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March 15, 2006

Reproductive Health Care: A Basic Human Right

Rafiqul Azad
by Rafiqul Islam Azad, Bangladesh

"Madam we have come again today. For, my wife has conceived again—a fourth time. We have already two children and we are not in a position to have the third. Last time, her M.R. was done in July last under your care but after that her menstruation became irregular. And we failed to notice it. As a result, we became careless in using contraceptive.”

This is what a Senior Assistant Secretary of the government was telling to Hasina Muqtadir, a Senior Counsellor working at the Reproductive Health Services Trainings & Education Programme (RH STEP) located at the 2nd floor of Dhaka Medical College Hospital (DMCH) a couple of weeks ago.

“Ok, I am taking care of her case,” the Counsellor assured the man, a resident of Mugdapara area in the city.

Being assured by the Counsellor of taking proper care of his wife, the man left for his office leaving the wife at her care saying, “I am coming back at noon.”

This was the conversation between the two that was heard by this Correspondent at about 9:45am on a Sunday last month while waiting for talks with the said Counsellor on the activities of the RH STEP.

After few minutes, another woman came to the Counsellor from Arihajar upazila of Narayanganj district for her follow-up treatment.

The woman, a mother of four daughters and one son, had earlier done her Pep’s Smear test in the center on July 12 last year and she received treatment as she was suffering from severe inflammation found in the test.

“Though I feel comparatively better than previous time but I have still some complications,” the woman, aged about 40, told the Counsellor, who advised her to continue the treatment.

It may be noted that the government began a special project namely Menstruation Regulation Training and Service Programme (MRTSP) in 1989 to promote the reproductive health. Later on, the project turned into an NGO called as RH STEP in October 1983.

The RH STEP now is playing a complementary role to support and supplement in consonance with the GoB’s national health programme targets in reducing maternal mortality rate and morbidity and other reproductive health hazards in Bangladesh.

Not only government officials or housewives, Hasina Muqtadir said, women and adult girls from all walks of life come to the RH STEP everyday with their various problems relating to the reproductive health and for treatment and counselling.

“The clients are given counseling first. If the counseling is of not considered sufficient to heal their complains, then other actions are also taken as deemed fit for,” she said.

Sometimes, the Counsellor said, “We have to do M.R for street girls and unexpected pregnancies of adolescent girls who are victimised socially considering the human ground.”

“Everyday 10 to 15 patients are being attended by us,” she said adding that for a single case of M.R an amount of Tk 120 to Tk 130 is charged for. However, if the case is complicated one, the amount may rise to Tk 500.

“Most of the women generally come to the RH STEP for M.R. Besides, Pep’s Smear, pregnancy test and such tests that are necessary are done here. When the women leave the center, they are provided with health education and contraceptive pills,” said the Counsellor adding that treatment for uterus infection, which is found common among the mothers or women of child bearing ages are also given to them.

A total of 18 RH STEP centers, mostly located at the government hospitals attached with medical colleges and major district hospitals, have been working from 1983 to facilitate the reproductive health care in the country.

The RH STEP, funded by the Swedish International Development Agency (SIDA), is engaged in an unabated fight to reduce the maternal morbidity and mortality rate due to induced and septic abortion by providing M.R training to doctors, FWVs, paramedics, nurses etc. It has been providing M.R and contraceptive services besides counselling to M.R clients for follow-up visits, the Executive Director, Quazi Suraiya Sultana said.

According to its annual report, the RH STEP has performed over 58 thousands M.R cases during the last fiscal year when about 63 thousands pregnant women were counseled during the period.

Of them, maximum clients (28%) are of 25 to 29 age group who were provided the M.R services while only 5.20% clients of 40 and above age group were in the minimum level. The percentage of M.R recipients of 20 or below age group were 5.44.

Of the M.R recipients, highest number of 17,160 women with two children were provided the service.

At the same time, contraceptive M.R training was imparted to 782 persons including, government and private doctors, FWVs, paramedics, nurses and medical assistants.

The report shows that contraceptive services were extended to 68 thousands women and girls when 8,926 patients were given treatment after pep’s smear test during the period.

Besides, the RH STEP also provided antenatal care, post-natal care, family planning and other services to more than 20 thousands clients.

In addition to the initiative, all the government medical college hospitals, districts hospitals, specialised hospitals, Upazila and Union Parishad level health complexes and thousands of health workers across the country have been providing the reproductive health services.

Health experts say there are excellent GO-NGO infrastructure across the country in providing the reproductive health but many of them alleged that most of those remained unutilized due to inadequate supply of medicines by the government and also non-availability of funds.

Sources said significant awareness has already been created among the people due to the GO and NGO effort but there are still 30 to 40 per cent women and adult girls in the country who remain unaware of the reproductive health issues.

Sources said maternal mortality rate has significantly been reduced to 3 per cent per thousand from the 6 per cent of the seventies.

The institutional delivery is also increasing day by day, sources said, it has now stood at 11 per cent with one per cent enhancement than that of last year to reduce child and maternal mortality rate.

According to sources in the Family Planning Directorate, about 23 thousand family welfare assistants and 15 thousand health assistants are working at the grass root level for providing basic health and family planning service delivery.

About 30,000 “satellite clinics” are also organised at ward and community levels every month all over the country aiming to bring the service facilities at the door step of the people. In that package we deliver antenatal care, family planning, health education and EPI services, said a highly placed official of the directorate.

MA Akmall Hossain Azad, Director General of Family Planning Directorate, said that under the directorate reproductive health service and education are being given from its 80 maternal and child welfare centers across the country.

On average some 5,000 safe deliveries are being conducted from the centers in each month, he said.

Besides, about 3,500 Family Welfare Centers are also proving reproductive health services including free distribution of contraceptives, the DG said.

Of the specialised government hospitals, Azimpur Maternity Hospital provides all sorts of maternal services including safe delivery and counselling to the mothers and adolescents.

Dr Md Ziaul Karim, Superintendent of the hospital said around 500 expecting mothers come to the hospital for taking health services. He added that over 500 delivery cases are conducted at the hospital in each month. Of them, about two-third are being conducted by Scissorian section operation as most of the complicated cases are referred to this hospital for its reputation.

The Urban Primary Health Care (UPHC) Project, assisted by the Dhaka City Corporation, also provides reproductive and general health services to urban people through its 38 centres in the city.

There are also many NGOs, which have been working in the field of reproductive health care along with the government initiative. Of them about 15 leading NGOs are specially dealing with the reproductive health.

Different GOs and NGOs like the RH STEP are implementing “Behaviour Change Community (BCC) activity to promote the awareness, particularly among the adolescents about the reproductive health so that they could protect themselves from deadly diseases like HIV/AIDS and STDs.

Under the Reproductive Health Initiative for Youth in Asia (RHIYA) project funded by EU and UNFPA, five leading NGOs—Concerned Women for Family Development (CWFD), Family Planning Associations of Bangladesh (FPAB), Marie Stops Clinics Society, Bangladesh Red-Crescent Society and Save the Children UK— are also working with the adolescents.

Some NGOs, notably BRAC, has a programme on sex education. Many NGOs have already developed culturally appropriate IEC materials regarding the issues for their campaign.