Sabina Faiz Rashid

Acute respiratory infections in rural Bangladesh: cultural understandings practices and the role of mothers and community health volunteers.

Qualitative data collected from 63 older and younger mothers revealed that almost all recognized pneumonia and all described mild and severe signs and symptoms to explain incidences of pneumonia. Respiratory illnesses were attributed to humoral imbalances, supernatural causes and ‘negligent’ mothers. Home care practices involved drinking specially prepared juices, massaging the child with oil and avoiding ‘cooling’ foods. Traditional and allopathic care was sought depending on the perceived severity of the illness. The role of the family was important in decision‐making. Rural mothers were relieved and satisfied to be able to quickly access low‐cost medicines from Bangladesh Rural Advancement Committee (BRAC) health volunteers, who clearly influence health care practices. In‐depth interviews and focus group discussions with 23 health volunteers showed that 22 were able to correctly identify breathing rates and their association with pneumonia. All had knowledge of acute respiratory infections (ARI) and were able to list a range of signs and symptoms. Some health volunteers complained of operational constraints with monitoring and technical equipment. Nevertheless, the programme has strong links with grassroots volunteers and community people, making it a successful intervention.

Explaining equity gains in child survival in Bangladesh: scale, speed, and selectivity in health and development

By disaggregating gains in child health in Bangladesh over the past several decades, significant improvements in gender and socioeconomic inequities have been revealed. With the use of a social determinants of health approach, key features of the countrys development experience can be identified that help explain its unexpected health trajectory. The systematic equity orientation of health and socioeconomic development in Bangladesh, and the implementation attributes of scale, speed, and selectivity, have been important drivers of health improvement. Despite this impressive pro-equity trajectory, there remain significant residual inequities in survival of girls and lower wealth quintiles as well as a host of new health and development challenges such as urbanisation, chronic disease, and climate change. Further progress in sustaining and enhancing equity-oriented achievements in health hinges on stronger governance and longer-term systems thinking regarding how to effectively promote inclusive and equitable development within and beyond the health system.

Newborn care practices among slum dwellers in Dhaka, Bangladesh: a quantitative and qualitative exploratory study

BackgroundUrbanization is occurring at a rapid pace, especially in low-income countries. Dhaka, Bangladesh, is estimated to grow to 50 million by 2015, with 21 million living in urban slums. Although health services are available, neonatal mortality is higher in slum areas than in urban non-slum areas. The Manoshi program works to improve maternal, newborn, and child health in urban slums in Bangladesh. This paper describes newborn care practices in urban slums in Dhaka and provides program recommendations.MethodsA quantitative baseline survey was conducted in six urban slum areas to measure newborn care practices among recently delivered women (n = 1,256). Thirty-six in-depth semi-structured interviews were conducted to explore newborn care practices among currently pregnant women (n = 18) and women who had at least one delivery (n = 18).ResultsIn the baseline survey, the majority of women gave birth at home (84%). Most women reported having knowledge about drying the baby (64%), wrapping the baby after birth (59%), and cord care (46%). In the in-depth interviews, almost all women reported using sterilized instruments to cut the cord. Babies are typically bathed soon after birth to purify them from the birth process. There was extensive care given to the umbilical cord including massage and/or applying substances, as well as a variety of practices to keep the baby warm. Exclusive breastfeeding was rare; most women reported first giving their babies sweet water, honey and/or other foods.ConclusionThese reported newborn care practices are similar to those in rural areas of Bangladesh and to urban and rural areas in the South Asia region. There are several program implications. Educational messages to promote providing newborn care immediately after birth, using sterile thread, delaying bathing, and ensuring dry cord care and exclusive breastfeeding are needed. Programs in urban slum areas should also consider interventions to improve social support for women, especially first time mothers. These interventions may improve newborn survival and help achieve MDG4.

Changing global policy to deliver safe, equitable, and affordable care for women’s cancers

Breast and cervical cancer are major threats to the health of women globally, particularly in low-income and middle-income countries. Radical progress to close the global cancer divide for women requires not only evidence-based policy making, but also broad multisectoral collaboration that capitalises on recent progress in the associated domains of womens health and innovative public health approaches to cancer care and control. Such multisectoral collaboration can serve to build health systems for cancer, and more broadly for primary care, surgery, and pathology. This Series paper explores the global health and public policy landscapes that intersect with womens health and global cancer control, with new approaches to bringing policy to action. Cancer is a major global social and political priority, and womens cancers are not only a tractable socioeconomic policy target in themselves, but also an important Trojan horse to drive improved cancer control and care.

Beliefs and practices during pregnancy and childbirth in urban slums of Dhaka, Bangladesh

BackgroundWorldwide urbanization has become a crucial issue in recent years. Bangladesh, one of the poorest and most densely-populated countries in the world, has been facing rapid urbanization. In urban areas, maternal indicators are generally worse in the slums than in the urban non-slum areas. The Manoshi program at BRAC, a non governmental organization, works to improve maternal, newborn, and child health in the urban slums of Bangladesh. This paper describes maternal related beliefs and practices in the urban slums of Dhaka and provides baseline information for the Manoshi program.MethodsThis is a descriptive study where data were collected using both quantitative and qualitative methods. The respondents for the quantitative methods, through a baseline survey using a probability sample, were mothers with infants (n = 672) living in the Manoshi program areas. Apart from this, as part of a formative research, thirty six in-depth semi-structured interviews were conducted during the same period from two of the above Manoshi program areas among currently pregnant women who had also previously given births (n = 18); and recently delivered women (n = 18).ResultsThe baseline survey revealed that one quarter of the recently delivered women received at least four antenatal care visits and 24 percent women received at least one postnatal care visit. Eighty-five percent of deliveries took place at home and 58 percent of the deliveries were assisted by untrained traditional birth attendants. The women mostly relied on their landladies for information and support. Members of the slum community mainly used cheap, easily accessible and available informal sectors for seeking care. Cultural beliefs and practices also reinforced this behavior, including home delivery without skilled assistance.ConclusionsBehavioral change messages are needed to increase the numbers of antenatal and postnatal care visits, improve birth preparedness, and encourage skilled attendance at delivery. Programs in the urban slum areas should also consider interventions to improve social support for key influential persons in the community, particularly landladies who serve as advisors and decision-makers.

Human rights and reproductive health: political realities and pragmatic choices for married adolescent women living in urban slums, Bangladesh.

BackgroundIn Bangladesh, particularly in urban slums, married adolescent women’s human rights to life, health, and reproductive and sexual health remain adversely affected because of the structural inequalities and political economic, social and cultural conditions which shape how rights are understood, negotiated and lived.MethodsThe focus of the research and methods was anthropological. An initial survey of 153 married adolescent women was carried out and from this group, 50 in-depth interviews were conducted with selected participants and, from the in-depth interviews, a further eight case studies of women and their families were selected for in-depth repeated interviews and case histories.ResultsThis paper speaks of the unanticipated complexities when writing on reproductive rights for poor adolescent women living in the slums, where the discourses on ‘universal human rights’ are often removed from the reality of adolescent women’s everyday lives. Married adolescent women and their families remain extremely vulnerable in the unpredictable, crime-prone and insecure urban slum landscape because of their age, gender and poverty. Adolescent women’s understanding of their rights such as the decision to marry early, have children, terminate pregnancies and engage in risky sexual behaviour, are different from the widely accepted discourse on rights globally, which assumes a particular kind of individual thinking and discourse on rights and a certain autonomy women have over their bodies and their lives. This does not necessarily exist in urban slum populations.ConclusionsThe lived experiences and decisions made pertaining to sexual and reproductive health and ‘rights’ exercised by married adolescent women, their families and slum communities, allow us to reflect on the disconnect between the international legal human rights frameworks as applied to sexual and reproductive health rights, and how these are played out on the ground. These notions are far more complex in environments where married adolescent women and their families live in conditions of poverty and socioeconomic deprivation.

Prevalence and Experiences of Intimate Partner Violence Against Women With Disabilities in Bangladesh Results of an Explanatory Sequential Mixed-Method Study

This study was aimed to estimate the prevalence of intimate partner violence (IPV) in a sample of 226 women with disabilities living in four different districts of Bangladesh. It also explored the physical and psychological suffering of women experiencing violence and their various coping strategies. A cross-sectional survey was carried out with 226 women with disabilities to measure the prevalence of IPV, and 16 in-depth interviews were conducted to document in detail the experiences of violence encountered by the abused women. Among the 226 women interviewed in the survey, about 84% reported ever having experienced at least one act of emotional abuse, physical, or sexual violence from their partner during their lifetime. Women who were older (aged above 32 years), separated, and members of economic/savings group were more likely to report ever having experienced any IPV than women with disabilities who were younger (aged 32 years and less), married, and not members of economic/savings group. Most of the women experiencing violence reported sufferings from physical and psychological problems. Of all the women who experienced violence, less than half (45%) reported seeking support to minimize or avoid violence experiences. However, seeking support from informal network such as family and relatives was commonly reported by many (81.4%) of them. Study findings suggest that women with disabilities who possess poor socio-economic status coupled with economic dependency on husbands’ income and wide-spread social stigma against disability make them vulnerable to IPV. Future interventions to address IPV against women with disabilities should include building community knowledge of disability and IPV, countering the pervasive social stigma against disabilities, and improving the socio-economic conditions of women with disabilities through education and employment.

Accessing Married Adolescent Women: The Realities of Ethnographic Research in an Urban Slum Environment in Dhaka, Bangladesh:

This article reports on the problem of obtaining reproductive histories from women in the slums of Dhaka, the capital of Bangladesh. Access to women in these slums is controlled by several gatekeepers. The gatekeeper problem is common in all field research, but the problem is particularly difficult when the research involves interviewing young Muslim women on the sensitive issue of reproductive health and family planning.

Experiences of abortion in Nepal and menstrual regulation in Bangladesh: a gender analysis

The extent to which abortion and menstrual regulation services are safe, legal, and women-friendly is a strong proxy of gender equity. This article draws on womens voices from Nepal and Bangladesh to illustrate that even where services are provided legally, women can still face multiple barriers to access to services, and problematic quality of care. This is exacerbated by the stigma which surrounds these services. Stigma is directly related to gender inequality, and is constructed at both the community and provider level. It is imperative to overcome these barriers by promoting gender equality across the board, in all services and all contexts.

Exploring the context in which different close-to-community sexual and reproductive health service providers operate in Bangladesh: a qualitative study.

BackgroundA range of formal and informal close-to-community (CTC) health service providers operate in an increasingly urbanized Bangladesh. Informal CTC health service providers play a key role in Bangladesh’s pluralistic health system, yet the reasons for their popularity and their interactions with formal providers and the community are poorly understood. This paper aims to understand the factors shaping poor urban and rural women’s choice of service provider for their sexual and reproductive health (SRH)-related problems and the interrelationships between these providers and communities. Building this evidence base is important, as the number and range of CTC providers continue to expand in both urban slums and rural communities in Bangladesh. This has implications for policy and future programme interventions addressing the poor women’s SRH needs.MethodsData was generated through 24 in-depth interviews with menstrual regulation clients, 12 focus group discussions with married men and women in communities and 24 semi-structured interviews with formal and informal CTC SRH service providers. Data was collected between July and September 2013 from three urban slums and one rural site in Dhaka and Sylhet, Bangladesh. Atlas.ti software was used to manage data analysis and coding, and a thematic analysis was undertaken.ResultsPoor women living in urban slums and rural areas visit a diverse range of CTC providers for SRH-related problems. Key factors influencing their choice of provider include the following: availability, accessibility, expenses and perceived quality of care, the latter being shaped by notions of trust, respect and familiarity. Informal providers are usually the first point of contact even for those clients who subsequently access SRH services from formal providers. Despite existing informal interactions between both types of providers and a shared understanding that this can be beneficial for clients, there is no effective link or partnership between these providers for referral, coordination and communication regarding SRH services.ConclusionTraining informal CTC providers and developing strategies to enable better links and coordination between this community-embedded cadre and the formal health sector has the potential to reduce service cost and improve availability of quality SRH (and other) care at the community level.