Married at 14, Sunita gave birth to her first baby at home two years later, assisted by a traditional birth attendant who had no formal training. It was the only way Sunita, now 20, knew since she had never visited a hospital in her life.
The closest contact she ever had with modern health care was when occasional satellite clinics set up in the tea garden areas. While a smart strategy to meet people where they are, the workplace clinics were insufficiently equipped to provide care to all workers. And since they were intermittent, the clinics were not always on site when people needed care. Such as when Sunita experienced a miscarriage soon after the birth of her first baby.
In 2020, Sunita was several months into her second pregnancy when she had a chance meeting with midwife Rujina Khatun. Rujina was enjoying a recreational visit to Burburiya Tea Garden, Sreemangal, in the Moulvibazar district.
Though tea gardens look picturesque, with lush green fields and stunning sunsets, the plantations are harsh places to live and work, with average labor rates of less than a dollar a day. Literacy levels are low among workers. Sanitation and access to health care are poor.
Even in these most remote areas of Bangladesh—and even during their days off work—Jhpiego-trained midwives like Rujina are saving lives, improving health and transforming the futures of women and their families.
Sunita’s frail appearance moved Rujina to interrupt her outing in the gardens and inquire about the woman’s health. Learning that the undernourished young mother was three months pregnant, the midwife talked with her about free health services available at the Sreemangal Upazila Health Complex where she worked.
Rujina, 26, is trained to provide comprehensive midwifery care for women. Though she’s assigned to a labor ward and has performed 1,500 deliveries, her duties go well beyond the ward. In fact, since attending a 12-day pre-pandemic training in postpartum family planning (PPFP) implemented by Jhpiego—which she says “gave a new dimension to my job”—she is regarded as a “PPFP Champion.”
Identifying and celebrating providers who demonstrate exceptional family planning service provision is an innovative initiative of the Accelerating Access to Postpartum Family Planning project in Bangladesh. The project aims to improve health outcomes among vulnerable women and their children through increased access to quality PPFP services and strengthened capacity of PPFP providers and facilities. Supported by a private philanthropy, the project builds on existing commitments by the Government of Bangladesh and others to scale up PPFP, with a focus on select underserved areas of districts in Dhaka, Chittagong and Sylhet.
Clearly, the strategy has inspired and motivated Rujina to ensure that counseling for family planning is part of every antenatal and postnatal visit. Even chance visits like the one she initiated with Sunita at the tea garden are important. Rujina was able to convince the young mother that she—and her unborn baby—would benefit from regular check-ups at her facility.
When Sunita went into labor, Rujina helped her to deliver a healthy baby girl at the hospital. The midwife also counseled her about family planning, and provided a postpartum intrauterine contraceptive device when Sunita chose that option.
At the Upazila Health Complex, where there are 100–120 deliveries per month, the expanded suite of contraceptive options now available means that postpartum women have greater choice if they want to space and time their pregnancies. Many of Rujina’s clients return home with some method of family planning, whether they choose a short-term method or, like Sunita, protection for the long term. The midwife provides, on average, five postpartum intrauterine devices every month. Rujina is proud of the fact that her facility sometimes even outperforms the district hospital in the number of new mothers counseled in PPFP and array of methods offered, according to an analysis of program data.
Sunita was happy to learn the contraceptive method she chose was safe and effective, allowing her to prevent another unintended pregnancy for up to 10 years.
“I do not want to have another child,” says Sunita, holding her now 5-month-old baby girl. “I want my two children to be healthy and also try to take care of myself for the sake of my family. I do not have any problem after taking the [family planning] method.
“I am happy with my life now. ”
Tajrian Chowdhury is a communications specialist, Jhpiego Bangladesh. Mohammad Rashedul Haque, district manager, and Tanvir Uz Zaman, former technical officer, also contributed to this story.