Bringing Choice To Women in Remote Bangladesh

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Recently, I had the opportunity to travel to Rangamati, Bangladesh, where Pathfinder has worked with a local NGO called Green Hill to set up clinics for women and children in a place where no such services existed. The women in this rural area are isolated and marginalized, not only because of their poverty, but also because they belong to indigenous ethnic minority groups that are politically, culturally, and linguistically alienated from the general Bangladeshi population.

Before Pathfinder established its clinics and trained health outreach workers, the only option for most women in need of health care was to travel to the hospitals in Rangamati City. The trip is arduous. Across hills, ravines, lakes, and rivers that are extremely difficult to navigate, especially when sick or heavily pregnant, women travel for at least a full day, which few of them can afford.  Again and again, the women I met told me that before Pathfinder set up its clinics, they sought health care only in dire emergencies.

I spoke with Reasly Chakma[*], 25 years old and 8 months pregnant with her first child, who was at the clinic for a routine prenatal check-up. “If Pathfinder hadn’t set up this clinic, I would have to travel by boat, foot, and bus for six hours to get to the hospital in town. It’s expensive and tiring, and I can’t leave my family for that long. I would only be able to go if there was a really serious problem with the baby.”

Reasly, like all the other women I met, learned about the clinic and its services from one of the clinic’s “depot holders,” local women who Pathfinder trained in reproductive health, contraception, maternal and newborn health, and other general health issues. Armed with this knowledge, depot holders travel by rowboat and by foot to the remote villages and settlements assigned to them, where they meet with women to talk about health, safe pregnancy, and family planning. They bring contraceptives and over-the-counter medications, which they sell at a reduced price.

I had the pleasure of meeting a number of the depot holders—strong, intrepid women, who brave the elements, hiking and rowing for miles to bring services and information to other women’s doorsteps. Nika Chakma, a 35-year-old depot holder, explained to me that many women are nervous about going to the clinic at first. “They have a hard time expressing themselves clearly and talking about health issues with strangers. I’m from the same community and I visit them in their home—and open my own home to them—so they trust me and feel comfortable talking about their concerns.” Often, depot holders even accompany women to the clinic and facilitate their first contacts with the staff.

By engaging members of the community as health outreach workers and hiring clinic staff from the area, Pathfinder’s project has confronted another formidable barrier to care—language. Bengali is the language used at the urban health facilities, but most of the women I met don’t speak it well, which makes visiting those faraway facilities even harder.

Urmi Chamka, a 33-year-old paramedic, used to work in a hospital in the capital, Dhaka, but she came home to Rangamati to work at Pathfinder’s Mogban clinic last year. She told me how gratifying it is to serve women from her own community. “When I speak to patients in their mother tongue, I can really connect with them and make sure they fully understand what’s going on with their health and what their choices are.”

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[*] Note that Chakma is the name of one of the larger indigenous ethnic minority groups in Rangamati and is therefore a very common surname.

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Because of the present economic system, capitalists are becoming more capitalist and poor becoming poorest. National revenue is growing cause of the earning of the richest and capitalist but approximately 82 percent of the country's population lived in rural areas, virtually all of them making their living exclusively or substantially from agriculture. Poverty in Bangladesh is primarily a ’rural phenomenon’, with 53 percent of its rural population classified as poor, comprising about 85 percent of the country’s poor. Without developing the agriculture, it is quite impossible to develop the country. While the country’s population is growing at the rate of 1.6 percent per year, demographic pressures and increased urbanization have caused cultivated area to decline at a rate of 1 percent per year. Population’s high birth rate is increasing the levels of poverty in Bangladesh. For nearly 45 percent of the rural population, who are already landless or functionally landless (owning less than 0.05 acre of land), and a majority of the new labor force every year, a declining land base and a small urban employment means that employment in the rural non-farm sector presents the best chance to escape poverty. So please give priorities for Agriculture, ‘Human population control’ and Rural Development to meet the Millennium Development Goals (MDGs).
Mahmudul Hasan July 15, 2012
beautiful work there! am so loving all this news cos am in chapter 3 of my thesis which is on THE IMPERATIVES OF FAMILY PLANNING IN MATERNAL MORTALITY REDUCTION, A STUDY OF WOMEN IN AJAH-LEKKI AREA OF LAGOS STATE, NIGERIA. Its all very good and encouraging news.
Sandra Opaluwah July 12, 2012
Wonderful piece Olivia! Thanks for writing this!
Jaime-Alexis July 5, 2012
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