Bangladesh has been an example for the world in terms of its achievements on the reproductive health agendas. The success story of many of the SDG goals already achieved, like in reducing maternal mortality rates, are amazing. Among many other inspiring stories in reproductive health, the story of a cadre of midwives created under the directives of Prime Minister Sheikh Hasina to reduce maternal mortality is also remarkable.
The generation breakthrough project which involves some 130,000 boys and girls from 300 schools and madrasas is also a concept developed in Bangladesh which can be motivating for other nations addressing adolescent health problems.
As a young nation, Bangladesh has a huge heart and the people of the country is also very resilient to countless adversities. They repeatedly face cyclones, floods and drought and yet they have coped to survive, build again and innovate all the time which is another lesson the world can learn from.
The excerpts of the chitchat are produced below.
Dr Asa Torkelsson, United Nations Population Fund (UNFPA) Representative in Bangladesh made the above remarks when she spoke to Bangladesh Post recently. She described her experiences in addressing reproductive health by supporting the government’s initiatives and shared how Bangladesh is accomplishing despite the challenges. She also described the progress on many difficult issues (referring to sustainable development goals, SDGs) Bangladesh made so far as ‘amazing’ but also cautioned about confronting the challenges by learning to retain and continue to work on the achievements since the country is moving to secure the status of a middle-income country soon. The energy must continue to drive the nation and reach its destinations, she said. She also reminded that Bangladesh needs to invest more in reducing the unmet needs of family planning and to erase and get rid of gender-based violence.
Torkelsson who comes from Stockholm, Sweden, said, “Bangladesh is an incredible country with a large population. As I have experienced in the past two years of my office here the nation is moving towards achieving the development goals”
She said that for the past 25 years as I have been following Bangladesh’s progress, there have been noticeable advances that have been made which we can say that Bangladesh is an example for the world in terms of its achievements on the reproductive health agenda. We are now working with Bangladesh to meet the three zeros with squarely focused on eliminating maternal mortality and to reduce unmet needs of family planning and to erase and get rid of gender-based violence. Despite the advances, unfortunately, there is still a long way to go. There are challenges and gaps and so there are still many unfinished agenda.
“In filling the gaps,” she said, “We are working with the government of Bangladesh on various aspects to strengthen the issues like maternal health. We are working to develop a cadre of midwives. We have been creating the profession of midwives and we are very happy and proud to be part of this incredible journey.”
The ultimate goal of this is to ensure no woman dies while giving birth but also as you may know until today the rate of institutional delivery is quite low. About half of the deliveries still take place at homes. So, there is a huge challenge in terms of outreach and what we tried to do until now is to make sure that women are informed about the reproductive options that they have. So, we are empowering women with different health services at different levels and at the same time we are working with the government to create quality environment and we feel that there is a large commitment too in working with the government from the highest level to achieve the goals. It was the idea of her Excellency Prime Minister Sheikh Hasina who had proposed developing the cadre of midwives about two years back.
Asked if the benefit of developing the cadre of midwives is now visible, Torkelsson said, “I cannot really say how much has been attributed to our intervention but surely maternal mortality rate (MMR) has dropped tremendously but considering our goal (SDG) of reducing MMR to 70 per 100,000 live birth there is still a long way to go. But it is surely achievable if we continue to develop midwife professionals and continue to strengthen the health system in every level making sure no woman is left behind then I am very optimistic that it is realizable.”
Bangladesh is now moving towards a middle-income nation with tremendous growth. If that growth is used for instance for interventions of pregnant women, surely it would be more efficient service. But reaching that extra mile would be more expensive, can require some innovative solutions, exploring the concept of mobile network, for example. So, we are trying to focus on urban centres and trying to find a model where women can call and get a referral that she needs.
Referring to this month’s International Conference on Population and Development (ICPD) Programme of Action titled, ‘Nairobi Summit on ICPD25: Accelerating the Promise, she said, “I am very inspired by what Bangladesh has done. Bangladesh is also sharing its growth trajectory and many countries will be learning from the Bangladesh models of achievements in reproductive health. We would like to promote that trajectory when I am in Nairobi.”
On the issue of contraceptive prevalence rate or TFR and the future population of Bangladesh, she said, “There are still unmet needs in family planning which we think can be linked to child marriage which is currently too high and needs to be reduced. The adolescent fertility rate is also too high and we think we need to invest more in sharing information and around life skills for everyone to be able to make informed choices about who to marry when to marry and how many children to have. And surely keep girls in education as long as we can and prevent drop out of girls in secondary schools. Although Bangladesh has registered amazing progress in education of girls in primary levels the gap is still very high for girls in the secondary level.”
“So, we are continuing to invest in sharing information about options, particularly for girls and boys for their reproductive health options. We have been working on a project called generation breakthrough which actually involves some 130,000 boys and girls from 300 schools and madrasas in adolescent health corners where they learn about adolescent reproductive health which I think has been tremendously successful. And we are also happy to know that the government is scaling up this project,” said Torkelsson.
Asked about government’s budget allocation to address the reproductive health challenges, she said, ‘Yes, I do believe that we need to invest more particularly when Bangladesh is moving or preparing to graduate to middle-income country from LDC. Thus, it is very important to start thinking about how to invest so that no one is left behind in health services. What we have also noticed in our study report that Bangladeshis out of pocket expenditure on health for everyone, irrespective of your earnings, is tremendously high which is a big burden and sufferings of course.”
Asked where does Bangladesh stand in terms of its SDG achievements, Torkelsson said, “If you were to consider Bangladesh it did very well in achieving millennium development goals (MDGs), it did show remarkable progress in reducing MMR, primary education, closing the gender gaps and reducing the infant mortality rate.”
She said that now to talk about more robustly what more needs to be done, I think our big challenge is lack of data. And if we look at hundreds of indicators used to measure 17 SDGs my understanding is that we have data which is about 45 per cent. So, we expect the government to focus more on that and perhaps invest more in this particular issue. The population census 2021 is coming up and we are ready to support the government in data collection as we have always done.
“I am really pleased to see Bangladesh showing interest in SDGs and being enthusiastic about them and having lots of activities around SDGs at local levels and awareness-raising. I am really amazed by the level of energy in Bangladesh concerning achieving the SDGs. I often feel I am in the centre of the world being in Bangladesh because many of the challenges of SDGs are represented here in Bangladesh and there is a lot of movement in trying to achieve the SDGs. So I am also excited to be a part of the UN system in Bangladesh.
Asked about contributions of the non-government organisations, Torkelsson said “The NGOs are indeed tremendously important for UNFPA and our works, and in fact, most of our activities are implemented by civil society actors. Just a few days ago we completed a wide range of consultation with such civil society like the parliamentarians, NGOs, CBO and many more to know how to achieve the 12 commitments of the ICPD goals. We work very closely with civil society and consider them our partners and allies in achieving the mandates.”
About any weaknesses in policy gaps, lessons to be learnt from other countries, she said that right now we are evaluating the country programmes and we would start a new country programme from 2021 and in addition there is this United Nations Cooperation Framework which is being developed right now, so our plan has to be supportive of these broader plans because we are indeed a part of the UN system.
“What could have been done more,” she said, “In general from my perspective as I have seen travelling across the country, I feel there is a huge challenge that we need to focus on outreach to the people everywhere. For example, for safe delivery, a mother needs to go for four antenatal visits and then there are postnatal visits as well. And so, to secure that chain of delivery for women we are facing big challenges to ensure midwives, doctors and other support healthcare members. The other challenge I see is that Bangladesh faces natural calamities and I am quite amazed to learn that Bangladeshis are actually coping to live with the natural disasters which are, of course, something that can be a lesson for other countries.
And the third challenge in Bangladesh is gender-based violence. In respect to women’s empowerment which is obvious is very impressive but it is still a bit limited, she observed saying that because I noticed still women’s participation in the labour force is pretty low, child marriage is also high. Although, these women or girls may not be part of the women’s empowerment story I am optimistic that these numbers would eventually change and women would be safe all the time everywhere. For that to achieve we need more ambitious, well-resourced plans, Torkelsson suggested.
Asked what lessons would you recommend from Bangladesh for other countries, Torkelsson said that Bangladesh has a huge heart and if the world can learn from that it is indeed amazing. The people of the country is also very resilient. You are showing again and again and again in the face of challenges to cope, build and innovate all the time that is another lesson the world can learn. And of course, in terms of reducing MMR, you can showcase to the world the inspiring stories of the midwives and I am sure such an inspiring story can be shared at the upcoming ICPD Nairobi conference this month. Another model that can be shared to the world is the women-friendly corner which is another initiative that the government has supported.
“I am sure the world would be impressed by this story as well. And lastly the generation breakthrough project of how we got the young generation onboard which can be super inspiring!” she concluded.
