Maternal Mortality and Nusrat

On the global health stage, the United Nations set the Millennium Development Goals and MDG 4 and 5 calls to reduce infant and improve maternal health. While Bangladesh has effectively reduced infant mortality, unfortunately women are still dying during child birth. One approach to reducing the maternal mortality rate is to get women to give birth in the hospital rather than at home. I discussed this problem with some employees of the medical college that I am working from while here in Sylhet and to guide my comments I drew from books I had read about the use of birth attendants and community helathworkers. It was a text booky macro public health discussion. Then I met baby Nusrat.
While attending a friends wedding here, I met 2 sisters who were kind enough to recognize that I was alone (Greg was with the men, see upcoming Wo/men post) and greeted me in English. I instantly felt the warmth of their genuine hearts . A wide-eyed smiling baby bounced back and forth between their laps and I started to coo and ca along with them. Between the wedding feast and photo session, my new friends revealed that 11 month Nusrat was motherless. He mother died while giving birth. Her mother did not go to the hospital because the elder son was taking exams, but the more deep seeded reason was that she feared the doctors and hospital and so gave birth to Nusrat at home. Suddenly that MDG #4 came crashing down to the personal level. “Her life will be full of sorrow”, one sister explained. I, drawing from my American optimist side, offered an alternative perspective, “Well now she has 3 mothers as you, your sister and mother care and love for Nusrat.” “Not 3 mothers, 3 sisters,” she corrected me “but she has brought new life into our family as my father died 3 months before she was born.” In Nusrat's case the the wide-spanning Bangladeshi family will support her but not all babies will be so fortunate.
Nusrat's story can teach the MDG #5 a valuable lesson. Yes, getting women to the hospital is important but understanding why they are not going is the first step in achieving this. Why are women scared of the hospital? What can doctors do to be more welcoming? It is not a simply matter of educating the uneducated as so many top down approaches preach. Nusrat's mother's fear was very real whether justified or not and being educated does not erase fear. Many of my friends have been or are recently pregnant and even for them, despite the technology and infrastructure of the British/ American health care systems, fear is part of pregnancy. We should not be afraid from learning about this fear from women themselves in order to reducing maternal mortality.