Bangladesh expands training of midwives to improve maternal and neonatal health

June 2014

When midwifery lecturer Farida Yesmin arrived at a hospital in south-west Bangladesh, she was expecting to teach student midwives. She ended up saving a baby’s life.

Diploma of Midwifery students doing a role play on a mother’s 3rd visit to  a clinic, Khulna Nursing Institute, Bangladesh. April 2014

“I wanted to see the maternity ward. A woman who had just given birth was really ill and the only nurse on duty was busy looking after her. Support staff told me her baby had died,” said Farida.

Seeing the apparently lifeless baby on the resuscitation table, Farida checked and detected a faint pulse. “I cleared the baby’s airways and began CPR. I kept doing this for 30 minutes until we could get him to the newborn intensive care unit where he began to breathe on his own,” she said.

The baby and his mother, Khadiza, were lucky that Farida, who had received World Health Organization training to teach midwifery, happened to be there. Bangladesh has a severe shortage of trained midwives. Nationally, just 32% of women are looked after by a skilled attendant while giving birth.

Training strategy

Bangladesh has made great progress in reducing the infant mortality rate and on improving maternal health as part of the Millennium Development Goals. For example, the maternal mortality ratio was halved between 2000 and 2013. But for every 100 000 live births 170 women still die, and 24 of every 1000 newborn babies don’t survive their first month.

To improve this situation and fill gaps in maternal and neonatal health provision, the Government of Bangladesh, supported by WHO and the UN Population Fund (UNFPA), is aiming to train 3000 midwives by 2015.

This strategy is composed of:

  • A 6-month advanced midwifery certificate to expand the skills of existing health workers known as nurse-midwives, running since 2010.
  • A 3-year direct entry diploma in midwifery, launched nationwide in December 2012.
  • Training to ensure there are enough experienced midwives qualified to teach the certificate and diploma courses.

Bangladesh’s midwifery education has been developed with technical and financial assistance from WHO and UNFPA to ensure it is targeted, effective, and in line with international standards.

Crucial for care

Diploma of Midwifery students doing a role play on a mother’s 3rd visit to  a clinic, Khulna Nursing Institute, Bangladesh. April 2014.

To date, 710 students have graduated from the certificate programme and a further 397 were due to complete their 6-month training in May 2014. Across Bangladesh, some 1225 students are enrolled in the diploma course, and the first group will graduate in 2015.

“These new midwives are going to play a crucial role in improving the advice and care given to women during pregnancy, birth and postpartum, and it is vital they are deployed where they can have maximum effect,” said Dr Khaled Hassan, WHO Acting Representative to Bangladesh.

“The challenge is also to ensure there are enough teachers with the right skills to keep developing the quantity and quality of midwives in Bangladesh. That’s why WHO is so engaged with the Bangladesh authorities on this,” he added.

For Farida, her experience that day in the hospital translated into her teaching. “Having done it for real, I now teach neonatal CPR with real confidence,” she said.

A day after taking Farida’s class, two of her students saw a baby struggling to breathe. “My students followed what I had taught them. After 10 minutes the baby was breathing normally,” she said.