Mother and child health

Mother and child health
The millennium development goals (MDGs) have been adopted by the UN, which contain a set of development activities agreed upon during a series of global conferences activities agreed upon during a series of global conferences over the preceding decade. After review & editing by the UN Secretariate, IMF, OECD and The World Bank, the objectives were published in September, 2001 as a set of 8 major goals accompanied by six considerably more specific targets and by a large number of indicators for measuring progress towards the targets.

The eight major MDGs are as follows:

1) Eradicate extreme poverty & hunger.
2) Achieve universal primary education.
3) Promote gender equality and empower women.
4) reduce child mortality.
5) Improve maternal health.
6) Combat HIV/AIDS, Malaria & other disease
7) Ensure environmental sustainability.
8) Develop a global partnership for development.

As a potential member of the UN, Bangladesh has taken comprehensive approach for achieving the development goals. Government of Bangladesh has prepared a policy document entitled a national strategy for economic growth, poverty reduction & social development which is popularly known as I-PRSP. Under this pragmatic strategy, Bangladesh is committed to achieve the following targets by the year 2015:

1) Remove poverty by eradicating hunger, chronic food insecurity & extreme destitution.

2) Reduce the number of people below the poverty line by 50%.

3) Attain universal primary education for all girls & boys of primary school age

4) Reduce infant & less than five mortality rates by two-third & eliminate gender disparity in child mortality.

5) Reduce the proportion of malnourished children under5 by 50% and eliminate gender disparity in child malnutrition.

6) Reduce maternal mortality rate by 75%

7) Ensure access of reproductive death service to all.

8) Reduce substantially, If not eliminate totally, social violence against poor and the disadvantaged groups, especially, violence against women & children and

9) Ensure disaster management & prevent environmental degradation for overcoming the persistence of deprivation.

Child Nutrition Status:

Data obtained from different rounds of child nutrition surveys conducted by BBS indicate that the child nutrition status is improving over the years. The child nutrition status of children interns of stunting, wasting & under weight has been provided in the following table-I:

Nutrition status indicators	2000	1995-96	1992	1989-90
Stunting (height for age)	49%	51%	64%	66%
Wasting (weight for height )	12%	17%	17%	15%
Under weight (weight for age)	51%	57%	68%	67%

Source: CNS, BBS

It may be mentioned that “stunting” indicates reduced linear growth compared to the expected growth in child. Wasting means a deficit in body weight compared to the expected weight indicates a deficit in body weight compared to expected weight for the same age. It is seen from the table that stunting was 66% in 1989-90 & reduced to 49% in 2000. Wasting also reduced during the period, it was 15% in 1989-90 & reduced to 12% in 2000. Underweight reduced from 67% in 1989-90 to 51% in 2000. Though the child nutrition status shows improving trend, still the current status in quite unsatisfactory $ lot of works are to done in this area to arrive at the desired level. Experts say, child malnutrition is not only due to poverty but knowledge gap of the parents for food combination of the child, id also an important factor.

Health: Health is an important indicator for determining the overall development of a nation. Bangladesh has achieved commendable success in the health sector over the past years due to introduction of effective community health care services.

Infant mortality rate: Infant mortality rate is an important indicator for assessment of the overall health & sanitation condition of country; it is observed that infant mortality reduce to great extent over the period 1991 to 2001. In 1991, it was 92 per thousand live births & reduced to 56 in 2001. In the rural area, it was 94 in 1991 & reduced to 60 in 2001, and for urban area, it reduced from 69 to 43 during the period.

Table II

Infant mortality rate 1991 & 2001

Year	Sex	National	Rural	Urban
2001	Both sexes	56%	60%	43%
1991	Both sexes	92%	94%	69%

Source: SURS, BBS, June 2009.

Considerable evidence exists that south Asian female children fare less well than male children during childhood in regards to health care, admission to hospitals & in intra-household feeding decisions. The reasons for this bias against girls are complex, & often rooted in cultural practices which create disparities in educational & outside employment opportunities. The comparative discrimination against females in health & nutrition, starting in child-hood is reflected in girls anthropometric status, the combination of the measurements of a child’s weight, height & mid-upper areas circumference with age, all provide direct evidence that girls are systematically worse off than boys.

The nutritional status of both boys & girls gets dramatically worse between 6 months & girls gets dramatically worse between 6 months & 14r of age with girls being slightly better off than boys until they reach 2 years. After these boys nutritional status starts improve. Girl’s underweight status continues to get worse until three years of age & then levels off around 74%.

Much emphasis has been placed on the role of mother’s education in increasing the health & well being of children. Clearly mother’s education has positive impact on health of all children. The promotion of “appropriate” education, which stresses the importance of the girl child, can play a key role in reducing sex differentials in morbidity & mortality.

(Helen Keller International reports)

Bangladesh is the 7^th most populous country in world with a population density just over 900 person per sq. km (PRB 2003).

The less than 5 mortality rate is 77 & infant mortality rate is 51 per 1000 live births (UNICEF-2003). These rates represent the 325000 child death occurring in Bangladesh every year. In Rajshahi division, 48% of all child death occurs during the 1^st 28 days of life & the prenatal mortality rate is 33 (DHS 99/00). The female child mortality rate is higher than male (DHS 99/00). Among the poorest quartile, 1 in 6 children dies before reaching age 5 (BBS ‘97). The major causes of child mortality are acute respiratory infections & diarrhea, which are directly attributed to 40% of child death (well scoping study, 2001). Malnutrition is the third cause of child death.

A bleaker picture exists for women’s health as maternal mortality remains high & stagnant. The national maternal mortality ratio between 377-440 per 1,00,000 live birth (BMMS 2001, DHS 99/00). An estimated 26000 maternal deaths are occurring every year in Bangladesh. Mortality levels are highest among adolescent mothers. Nearly half of maternal deaths occurred after the delivery up to two months postpartum. The main causes of maternal mortality are eclampsia, complication of abortion, bleeding & obstructed labor (BMMS 2001). Poor maternal health situation is exasperated by high levels of anemia, maternal malnutrition, gender in equalities & domestic violence. However, national studies have found only 61% of babies are protected at birth against tetanus.

In Rajshahi Division, about half (54.7%) of women received no maternal care services (antenatal care, delivery service nor post deliver care). In rajshahi Division from 1996-99 90% of deliveries took place in the home of which only 8% assisted with a trained birth attendant.

The malnutrition levels are among the most severe in the world for women & children. Just half of all children are underweight, 48% are stunted in height, and 12% are wasted (BBS & UNICEF-2002). The intergenerational cycle of malnutrition is pronounced in Bangladesh with 1/3 of all babies born with birth weight <2500g,56% of women of reproductive age have low body mass index (BMI<18.5),>

(CONCERN- World Wide)

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