Editorial
Pitfalls of August 15
being felt even today
The bloody events of August 15, 1975 — when the then president Sheikh Mujibur Rahman was assassinated en famile along with numerous of his political allies — will stand in history books as probably the most significant constituent factor in the way the nation has been politically divided through the middle ever since.
The nation is divided, to say the least, in the way it interprets, as a tragedy or otherwise, the actions of the military men on that day — some seeing it as the moment that democracy went into demise for years to follow, others seeing it as a necessary end to an authoritarian regime that practised democracy only in its exceptions, if at all. The nation is divided in the way it holds on to the legacy of the day — some mourning the brutal murder of their father figure and turning that grief into the strength needed to regroup and revitalise their political creed, while others drawing power, quite literally, from the legacy that the young soldiers who went errant in the eyes of the law that day left behind. And not insignificant to the iconoclasm that dictates the fractious polity that is Bangladesh, the nation is divided on how it chooses to remember the man himself, Sheikh Mujibur Rahman — recalled either for the supreme leadership he provided in the final stages of the struggle for independence from Pakistan, the nine-month-long War of Independence inclusive, or for the largely despotic, undemocratic rule that he presided over in the years that immediately followed, but rarely for both.
As much of a political minefield that the return of August 15 every year proves, a few facts can be, and perhaps need to be, admitted to by both sides of the current political divide. First, that it was Sheikh Mujib’s leadership that thrust the nation to the verge of independence, and the political leadership during the 1971 war was provided, albeit it absentia, by none other than Sheikh Mujib. Many a leader — Maulana Bhasani among them — had guided the movement for independence, but it was Mujib who had taken up the baton in the latter stages of that advance, and it was his vision and oratory that brought the nation to the brink of the war that ultimately won liberation.
Be that as it may, the second fact remains that it was Sheikh Mujib himself who during his rule went contrary to one of the basic tenets of the movement for independence — multi-party democracy. As if the establishment of the paramilitary Rakhhi Bahini — deliberately created to undermine the army (which Mujib distrusted) — was not enough to arouse disgruntlement within the organs of the state and fear of extra-judicial exertions of power among the people, in decreeing one-party rule on January 21, 1975, Mujib hammered in the final nail in the coffin of democracy — going squarely against the aspirations of the millions he had himself led in their struggle for an egalitarian polity.
The fate of the military adventurers of the day has ever since been subject to power play — first in the indemnity provided to the killers, then the setting aside of the indemnity to try them, then the announcement of a verdict that is yet to run the full course of the law, hence remaining unenforceable. The shenanigans that have surrounded the Sheikh Mujib murder case, perhaps, exemplify the need for a third admission: that indeed a line needs to be drawn under the events of August 15, 1975 — if not politically then at least legally. Any extra-judicial action, murderous or not, is not only reproachable but also must be subjected to a serious scrutiny of the law and punishments handed out accordingly. This becomes more of an imperative when forceful usurpation of state power and the assassination of the country’s president, however popular or unpopular, is concerned.
One claim that the killers of Sheikh Mujib frequently hide behind is that they brought an end to one-party rule. But one of the most significant legacies of their actions was the nation reverting to military and pseudo-democratic rule for years to follow — from one party to one man. The pitfalls of that regression are being felt in Bangladesh even today.
Unsafe highways lead to
head-on collisions
A monstrous tragedy unfolded yet again on Dhaka-Chittagong Highway on Monday morning. Road accidents and other types of fatal accidents do result from human failings or any other causes and occur everyday at some part of the world or other, but that is no reason a violent road accident destructive of numerous lives should me dismissed as unavoidable contingencies. In our country, as has been seen, many accidents result from mismanagement and unconcern over road safety which were certainly avoidable. Road accidents on highways usually prove more lethal but hardly is any effort visible to strengthen road safety and minimise deaths on the roads. Those concerned (mainly traffic authorities, district administrations, R&H people) are not wise before an accident, and are no wiser even after an accident, so that fatalities keep recurring.
In Monday’s incident eight people including five school children were killed and two others were critically injured. It occurred when a bus bound for Ramgati hit a CNG-powered taxi coming from the opposite direction in an effort to overtake another vehicle, at Kumira. Owing to neglect of the railways the country is becoming overwhelmingly dependent on transportation on roads and highways. But the condition of roads and highways and traffic efficiency are not to match. To minimise accidents the highways must ensure one-way flow of traffic by placement of a road divider. This will at least prevent head-on collisions which are particularly devastating. From reports it appears that the accident occurred when the offending bus was overtaking another vehicle. The buses have a compulsion to complete their trip within the shortest time in order to maximise profit. The profit-obsessed transport owners have shown no urge to contribute to road safety.
Every mother counts
Concerted efforts from the government, private organisations and the non-governmental organisations are of paramount importance in curtailing maternal mortality and improving mother and child’s health in general, writes Sonia Kristy
The world has come a long way from the times when a woman surviving childbirth was considered to be blessed with a ‘second life’. Only a century ago, maternal mortality was much above 1,000; it has now been brought down to single digit in the developed world. However, there is a large disparity as regards maternal mortality between the developed and developing world. Maternal mortality rate in the subcontinent is one of the highest in the world while developed countries hardly consider it a threat to women’s health. In fact, it is said that every time a woman in the third world becomes pregnant her risk of dying is 200 times higher than an expectant woman’s in the developed world.
Maternal health refers to the health of women during pregnancy, childbirth and the postpartum period. Maternal morbidity and mortality occur due to lack of care and facilities during these periods. The chief causes of maternal deaths are haemorrhage, infection, high blood pressure, obstructed labour and unsafe abortion. The majority of these deaths occur in Asia (253,000 per year) and Africa (251,000 per year). The concentration is rather alarming considering that only 13 countries, mainly from these regions, account for 67 per cent of all maternal deaths. While in the United States, only 540 maternal deaths took place in 2004 (Maternal and Child Health Bureau, US), there are over 100,000 such deaths in India each month (Maternal Mortality — Indian Scenario, Surgeon Vice Admiral Punita Arora, Director General Medical Services, Indian Navy). In spite of the fact that maternal mortality has declined from nearly 574 per 1 lakh live births in the 1990 to between 320 and 400 in 2001, such deaths in Bangladesh remain one of the highest in the world (MDG Progress Report: Bangladesh).
That maternal health is a serious issue goes without saying and accordingly the high maternal mortality should be considered with due seriousness and commitment. Moreover, if Bangladesh is to achieve targets of the fifth millennium development goal, maternal mortality must be reduced from 574 deaths per 100,000 live births in 1990 to 143 by 2015, the proportion of births attended by skilled health personnel increased to 50 per cent, and the total fertility rate reduced to 2.2 per woman by 2010. In Bangladesh, maternal deaths are, more often than not, under-reported. This is so not because of a lack of clarity in defining maternal deaths, but because of an inherent weakness in healthcare facilities and socio-economic structure. According to Halida Hanum Akhter, director general of the Family Planning Association of Bangladesh, ‘Many of the factors that cause maternal death are not related only to deficiencies and poor health care. They are largely social, cultural and economic (New Age, August 6)’. The MDG Progress Report: Bangladesh also states that 14 per cent maternal deaths are caused by violence against women.
Early marriage and child bearing, child spacing, family size and fertility patterns, literacy, socio-economic status, customs and beliefs are many of the reasons of high maternal mortality in our country. In other words, this can be linked to the ‘three delay dynamics’. The first delay, arising mainly from poverty, is in seeking professional care; the second delay is logistical as most of the health centres and private clinics are located in district towns whereas majority of the population are rural based; the third delay arises from the lack of adequate human recourses and trained personnel at the service centres. A large segment of expecting mothers in Bangladesh does not get the required care during pregnancy in terms of sufficient and nutritious food, rest and medical care. Delivery is usually attended by traditional birth attendants (dhais) instead of skilled birth attendants. Majority of the expecting mothers, especially those in their teens suffer from acute malnutrition and various other ailments as some 45 per cent of all mothers are malnourished (MDG Progress Report: Bangladesh). As a result, they give birth to underweight babies. That not many mothers get extra nourishment, family care and timely health advice is evident from the fact that still today 320 mothers per 100,000 live births die either while giving birth or within 42 days of termination of pregnancy (World Health Organisation).
One of the main causes of Bangladesh’s vulnerable maternal health condition is early marriage and early child bearing. In our country, we still continue to marry off girls even at the age of 13/14 even though the Child Marriage Restraint Act 1948 prohibits such practice. According to a worldwide research on child-and early-marriage by UNICEF, Bangladesh has one of the highest percentages of marriage among girls before 18 years of age. Early marriage, especially in rural areas, could not be contained mainly because of extreme poverty of the parents and their failure to provide security to the daughters. In urban areas especially in slums, girls are also married off at a very early age due to the same reasons. According to government statistics, about 5 per cent of the girls falling within 10-14 years and 4 per cent within the 15-18 years age group are married off in Bangladesh. With early marriage occurs early pregnancy. At such young age, these girls are in no way prepared, either physically or mentally, for pregnancy. According to a WHO survey, nearly half the adolescent girls (15-19 years) who are married, 57 per cent become mothers before the age of 19, and half are acutely malnourished. Thus mortality among adolescent mothers is typically 30-50 per cent higher than the national rates.
The risks of early pregnancy and childbirth include high risk of death, premature labour, complications during delivery, low birth-weight, and a higher chance that the newborn will not survive. When an unhealthy teenage mother gives birth to a child the newborn usually turns out to be of a low weight baby, which again puts at risk the lives of both the mother and the child. If we are to improve maternal mortality and women’s health condition in general, early marriage must be contained. This primitive practice cannot be allowed to continue for this is directly linked to general status of maternal health. By marrying off a girl at an early age, we not only deny her proper physical and mental growth but curtail her personal freedom as well. Early marriage also exposes adolescents to the risk of higher fertility leading to rise in population. Because of early pregnancy, nearly 800,000 girls suffer from disabilities caused by complications during pregnancy and childbirth each year. ‘Pregnancy related deaths are the leading cause of mortality for 15-19 year old girls worldwide and at present Bangladesh has the world’s highest rate of maternal mortality which is 4.5 per 1,000 live births. The risks of early pregnancy and child birth not only increases the risk of the mother dying of premature labour but it also creates complications during delivery and the chance of the newborn’s survival becomes exceedingly slim,’ says Dr Parveen Sultana, a gynaecologist at Bangabandhu Sheikh Mujib Medical Hospital.
Improving women’s health requires a strong and sustained government commitment, a favourable policy environment, and well-targeted resources. The government’s strategy should include balancing the roles of the public and private sectors to maximise resources and to extend care to women who do not have reasonable access to the normal public services i.e. women in rural and remote areas. The challenge for the government is to help direct and improve privately provided services through appropriate regulatory arrangements and by encouraging an expansion of their scope to include promotion and prevention, in addition to curative care. Concerted efforts from the government, private organisations and the non-governmental organisations are of paramount importance in curtailing maternal mortality and improving mother and child’s health in general. The efforts should include allocation of sufficient funds to all the health institutions including primary health centres. More important is to ensure that the funds actually reach the users. Local dhais and female health workers should be imparted periodic training and be incorporated as integral parts of the health care system. Health education of couples to make them understand the importance of antenatal check ups, hospital deliveries and family norms should also be made mandatory. Facilities should be provided for hospital deliveries for high risk cases like severe anaemia, diabetes and heart disease. Prevention and early treatment of infection, antepartum and postpartum haemorrhage would decrease maternal mortality significantly. Another issue that needs to be taken care of is unsafe abortion, which continues to be a major health hazard in our country. According to a health ministry publication on ‘National Reproductive Health Strategy’, 21 per cent maternal deaths are caused by abortion (New Age, May 28, 2006). Although Bangladesh is one of the countries that allows abortion, efforts must be initiated to prevent unsafe abortion and increase contraceptive choices and access, and comprehensive post-abortion care of good quality.
The World Health Organisation’s theme for 2005 was, ‘every mother counts’. Each and every mother certainly needs to be treated with special care as they are the ones who give birth to the future generation. It is for the sake of our own that we need to take care of the mothers and provide them with all sorts of facilities. Only then can we expect a nation of healthy and happy citizens.
MAIN PAGE | TOP
|
|
