MOULVIBAZAR, Bangladesh – When labor pains started for Anjana, 20, she had no idea her life was at stake. She was 36 weeks into her first pregnancy and felt contractions for a full day before her family called for the midwife. By then, she was well into an obstructed labor – a potentially fatal condition for both her and the baby.

Yet Anjana was fortunate.

Midwives, antenatal care and a full complement of safe delivery services were available, part of a recently implemented UNFPA program targeting workers at tea gardens in Moulvibazar District.

“I didn’t understand, when I felt labor pain, whether there was a problem or not,” Anjana later recounted.

The midwife saved her life by urgently sending her to the Kamalganj health complex, she said. “She arranged everything for me. When the doctor delivered the baby, they said that if I had delayed going to the hospital, my baby would have died.”

Targeting those most at risk

The workers in Bangladesh’s tea plantations – called tea gardens – are primarily women, and they are among the most impoverished and marginalized in the country. They also face some of the country’s highest rates of death from causes related to pregnancy. According to national findings from 2014, tea gardens and surrounding areas accounted for nearly 40 per cent of the district’s maternal deaths.

There are a variety of reasons for tea garden workers’ increased risks. Health services are often difficult to access due to distance and terrain. And fears among tea garden workers – including anxieties about losing their jobs due to pregnancy and motherhood – compel many to keep their pregnancies secret and forgo antenatal care.

In February 2016, UNFPA, together with the Centre for Injury Prevention and Research (CIPRB), the Government of Bangladesh and tea garden authorities, initiated a midwife-led health program in five pilot tea gardens. Five professionally trained midwives were recruited to meet the needs of women and girls.

“I am responsible for providing quality antenatal care, safe delivery services, and post-natal care,” said Sabana Begum, one of the midwives.

She and her colleagues provide care at the dispensaries operated by tea garden authorities and also visit the homes of pregnant and post-partum garden workers.

They refer complications to nearby rural hospitals, where UNFPA helps to train staff.

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