Migration and Maternal Health: BRAC's experience in delivering Maternal, Neonatal and Child Health services in slums of urban Bangladesh

Purpose Despite Bangladesh’s significant improvement in maternal and child health status over the past few decades, the situation still remains very poor, especially in the compromised socio-economic condition of urban... [ view full abstract ]

Purpose
Despite Bangladesh’s significant improvement in maternal and child health status over the past few decades, the situation still remains very poor, especially in the compromised socio-economic condition of urban slums. One of the major challenges in improving this situation is the highly mobile slum dynamic due to rapid urbanization and migration. BRAC has undertaken a unique health programme since 2007, known as Manoshi, to improve maternal, neonatal and child health care in the challenging context of urban slums of Bangladesh. This paper attempts to review the existing situation of delivering maternal health services like pregnancy identification, and antenatal and postnatal care visits by community health workers in Manoshi working areas with respect to migration.
Method
Data was extracted from the Management and Information System of Manoshi. Community Health Workers collect this data monthly, BRAC management analyzes it and Quality Assurance Team regularly validates it.
In Manoshi, Community Health Workers provide scheduled household level services that include pregnancy identification, antenatal care and postnatal care. In 2014, they identified 47%, 39% and 14% pregnancies in first, second and third trimester respectively (n=191,631)among the non-migrant women. Whereas, they identified 75% of the pregnant migrants in third trimester, 23% in second trimester and only 2% in first trimester (n=8,331). Still, they are increasingly providing 4 or more antenatal care visits (from 26.7% in 2007 to 81% in 2014) and are providing almost 100% postnatal care visits to the delivered mothers within 48 hours of delivery.
Conclusion
Delay in pregnancy identification increases the chance of missing high risk pregnancies and timely management resulting disability and death. Therefore, we need to reinforce Manoshi intervention through intensified and innovative efforts to identify all pregnancies and ensure proper health care. Besides, government should also strengthen its policy to address migration and minimize its negative impact on health.