Bangladesh

Bangladesh is one of the world's most densely populated countries. Although social norms favor early marriages and large families, the government is committed to improving women’s status as well as raising awareness of family planning options. Indeed, Bangladesh has emerged as one of the world’s success in terms of increased use of contraceptives and better living standards for women.

Since 1974, EngenderHealth’s work Bangladesh has helped expand the availability, quality, and use of reproductive health care services. Most recently, through our USAID-funded ACQUIRE Project, we have doubled the number of districts of Bangladesh we reach, and today have national coverage in all 64 districts to:

• Revitalize family planning
• Ensure quality health care
• Prevent obstetric fistula
• Promote maternal health
• Increase access to postabortion care
• Integrate HIV and AIDS care with other reproductive health services

Revitalizing Family Planning
Today, through EngenderHealth’s ACQUIRE Project (Access, Quality, and Use in Reproductive Health), we work with local partners and the Bangladeshi government to revitalize family planning in Bangladesh, with a focus on expanding access to and use use of long-acting and permanent contraceptive methods. This involves:

• Preparing a strategy for 2006-2010 to guide family planning, safe motherhood and efforts to expand long-acting and permanent contraceptive methods, including Norplant, IUDs and sterilization;
• Educating women and men about available contraceptive options;
• Mobilizing communities to improve health services;
• Training health care providers, supervisors, and governmental staff in infection prevention;
• Introduce COPE® and facilitative supervision—two quality improvement tools that help health care staff identify and resolve problems on their own.

 
Ensuring Quality Health Care
EngenderHealth has partnered with two local organizations, Concerned Women for Family Planning and World Vision Bangladesh, to develop quality assurance monitoring systems. Recent efforts include:

• Training 936 health care providers and conducting 226 site visits in 2001;
• Developing government-endorsed technical standards for treating reproductive tract infections and sexually transmitted infections;
• Expanding the reach of programs though “train-the-trainers” initiatives;
• Encouraging the Ministry of Health and Family Welfare to remove political barriers to surgical sterilization;
• Providing technical assistance to 13 medical colleges;
• Conducting quality improvement training at 638 nongovernmental sites.

 
Preventing Obstetric Fistula
EngenderHealth promotes efforts to prevent and treat obstetric fistula, a vaginal tear resulting from prolonged obstructed labor that can lead to incontinence, nerve damage, and severe social stigma. Efforts include:

• Providing technical assistance to three large private hospitals: LAMB Hospital in Dinajpur, Memorial Christian Hospital in Cox's Bazar, and Kumudini Hospital in Tangail;
• Upgrading instruments and equipment;
• Training doctors and nurses in fistula repair and postoperative care, comprehensive case management, and counseling;
• Engaging religious leaders to raise awareness of fistula prevention and repair services.

 
Promoting Maternal Health
EngenderHealth helped establish a national task force on the prevention of postpartum hemorrhage, a leading cause of maternal deaths in Bangladesh. The task force, which includes policymakers, obstetricians, gynecologists, nurses, midwives, and other partners, is revising national guidelines regarding the active management of the third stage of labor.  EngenderHealth also provides technical assistance to help improve infection prevention practices at emergency obstetric wards of regional hospitals.

 
Increasing Access to Postabortion Care Services
EngenderHealth published the first national technical standards on postabortion care in Bangladesh and developed a curriculum and manuals for health care providers. In addition to improving their own technical skills, the doctors and nurses who complete EngenderHealth’s training courses are also trained to teach others, so that even one training event can have far-reaching effects. Billboards and other media are used to promote community awareness of available services.

 
Addressing the HIV and AIDS Epidemic with Integrated Health Care
EngenderHealth works with 16 governmental ministries to integrate HIV and AIDS prevention activities into existing health plans by:

• Developing national guidelines on opportunistic infections, post-exposure prophylaxis, and HIV counseling; and
• Preparing a trainers’ manual for HIV and AIDS clinical management.