Awareness of Rural Men for Safe Motherhood: A Study on Horian Village in Rajshahi District of Bangladesh

Md. Delwar Hossain Department of Social Work, University of Rajshahi, Rajshahi-6205, Bangladesh.

ABSTRACT The aim of this paper is to investigate the awareness of rural men regarding safe motherhood. Using the information from 200 ever married males of Horian Village of Rajshahi district we found that the average age of respondents' wives at first marriage was <18 years, with the average duration time of first baby was found to be <2 and the majority of the women had their first delivery under age 20. It was found that rural men are mostly less educated and their occupation mainly agricultural based and small business. Some important indicators found that were related to safe motherhood were likely to have medical checkup or vaccination, rest of pregnant women, and regular checkup for their wives, were recorded as positive results for safe motherhood. On the other hand some negative results found from this study were respondents' educational qualification, place of delivery, types of treatment process, age of marriage, duration time to first baby. Key words: safe motherhood. Male population, awareness, pregnancy checkup, Rajshahi District.

INTRODUCTION

When the safe motherhood initiative was launched in 1987, death from the complications of pregnancy and childbirth was a little-known, seriously neglected problem. Ten years later, preventing these deaths is an international priority, and many countries have made significant progress in expanding and improving maternal health services. The global initiative has become a unique partnership of governments, donors, technical agencies, non-government organizations and women's health advocates in more than 100 countries. These partners are now working to protect the health and lives of women, especially during pregnancy and childbirth.

In Bangladesh, maternal mortality represents the end point in a lifetime experience of gender discrimination, neglect and deprivation. Its high rate also represents the failure of the health system to effectively provide services and care for women. The near absence of skills and facilities to cope with obstetric emergencies is matched by a virtual absence of strategic responses and ability of the health system to respond to the dimension of violence. Improvement of Bangladeshi women's health is not just a social and moral necessity; it is also an economic imperative. The government of Bangladesh thus envisions a fulfillment of the right to safe motherhood by all women in the country with a mission to reduce maternal mortality and morbidity and also to enhance the self-esteem and status of women.

Until now, maternal-death-rate is a matter of concern in Bangladesh. Around 20 thousand mothers have died due to the complexity of pregnancy and delivery in the country per year. Maternal death rate is four per thousand in the country. The causes of maternal death are acute bleeding after delivery (26 %), problem of high blood pressure (16 %), dangerous miscarriage (21 %), contagion/infection after child birth (11 %), obstructed childbirth (8 %), as well as poverty, illiteracy, superstition, social discrimination, malnutrition, lack of proper treatment etc. (The Daily Ittefaq, May 28, 2006).

Only 12 % of mothers go to the hospitals and health centres in Bangladesh. The number of skilled midwives is only 10 percent in the country. As a result many pregnant mothers, from various complexities during their childbirth suffer vesico-vaginal fistula (VVF).
to build awareness. So, after being aware of safe motherhood village men must be involved in every step of safe motherhood.

Importance of this study
In Bangladesh, three women die every hour of complications due to pregnancy and childbirth. These women die a silent but tragic death. This translates into one of the highest maternal mortality rates in the world. It is five times higher than Sri Lanka and Vietnam and about ten times higher than Malaysia. Since maternal mortality rate is recognized as a global indicator of the status of women in a country, it reflects clearly the status of Bangladeshi women. This study is meant to contribute to understanding rural men's awareness of Bangladesh by examining the situation prevailing in one particular area Rajshahi, Bangladesh. The questionnaire and the result that are in the survey are barely adequate for researchers regarding awareness of the rural men about safe motherhood. This study has also a great importance to find out the age of marriage, age of first child birth and place of child delivery as a determinant of safe motherhood. To see the effects of different socio-economic and demographic determinate of safe motherhood this study may play a vital role on national population policy. This study is mainly to examine rural men's awareness to improve the safety of motherhood.

DATA SOURCES AND METHODS

These data were collected from a rural area (Horian Village) of Rajshahi district, Bangladesh. From this area we have collected information of 200 ever-married males by interview method. All the information is taken by purposive sampling method and the methodology applied for this study was percentage distribution, mean, median, standard deviation and graphical representation.

RESULTS

In Bangladesh, for women in reproductive age, getting proper maternal health care services was found to be beyond their reach, which is mainly due to their poverty, illiteracy, general backwardness and adherence to superstitious beliefs, lack of awareness about safe motherhood and inadequate facilities. Most of the rural men in this study area are not aware of their wives reproductive health as well as safe motherhood. Some basic characteristics of the study population have been incorporated in Table 1, which are very much related indicators of safe motherhood.
In this study respondents means rural men who are married and most of them having children. So, their age should be 18 years or more.

Figure 1: Age of Respondents

Table 1 shows the level of age group of <25 years, 25-30 years, 30-35 years, 35-40 years and 40+ years are 8.6%, 32.9%, 15.7%, 24.3% and 18.6% respectively. It should be mentioned that the average age of respondents is 25-30 years (32.9%).

Education is the factor, which modifies the life, attitude, outlook and the status of a person as well as reproductive behavior. The education of rural men is important to ensure safe motherhood.

Table 2 has revealed that a number of village men (32.9%) acquired secondary level schooling and 24.3% to primary schooling. About 2.9% are illiterate and 18.6% can only sign their name. The rest 15.7% and 5.7% are higher secondary and higher education respectively. It is observed that the rate of total secondary and primary level education is the highest.

Bangladesh has among the lowest indicators of use of maternal health care services in the world. Around 67% of all pregnant women had no antenatal check-up throughout their whole pregnancy, (ICDDR, B, 2003).

The study has revealed that 94.3% of village men agreed that their wives should have a checkup or vaccination during their pregnancy period.

Place of birth is very important to ensure safe motherhood. In 2003 ICDDR, B, stated that around 92% of deliveries occur at home and approximately 87% of deliveries occur without the presence of a skilled attendant (ICDDR, B, 2003).

Table 4 shows about 70.0% of deliveries occur at home, 27.1% at Government, hospital and the remaining of 2.9% deliveries occur at private hospitals.

Treatment process is one of the most important indicators to ensure safe motherhood.

The study has revealed that most of the respondent's wives have taken treatment from village doctors (50.0%), about 24.3% by skilled doctors from government hospitals, 22.9% doctors from family planning centers and 2.9% homeopathy doctors, during their pregnancy period.

Family is the basic social unit and deals with the care of pregnant women. The families have important socio-economic functions and provide the basic emotional, financial and economic support necessary for proper care of mother's health. The following table shows the distribution of monthly income of the respondent's family.

Figure 2:

Table 6 presented above has revealed that the monthly income of 35.7% respondent's family is Tk. 2000-3000 and only 12.9% is above Tk. 5000. About 24.3% family's monthly income is Tk. <2000 and 10.0% is Tk. 3000-4000. About 17.1% family's monthly income is Tk. 4000-5000. It can be said that the monthly income of the majority of respondent's families is not satisfactory for care of reproductive health.

By the constitutional law of Bangladesh the minimum age at first marriage for women is 18 years and on average first age at marriage is found 20.44 years and 21.4 years in urban and rural areas, respectively (SVRS, 2002).

Table 7 stated that in the study area early marriage of respondent's wife is most frequent (77.7%) and women get married before their early eighteens. This clearly depicts that the female populations in that study area and their guardians as well as rural men are not aware of the extent of various physical and mental complications for early marriage.

Age at first birth is also a measure of proper reproductive behavior. In Bangladesh average age at first birth is 19 (BDHS, 2001). But, early pregnancy and early motherhood is commonly observed in our study area.

The study has revealed that more than 75% of married women gavehad their first birth before reaching 20 years of age that is most of the mothers are in high risk with respect to their proper physical growth of being pregnant.

CONCLUSION AND RECOMMENDATIONS

The study is related to the awareness of rural men regarding safe motherhood using primary data collected by purposive sampling method from Horian village in Rajshahi district of Bangladesh. In this study we found that the average age of respondents wife at first marriage was <18 years, average duration time of first baby was found to be <2 and the majority of the women gave their first child delivery under age 20; Which are very important considerations regarding safe motherhood.
It was found that rural men are mostly less educated and their occupation mainly agricultural based and small business. Some important indicators were found which very much related to safe motherhood like checkup or vaccination, rest of pregnancy women, regular checkup to their wives were recorded positive result for safe motherhood. On the other hand some negative result found from this study like respondents educational qualification, place of delivery, types of treatment process, age of marriage, duration time of first baby, these are very much important indicators to ensure safe motherhood.

Based on the discussion some recommendations have been suggested that would help the government and NGO's to take initiatives to promote maternal and child health care facilities.

• The results of this study indicate that there is a strong need to focus strategic measures upon the increase of health facilities, such as the THC, health clinic and FWC. Emphasis should be given to the IEC activities of the national health programme that communities, particularly the poor and uneducated women become aware of the need for regular antenatal care check up and safe deliveries by competent health personnel. Trained TBAs should be linked with the health service facility-delivery system at different levels to ensure their utilization.
  
• As most people go to TBAs and village doctors they should be given proper training and integrated into the main stream of government health intervention programmes, which should upgrade the poor maternal and child health care status existing in Bangladesh to a greater extent.
  
• Policies to expand educational opportunities, particularly for girls, would increase access to information and health services and improve their ability to make good use of it in order to lead healthier lives. Besides, it would ensure male involvement in maternal health related issues.
• To make rural men conscious of maternal health and health services during their pregnancy and during their childbirth.
  
• To create the demand for available maternal health services and to change or develop the persons who providethe health services.
  
• Taking intensive measures for the rural male regarding consciousness of safe motherhood; if needed they should be given advice, suggestions, and proper training.
  
• To give proper training and provide necessary treatment equipment to cope with the emergency situations of the pregnancy period and delivery period of the mother, to the employed doctors in the thana health complexes.
  
• To give emphasis about the age at marriage of girls/women, i. e. no women shpuld marry marriage before 18 years of age.
  
• To fulfill the need of the rural women's medical checkup on a regular basis during their pregnancy period.
  
• Increase the consciousness of the family members so that the pregnant women can get rest or keep themselves away from hard work. In this regard the family planning workers can play an effective role.
  
• To create a responsible structure in the whole medical system.

Above all, we can say that the distance of health care centre or medical facilities is the main hindrance to get proper health services for women. In these circumstances, if we can deliver the services to the doorsteps of the mass of people and decrease poverty, illiteracy, superstition, ignorance, and familial hindrance etc. then it is possible to ensure the safe motherhood and enhance women's dignity, self-esteem and status. So, a massive awareness drive should be launched at the rural level for ensuring safe and better motherhood.
Lastly no policy can be fulfilled if it does not follow from grass root to the national level. I hope this study will help the policy makers to adopt strategies to improve male knowledge regarding safe motherhood in order to reduce maternal and child mortality in Bangladesh.

REFERENCES

1. Alam, Dr. Khurshed 2000. Samaj Gobeshana Paddati (Methods in social research) Bangla medium.
2. Ahmed, S. F. Sobhan and A. Islam. 1998. Neonatal morbidity and care-seeking behavior in rural areas in Bangladesh. Operational Research Project- Health and Population Extension Division. Working Paper No. 148. Dhaka: International center for Diarrhoeal Diseases Research, Bangladesh.
3. Mitra, S.N., M. Nawab Ali, S. Islam, A.R. Cross, and T. Saha. 1994. Bangladesh Demographic and Health Survey 1993-94. Calverton, Maryland: National Institute for Population Research and Training (NIPORT), Mitra and Associates, and Macro International Inc.
4. Ahmed S, Haque I, Khuda B, Hossain M B and Alam S. 1996. Abortion in Rural Bangladesh: Evidence from the MCH-FP extension project, working paper no 121, (ICDDRB), Dhaka, Bangladesh.
5. Bangladesh Bureau of Statistic (BBS), 2002- Statistical pocket Book 2001. Dhaka, Bangladesh.
6. Bangladesh Fertility Survey, 1998. Secondary analysis, National Institute of Population Research and Training (NIPORT), Dhaka, Bangladesh.
7. United Nations Children's Fund (UNICEF). 2002. the State of the World's Children 2003, New York.
8. World Health Organization (WHO). 2001. Women's Health in South-East Asia, chapter-3, Reproductive Health, WHO, SEARO Feb 2001.
9. ICDDR, B: Centre for Health and Population Research, Annual Report, 2003.
10. BMMS: Bangladesh Maternal Mortality Survey, 2002.
11. The Daily Ittefaq, May 28, 2006.