families within the community and the number of patients is gradually increasing.

Earlier, pregnant women did not come for antenatal care. Now, they come to Bilkis for antenatal care to better prepare for their delivery. When it’s time, the expectant mothers turn to Bilkis for a safe delivery.

And now she proudly walks every day to work even though it is relatively far from her home.