In Bangladesh, 90 percent of deliveries take place at home and are being conducted by the Traditional Birth Attendants (TBA) and relatives. They can neither recognise the risk factors during pregnancy and delivery, nor be able to deal with the situation as because they are not skillfully trained up. TBAs are not medical professionals. They do not have the lifesaving skills necessary to deal with life threatening problems. They cannot treat women with haemorrhage, eclampsia, obstructed labour or other obstetric complications, which are the main cause of maternal death during delivery or immediately after childbirth. WHO recognises Skilled Birth Attendants (SBA) as delivery service providers who are trained with skill to deal with normal deliveries along with complications. These days, the number of deliveries conducted by skilled birth attendants is taken as a maternal health indicator. Bangladesh have only 13 percent deliveries conducted by SBA, which include delivery by specialists, doctors, nurses and midwives. Whereas in many of the developing countries, the figure is around 60-80 percent.

In our country we do not have sufficient health centres. Culturally home delivery is more acceptable here. So we need to develop skilled health service providers. There are 25000 Health Assistant (HA) and Family Welfare Assistant (FWA) at present in our country. We can use this resource by training up them.

Bangladesh Government had many strategies in the past to reduce maternal mortality and morbidity. But home delivery situation was never taken much in consideration. Since 90 percent of deliveries take place at home, majority of death (80 percent) also take place in that situation, during and immediately after child birth. Unless some skilled personals are not attending the deliveries at home, it is not possible to reduce the maternal mortality and morbidity.

A Skilled Birth Attendant (SBA) in one who is being trained in an Institute with structured curriculum in Midwifery, acquire knowledge and skill and certified by competent authority and then registered by Nursing Council to practice in the community.

Bangladesh had no SBA in the community before. And mothers were left with the TBA who had no skill-based training. The result was persistent high MMR and their morbidity. In early '90s Bangladesh Government took a strategy of Emergency Obstetric Care (EOC) and programmes were taken to strengthen District hospitals and Upazilla Health Complexes to comprehensive EOC service. EOC service is always a backup service for the grass root level. Whenever there is any complication this backup service centres deal with the complications. But primarily deliveries need to be safeguarded in the community to avoid complications. SBA is the answer for this safeguard. So EOC and SBA programmes are complementary to each other. SBAs can conduct normal delivery at home in a scientific and safe way. As they have sound knowledge about obstetric procedure as well as treatment during pregnancy a SBA can also identify high-risk pregnancy and they can easily refer these high-risk pregnancy to the appropriate health centres.

An excellent initiative of Prof Abdul Bayes Bhuiyan

To meet the high demand of qualified SBA/midwife in the coming days we should be prepared with sufficient manpower available to meet the demand. But how can we get adequate skilled human resource? Renowned Gynaecologist and Ex President of Obstetric and Gynaecological Society of Bangladesh (OGSB) looked at current situation of our country that we have so many HA and FWA who work in the grass root level. If we are able to train up them they can serve the community much better with the skill of obstetric knowledge. As these HA and FWA (specially female) come close contact of the people they can motivate them easily and also refer the high risk pregnancy to the appropriate health centres. With this point of view he surveyed two districts on the facts of SBA. He found that SBAs were well accepted and they looked more confident. Community people were satisfied enough and happy with their services. The most effective outcome was the referral increased in the Upazilla Health Centre, District Hospitals and so on by these SBAs. He preformed this survey with the funding of WHO. When he placed his wonderful report to the Minister of MOHFW. He was pleased to implement a project with the help of development partners.

Now it is a matter of great joy for us that the Government of Bangladesh has decided to train all the FWA and FeHA to make them SBA in phases and thereby covering the whole country. The NGOs and private sector have opportunity to train their paramedics as SBA in the line of pilot, keeping the standard set by the Government programme. The current ongoing SBA training programme started at March 1, 2003. By this programme we will get 10,000 SBA by the year 2010.

Our duty and goal

Now what is our duty? We should engage these SBAs to perform the delivery in the remote areas to ensure safe delivery. Doctors can encourage people to ensure skilled attendants at delivery. There is a hope that in coming 10-15 years there is very little chance of institutional delivery.