Sylhet Division, Bangladesh—Halima Begum, 25, lives in a remote village of Habiganj. Married with two children, Halima’s life looks typical of the women in her region; however, her outlook and recent decisions have proven extraordinary.
Five years ago, Halima had her first baby at home with the help of an untrained traditional birth attendant. With no nearby facilities available for delivery and no antenatal care, Halima was afraid during labor. She remembers the attendant gave her baby boy a bath immediately after birth and, because Halima was not informed about the importance of exclusive breastfeeding, she and her family introduced complementary foods (fruit, cow’s milk, and rice) before her son was six months old. She never had postnatal counseling of any kind—including discussions about birth spacing and options for family planning.
After her son’s birth, Halima’s husband, Din Islam, left the village for a few years in search of work. At the same time, the MaMoni Project1—a USAID award to the Maternal and Child Health Integrated Program (MCHIP) that provides integrated safe motherhood, newborn care, family planning, and nutrition services—opened its doors in her neighborhood. Her friends and relatives joined community action groups and became community volunteers. The MaMoni Project’s community health workers (CHWs) visited her house regularly and provided counseling on all family planning methods. As a result, Halima knew what contraceptive services were available and, when her husband returned to the village, began receiving injectable contraceptives.
The MaMoni Project in Habiganj works with approximately 7,000 community volunteers and support groups, 41 CHWs, and 37 paramedics linked with health centers of various types to improve the quality of maternal and newborn health care and family planning services. The Project aims to close critical gaps in the health system and build the capacity of relevant workforce at the district and national levels.
When Halima’s son turned three, she conceived again, and she recognized the benefits of this unintentional, but optimal, birth spacing: “I am lucky that my husband was away for a year after the birth of our first baby, because I would have been pregnant not much later.” During her second pregnancy, she received antenatal care and followed the advice of the family welfare visitor. Because Sajangram Village is located in a very remote part of Habiganj, Halima decided to deliver at home again. However, this time a CHW provided postnatal counseling and encouraged Halima and Din to opt for a long-acting family planning method.
Sabrina Chowdhury, the CHW who helped Halima after her second delivery, has done the same for nearly 1,200 area families. She provides counseling on family planning, as well as how to improve the overall health of the whole family.
Thanks to Sabrina’s counseling, Halima practiced the Lactational Amenorrhea Method (LAM) as her initial postpartum method of family planning. LAM is an effective method of contraception for women with children under six months of age who are exclusively breastfeeding and have not yet seen their menses return.
After exclusively breastfeeding her new baby girl for three months, Halima and Din visited the Upazila Health Complex (UHC), where Halima underwent a tubal ligation, a permanent method of family planning.
Halima’s husband, Din, reflected on his own life and his and Halima’s choice of family planning: “I have five brothers and a sister, and we all suffered the consequences of having no education and proper care given our socioeconomic status. I want to keep my own family size small and provide the best I can for my children.”
********** 1 The MaMoni Project is implemented by Save the Children in Bangladesh and two local nongovernmental organizations, Shimantik and Friends in Village Development Bangladesh (FIVDB), in collaboration with the Bangladesh Ministry of Health and Family Welfare.