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Working with HeRWAI

Working with HeRWAI. Interrogating the Maternal Health Conditions in Bangladesh Naripokkho November 2006. Application Context. Women in Bangladesh are subject to severe discrimination and denial of basic rights. One manifestation of this is the very poor health status of women.

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Working with HeRWAI

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  1. Working with HeRWAI Interrogating the Maternal Health Conditions in Bangladesh Naripokkho November 2006

  2. Application Context • Women in Bangladesh are subject to severe discrimination and denial of basic rights. One manifestation of this is the very poor health status of women. • Women are not able to exercise autonomy over their own bodies and the daily denial of this freedom means that women have no control over their reproduction, choice of contraception, or expression of sexuality, and were subjected to frequent and arbitrary violence often from their near and dear ones.

  3. Women have limited opportunities for education and employment. Issue of women’s independence and their role in decision making has been neglected. • Women’s rights and needs have not been prioritised in government policies and programmes. Although there was a marked change in this post-ICPD, when the Government of Bangladesh produced a Maternal Health Strategy and the Health and Population Sector Programme emphasising women’s needs and rights. The Safe Motherhood Programme introduced under HPSP was notable in this regard.

  4. Despite the improved policy content and declared intent of the Government, implementation remained weak. Structures of accountability are either non-existent or non-functioning. • Health parameters have, however, shown remarkable progress in recent years (MMR has declined from 5.9 in 1990 to 3.2 in 2003, life expectancy has gone up, the sex ratio has improved).

  5. Morbidity, and in particular maternal morbidity is however understated and remains invisible both to the public eye as well as in the national statistical index. Post-ICPD Naripokkho undertook an action research project which revealed that on average a woman suffers from 5-6 ailments at any given time. • Future search conferences carried out by Naripokkho in collaboration with UNICEF during 1997-98, Bangladesh revealed that most women dying from pregnancy related causes were under the age of 25.

  6. A subsequent study carried out in collaboration with the Royal Tropical Institute in The Netherlands showed that despite good infra-structure and a system of extension services in the public sector, most women were dependent on the private providers, including faith healers and traditional practitioners, because of the non-availability of government health services. • Dependence of the GoB on foreign donations and loans have resulted in harmful decisions regarding the delivery of health services. E.g. GoB decision to discontinue training of Traditional Birth Attendants under pressure from the World Bank without ensuring Emergency Obstetric Care services and good referral linkages to tertiary care.

  7. In this context HeRWAI appeared to be an important and useful tool for highlighting the links between women’s rights violations and their poor health and for the identification of gaps at different levels - policy, programme, implementation and outcome/impact.

  8. Experience with HeRWAI Challenges • No data available at community level. • GoB data mostly not analysed or are classified, & GoB institutions are reluctant to provide access to raw data. • Discrepancy between findings of GoB & others. Different measurements used by different organisations means that data is often not comparable.

  9. Data on many aspects of health inadequate, outdated, or non-existent (especially morbidity & service delivery). • Lack of dedicated resources - skilled staff & time.

  10. Overcoming challenges Many of the challenges are beyond our control and could not be overcome during the first exercise. • Focus Group Discussions to obtain primary data. • Document search and review of unpublished reports. • Use of case studies collected from different sources. • Information from Naripokkho’s ongoing work on women’s health rights.

  11. Recommendations to overcome challenges • Advocate for Right to Information legislation which will enable citizens to access government data. • Lobby for the establishment of Union level data bases. • Lobby for research and data collection on morbidity and service delivery.

  12. Further work with HeRWAI • Findings from the HeRWAI testing has been incorporated into Naripokkho’s advocacy agenda. • Naripokkho’s data on EmOC services is under process and HeRWAI will be used to examine and analyse the policy aspects. • Incorporate HeRWAI into WHRAP work as a way of tracking GoB policy & programme decisions & their effectiveness.

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