The Historical Development of the Midwifery Profession in Bangladesh

Sexual and reproductive health and rights have been identified as the core areas of practice, theory and research for the midwifery profession. The midwifery profession, as defined by the International Confederation of Midwives Global Standards, is new in Bangladesh. This paper aims to give an overview of the historical process that has taken place in the past decades to develop the midwifery profession in Bangladesh. The professional development of midwives is the result of many years of collaboration and relationship building among stakeholders such as the government, non-government organizations, academia, professional associations, United Nations agencies, and donors. All are working toward achieving the common goal of preventing/ reducing maternal and child mortality through education, the development of supportive laws, policies and guidelines, and the deployment of midwives. Lessons learnt from the Bangladesh experience can provide useful guidance for other countries in Asia that are currently establishing midwifery as a profession that aims to provide safe and high quality sexual, reproductive, maternal and newborn care

Building a new generation of midwifery faculty members in Bangladesh

This paper presents an initiative to build a new generation of midwifery faculty in Bangladesh, with the ultimate objective of providing insight into how to build capacity in the midwifery faculty to best utilize the existing academic, health care and policy environment. The initiative focuses on a promising approach that starts with a new generation of midwifery faculty who can lead a chain of change when separating midwifery teaching from nursing. The initiative identified four different interdependent components of equal importance, namely the initiation of master’s and bachelor’s degrees, development of accreditation guidelines and tools, and a mentorship programme. Building a new generation of midwifery faculty has the potential, despite challenges, to enhance retention, foster greater commitment for the institutions, increase research and contribute to the attainment of national goals

Floods and maternal healthcare utilisation in Bangladesh

Published online: 06 September 2022Floods are a common natural hazard in Bangladesh, and climate change is expected to further increase flooding frequency, magnitude and extent. Pregnant women in flood contexts could face challenges in utilisation of maternal healthcare. The aim of this paper is to analyse associations between flood exposure and the use of maternal healthcare (antenatal care visits, birth assisted by skilled birth attendants, and giving birth in a health facility) in Bangladesh for pregnancies/births between 2004 and 2018. Bangladesh Demographic and Health Survey data from four surveys in the time period 2007–2018 and data on floods from the Emergency Events Database and the Geocoded Disasters Dataset are analysed using multilevel linear probability models. In line with previous results, we find clear bivariate associations between exposure to flooding and maternal healthcare use. These associations are largely confounded by socioeconomic and demographic variables. In general, exposure to flooding — whether measured as exposure to any floods or severe floods — does not affect maternal healthcare use, and we suggest that the lower usage of maternal healthcare in areas exposed to flooding rather relates to the characteristics of the flood-prone areas and their populations, which also relate to lower maternal healthcare use. However, we find negative associations in some supplementary analyses, which suggest that even if there is no effect of floods on average, specific floods may have negative effects on maternal healthcare use.This article was published Open Access with the support from the EUI Library through the CRUI - Springer Transformative Agreement (2020-2024

Saving Lives of Mothers and Babies. An Assessment on Nurse-Midwives´ Knowledge in Bangladesh.

Introduction: Two women die every hour due to pregnancy and childbirth related complications in Bangladesh. It is well known that a strong midwifery profession is the key to achieving safer childbirth and it is the right of every woman to have access to a fully trained midwife and to a safe delivery. However this is not the case in Bangladesh. Today, the existing nurse-midwives are not fully utilized for the midwifery services. The profession is mal-distributed, functioning as multi-purpose service provider and are not recognized as a separate cadre of midwives. In relation to develop a six month additional Midwifery training for these nurse-midwives, it was therefore essential to get a better understanding about their current knowledge in the field of midwifery. Aim: The aim of this study was to assess the knowledge of the nurse-midwives providing midwifery services in twelve different health facilities in Bangladesh. Methodology: This baseline study was conducted at twelve different health facilities in Bangladesh, using a questionnaire adapted from Johns Hopkins University (JHPIEGO), Maternal Health Programs, Guidelines for Assessment of skilled providers and modified into the context of Bangladesh. It was a total of 38 respondents attending the survey and data was compiled and analyzed manually. Result: The assessment showed that the respondents had a vast gap in their knowledge of basic midwifery skills. The findings showed that the majority of them had a significantly low score of knowledge related to antenatal care, normal labour, and management of complications, childbirth and immediate newborn care as well as in post partum care. Discussion: The study demonstrated that the midwifery knowledge of the respondents did not fulfil the International standards based on International Confederation of Midwives (ICM) competencies. However, not only further training is needed, they need to be posted in a maternity unit to maintain their skills so therefore, creations of separate Midwifery posts are crucia

Buildning a midwifery profession in South Asia

Midwives are key professionals in improving maternal and child health globally, but establishing a midwifery profession in low-income countries is proving to be difficult. The overall aim of this thesis was to explore the situation and building of a midwifery profession in South Asia, and to reveal how influential actors are connected to one another in the building of a profession, especially in Nepal and Bangladesh. A mixed-methods approach was applied, combining qualitative and quantitative methods to gather and analyse data. Study I involved data collected through three questionnaires with closed- and open-ended questions, constructed by the International Confederation of Midwives (ICM) and the United Nations Population Fund (UNFPA) Investing in Midwives Programme, used at a regional workshop in Bangladesh. Study II comprised a review of policy documents; semi-structured interviews; and structured observations of competence and equipment at university colleges and hospital maternity departments in Nepal, building of the ICM’s Global Standards, and JHPIEGO’s (Johns Hopkins Program for International Education in Gynecology and Obstetrics) site assessment tool for maternal and newborn programmes. The two last studies used a Complex Adaptive Systems approach to explore how actors representing the establishment of a midwifery profession in Nepal (Study III) and Bangladesh (Study IV) connected to one another in this establishment. Data were collected through semi-structured interviews with 17 actors in Nepal (Study III) and 16 actors in Bangladesh (Study IV). The analyses were descriptive statistics and content analysis (Studies I and II), and qualitative analysis (Studies III and IV). The results showed that none of the six countries in South Asia had obtained full jurisdiction for the midwifery profession to autonomously work within its full scope of practice (Study I). In Nepal it was feasible to establish a midwifery profession separate from the nursing profession, and the study delivered a proposed strategy to support this (Study II). The actors’ connections for the establishment of a midwifery profession in Nepal can be described with a complex set of facilitators for and barriers to promoting the establishment of a midwifery profession. A driving force for collaboration was that they had a common goal to work towards reducing the country’s maternal and child mortality. The main opposing factors were different political interests and priorities, competing interests from the nursing profession, and divergent academic opinions on a midwifery profession (Study III). In Bangladesh, the system actors for promoting the establishment of a midwifery profession connected through a common goal to reduce maternal and child mortality and morbidity in the country. To achieve this goal, actors contributed their unique competence, which resulted in curriculum development and faculty development plans. A main challenge the collaboration faced were the different interests and priorities influenced by individual philosophies versus organisational mandate (Study IV). The conclusion of this thesis is that a fundamental step in establishing a midwifery profession with professional status and formal control of the profession and its work requires a comprehensive approach. It is acknowledged that focusing on education alone is not enough to establish a midwifery profession. Support for building educational infrastructure, resources, and regulation systems are also required to establish the midwife as a separate profession that can meet the needs of women and children. A prerequisite for ensuring that midwives can meet the needs of women and children is that the profession is aligned with national policies, and that midwifery strategies are in place to guide the establishment forward. Such an approach will require close connection among all involved actors in terms of their ability to collaborate and utilise each other’s unique competence to achieve results

Midwifery Education, Reulation and Association in six South Asian countries - A descriptive study

Background: Countries in South Asia continue to have high maternal and newborn mortality rates. Midwifery has been broadly acknowledged as an evidence-based response to improving maternal and newborn health outcomes. Education, regulation and the establishment of an association are regarded as the foundation of strong and effective midwifery profession. Objective: The objective was to describe the situation of midwifery education, regulation and professional associations in six countries in South Asia. Methods: Data were collected via three questionnaires, constructed by the International Confederation of Midwives (ICM) and United Nations Population Fund (UNFPA) Investing in Midwives Programme, used at a Regional workshop in Bangladesh, 2010. The questionnaires included both closed and open-ended questions, and 55 out of 134 were selected for the purpose of this study. The data were analyzed with descriptive statistics and the open ended answers with a qualitative content analysis. Results: There was a variation in midwifery education across South Asia, in terms of entry level, competencies and requirements for teachers. None of the countries had national legislation that recognized midwifery as an autonomous profession. Four of the countries had a midwifery association. Main recommendations for improving formal midwifery education across the countries were: development of legislation, strengthened formal midwifery education, strengthened professional value, and an improved learning environment. Conclusion: South Asian countries in this study are working hard and have made some progress towards international standards. However, midwifery is not yet recognized as an autonomous profession. Only Afghanistan and Bangladesh had a curriculum based on ICM´s basic competencies. With further assistance, the area of South Asia will be able to create a midwifery workforce that complies with ICM’s global standards for midwifery education and regulation in order to provide high quality, evidence-based health service for women, newborn and childbearing families