As Bangladesh female health workers strengthened family planning | Kenneth R White

Community health workers, Salma one-acter, interviewed mothers in MATLAB data input at the research centre health to be compiled. Photo: Kenneth R. Weiss
§ Wearing sandals and draped in dark blue Sari, Aparajita Chakraborty slides into the Hill houses cluster with the confidence of someone who has long made home visits.
She has. For more than 30 years, Chakraborty was advice visit this family, to do checkups and dispensing equipment. But she is not a doctor, community health of workers has been sent by the local hospital. Still, she has won the trust and gratitude of the surrounding villages to save lives - especially from cholera and other deadly diarrhoeal diseases.
With all the men removed either in the rice paddies or emigrated to the city work Chakraborty, down connection half a dozen houses to the business in the family fast. She and a colleague guide a group interview asked four women personal questions like: when you menstruate last? They are taking the pill, or through any other method of family planning?
A woman explains that they the pill to take ceased when her husband worked in Chittagong, a day's journey away. She took their use of contraception immediately after his surprise visit. Until then, it was too late, and she is now expecting her third child.
Another woman says that she used any form of contraception. Her husband turns out, had a vasectomy after her fourth child. But he wants to know his brothers, not out of fear, they think him impotent. It is a secret, if documented the hospital staff, along with every birth, death, marriage, divorce and other vital statistics of 225,000 people in the region has.
Chakraborty know more intimate details about the community than they know about each other. But discretion is of the utmost importance, she says: "I'm, what I hear. "I feel like I'm part of the family."
It is part of an all-female team of health care workers, this portion of Bangladesh low-lying delta, span carefully one maintain the longest and most detailed health and population records in the developing countries.
The MATLAB hospital, the Chakraborty shipped has grown extensively since 1963, when it was started as a cholera research station on a barge close to Dhaka. The institution was from the International Centre for diarrhoeal disease research, Bangladesh set up.
Half a century later, this hub for child and maternal health is widely credit attributed to demonstrate how poor Muslim women with little or no formal education can plan their families. The approach has settled this tight, impoverished themselves country spread out on its rapid population growth.
In the year 2000 which was UN saying that Bangladesh is 160 million strong population would rise to 265 million by the year 2050. Recent forecasts show that the numbers on something likely to rise more than 200 million by mid-century before soon after stabilization.
"Matlab the way shown us", says Ubaidur Rob, non-profit population of Council of Bangladesh Director. "Women were in the 1970s, as fertility was very high and employment of women was almost zero as a sales representative. This is where change began."
Good chronological achievements MATLAB something of a Mecca for public health have made researchers. First, many of the rural outposts were attracted because regularly it suffered cholera epidemics. Now is the lure of the detailed population and health data bank which health can reproduce the success or failure of a drug study or intervention.
Decided in the mid-1970s the family planning advocates was this an ideal place to test, whether poor, poorly educated accept women in a religiously conservative area, the use of contraceptives. To set up the experiment, researchers have divided into two groups 149 villages. Half took maternal and child health initiatives, including home delivery of modern contraceptives, in the MATLAB Observatory while the other had only access to government services.
The municipalities were identical: poor fishing and farming families live in bamboo houses in the villages with little or even no electricity, running water or sewage. Most had dirt floors and cooked on fire wood, cow dung and rice chaff.
The area was 88% Muslims and Islamic clerics denounced contraception. Purdah - the women out of the House, practiced most households only if they covered "correctly" and accompanied by a male relative.
Researchers quickly learned, it was not enough just to contraceptive methods available, says Dr. Mohammad Yunus, the MATLAB Central ran for nearly 40 years. What works, he says, was a comprehensive door service with trained female health workers, regular follow up visits to help mothers, choose a method of contraception that it was best to handle side effects and offer basic maternal and child healthcare.
Differences emerged immediately. Married women were more likely to use contraceptives, and in the course of time were on average 1.5 of fewer children than their counterparts in the comparison area. Their children were healthier, fewer women died from pregnancy-related causes and toppled.
These families grew even more prosperous. With fewer children, support parents accumulated built more arable land, valuable houses and were given access to running water. Their children stayed in school longer, and women enjoyed higher incomes.
The results of the proposed family planning was a cost-effective way to improve public health and to help people out of poverty free, said health experts. And it showed that municipalities not to wealthier or better educated before the birth rate can - fall if contraception in a suitable manner will be made available.
Work programme of the MATLAB Observatory attracted the attention of government officials, who decided it roll-out in two areas. MATLAB Government employees trained in the door-to-door approach. In the early 1980s the areas a similar increase had experienced the contraceptive use, and set the Government on the training of tens of thousands of female workers with the MATLAB model.
"In the next five years it was introduced throughout the country", says Yunus. "Bangladesh has been a success story for family planning and reducing infant mortality."
Since average birth rate have to slightly more than two fell from six children of a woman, and Bangladesh has become one of the first impoverished countries to meet two-thirds of the UN Millennium development goal of reducing child mortality.
• Ken Weiss writes about science, environment and health for the LA Times, and elsewhere. A grant from the Pulitzer Center crisis reporting supports research for this article

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