INTRODUCTION:

WHO launched the Making Pregnancy Safer (MPS) Initiative in 1999 to respond to global challenges of maternal and newborn health. It is a strategy to work with the health sector, focusing on evidence based intervention that target the major causes of maternal and newborn morbidity and mortality, by strengthening the health systems and identifying actions at community level, with emphasis on skilled attendance at delivery and referral to facilities able to provide emergency obstetric care.

The goal is to reduce maternal and newborn mortality and morbidity: Maternal mortality ratio by 75 percent from 1990 levels by 2015 and infant mortality ratio to below 35 per 1000 live birth.
The MPS initiative aims to save the lives of more than 500,000 women who die world wide every year, as a result of causes related to pregnancy and child birth.

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COUNTRY SITUATION:

Bangladesh, a country with annual birth of close to 4 million, still has a very high maternal mortality rate estimated at 3.2 to 4 per 1000 live births. Eighty percent of the maternal deaths happen at home as because more than 90% of deliveries occur at home attended by traditional birth attendants (75.6 percent) and relatives (10.8 percent). Deliveries by a medical trained person are 11.6 percent, i.e. 6.5 percent doctors and 5.3 percent by nurse-midwives/Family Welfare Visitors/others. 47.5 percent of pregnant women avail one or more antenatal care check.

The infant mortality rate is 66.7 per 1000 live births, with the neonatal mortality rate also 42 per 1000 live births. The total fertility rate is estimated at 3.2, with the contraceptive prevalence rate 50.8 percent, of which 44.5 percent are modern and 6.3 percent traditional methods.

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WHO SUPPORT 2002-2003:

Skilled Birth Attendant (SBA) Training Programme in Bangladesh aims to provide skilled attendants at birth in rural Bangladesh.

Starting mid 2003, the Government of Bangladesh implemented piloting of the SBA training programme supported by WHO and UNFPA in six districts with the technical assistance from OGSB. WHO assisted in designing the competency based training for basic health workers (Family Welfare Assistants and Female Health Assistants) to conduct essential pregnancy care, childbirth, postnatal and neonatal services. It includes the certification and registration of those who completed the training successfully as SBAs by the Bangladesh Nursing Council. The performance evaluation of the SBA Training programme, including the assessment of skill retention is conducted 6 months after the training.

In the SBAs catchment area, community support systems through establishing community groups are addressing the delays for emergency obstetric care through popularising birth planning, preparation for safe delivery, recognition of danger signs and provision of community transport and funds for referral of women with obstetric emergencies. It was preceded by district and upazilla level stakeholders' workshops.

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WHO Support 2004-2005:

SBA Training and its accreditation/ registration system strengthened at National and District Level.
Coverage and quality of maternal and newborn care monitored at district level.
Community awareness for birth planning, safe deliveries by SBAs and its referral improved.
Performance of the piloting of SBA training and the acceptance of SBA services by the community evaluated.

RELATED SITES:

Reproductive Health and Research (RHR):	http://www.who.int/reproductive-health/
Family and Community Health:	http://www.who.int/fch
Adolescent sexual and reproductive health (Department of Child and Adolescent Health and Development (CAH):	http://www.who.int/Child-adolescent-health/ashr.htm
Reproductive health (Western Pacific Region):	http://wpro.who.int/themes_focuses/theme2/focus3/index.asp
Adolescent sexual and reproductive health (Department of Reproductive Health and Research (RHR):	http://www.who.int/reproductive-health/adolescent/index.htm

New Publication

The Reproductive Health Strategy: to accelerate progress towards the attainment of international development goals and targets is now available in print and can be downloaded from the web link listed below. This is the World Health Organization's first global strategy on reproductive health. It was adopted by the 57th World Health Assembly (WHA) in May 2004. The strategy was developed as a result of extensive consultations in all regions with representatives from ministries of health, professional associations, non-governmental organizations, United Nations partners and other key stakeholders. It lays out actions needed for accelerating progress towards the attainment of the Millennium Development Goals (MDGs) and other international goals and targets relating to reproductive health, especially those from the International Conference on Population and Development (ICPD) in 1994, and its five-year follow-up (ICPD+5).

It can be downloaded from:
http://www.who.int/reproductive-health/publications/strategy.pdf

KEY DOCUMENTS (For download as PDF format and MS word):

• Need Assessment for Conducting Training of Skilled Attendant at Delivery in Bangladesh '2002
• Strengthening the District Trainers'2003
• Stakeholder Planning Workshop and SBA Promotion'2003
• SBA Training Community Field Practice'2003
• District Skilled Birth Attendant Training, Coordination, Supervision and Training Follow up: Tangail, Comilla, and Barisal'2003
• Pregnancy Childbirth and Neonatal Care Guidelines'2003

Reproductive health best practices:

http://www.who.int/reproductive-health/rhl/index.html

Reproductive health best practices:	http://www.who.int/reproductive-health/rhl/index.html
Maternal and newborn health:	http://www.who.int/reproductive-health/MNBH/index.htm
Maternal and child health (European Region):	http://www.euro.who.int/healthtopics#MATERNALCHILD
Family planning and human reproduction (European Region):	http://www.euro.who.int/healthtopics#FAMPLANHUMREP
Infant and neonatal health and development:	http://www.who.int/child-adolescent-health/OVERVIEW/HNI/neonatal.htm

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