Nancy TenBroek walks many miles on narrow, muddy roads and crosses streams on rope bridges in order to reach tribal villages in Bangladesh, where she helps train workers to care for mothers who are at risk of delivering seriously ill, low, birth-weight babies. As the health care advisor for the Christian Reformed World Relief Committee in Asia, TenBroek does this work in Netrokona, a remote northern district that government officials in Bangladesh have identified as one of 14 districts having a high child and maternal mortality rate.

Nancy TenBroek walks many miles on narrow, muddy roads and crosses streams on rope bridges in order to reach tribal villages in Bangladesh, where she helps train workers to care for mothers who are at risk of delivering seriously ill, low, birth-weight babies.

As the health care advisor for the Christian Reformed World Relief Committee in Asia, TenBroek does this work in Netrokona, a remote northern district that government officials in Bangladesh have identified as one of 14 districts having a high child and maternal mortality rate.

“These are villages where anemia is chronic, women marry at a young age, and there is low literacy. The women live on the margins and have little access to health services.” TenBroek said recently during a presentation on CRWRC’s work in Bangladesh.

Speaking to a group at Calvin College in Grand Rapids, Mich. earlier this month, TenBroek said the work requires sensitivity to the challenges that woman in these far-flung villages confront.

The women are frequently in family situations in which they have little freedom and their husbands and mothers-in-law tend to make the decisions surrounding childbirth. Often, the women deliver their children at home with little medical supervision.
“These women are all children of God and we believe it is important to reach out to them and help them in any way possible,” said TenBroek.

In Bangladesh, 120,000 newborns die each year, accounting for 55 percent of all under-five mortality. The main causes of neonatal deaths are mostly preventable, namely birth trauma, low birth weight, severe infection, and acute respiratory infection. Maternal mortality is also high, as 75 percent of births are attended by untrained birth attendants.

CRWRC works with partners in the remote communities to train traditional birth attendants and unpaid community health volunteers to assist in deliveries and to provide rudimentary health care to mothers and children, both before and after a birth. Birth attendants are also trained to refer a mother to a regional clinic or health-care facility if need be.

The benefits of breast-feeding are taught, as are methods of caring for a child who is born with an infection or who is in respiratory distress. In addition, CRWRC helps to set up emergency health-fund programs. This way money is available to lend to families in need of transporting a mother to a clinic or hospital, and to help pay for the care while there.

“In our hearts, this work is important. It is helping to create health-care equity. We see this as a moral obligation,” said Dr. Alan Talens, CRWRC’s health care specialist, during the presentation at Calvin.

Also, CRWRC has undertaken a research project with the University of Michigan’s School of Public Health to interview fathers, mothers, mothers-in-law and others in this region about current childbirth decision-making and other practices.

Will Story, a former CRWRC employee and now a doctoral student at U-M, is overseeing the research. He has gone to the area to interview several families. “We want to understand how people make decisions so that we can design interventions to reach the poor,” he said at Calvin.

Some of this will involve helping families in these remote areas to understand that some traditional views of pregnancy – such as pregnant women need to eat little food and should do hard work – are counterproductive, he said.

“We’ve realized that it is a complicated process of who should be involved in making decisions about childbirth – who catches the baby, who is in the room when the birth occurs, who decides when a woman should seek outside help,” said Story.

His research has found other challenges as well. He says that it is “shocking what some women go through to get to a hospital and then to be refused care.”

CRWRC has 18 years of experience using a “People’s Institution Model” in Bangladesh to form independent, self-sustaining community organizations to address challenges that people in those communities face. The community organizations interact and collaborate with the informal health care system (village doctors) and the public health sector (clinics).

CRWRC’s wide-ranging, maternal and child-health work, and public health work is also carried out in parts of India and Africa.

~ by Chris Meehan, CRC Communications