As in countries around the world, Bangladesh’s entire health system is heavily occupied in meeting the rising demand of health services for COVID-19 patients, and continuing to provide emergency medical services.  There is also a decline in demand in seeking health care services from general patients, fearing exposure to COVID-19.  The question remains—what should expectant mothers do in such a scenario?  Do they still go to healthcare centers for their check-ups and deliveries?

Since the beginning of the COVID-19 pandemic, the number of mothers visiting healthcare centers started declining, from an average of 100 antenatal care, 30 deliveries, and 40 postnatal care services per month.  In April, these numbers decreased by nearly 50 percent.  This is mostly because they had no direction on what to do.  Service providers themselves were not yet ready to prepare their facilities and follow the measures required to continue maternal and newborn care services safely.  However,they did not have time to pause.  Midwives, paramedics, nurses, and doctors in public facilities all around the country soon took steps to be able to continue their services.

Many midwives came up with their own initiatives to encourage women and their families to visit healthcare centers.  Some even went further by making one-on-one telephone calls for follow-up check-ups.  Others engaged local elected members or government bodies to raise awareness regarding their service centers being open and their safety measures taken.

In Lakshmipur, four midwives are assigned to the Ramgonj Upazila Health Complex.  One of them, Kazol Rani Paul, has been working there for the past 17 years.  Starting her career as a nurse, she trained to become a certified midwife offering antenatal, normal delivery, postnatal, family planning, and newborn care services.  Kazol has never experienced a pandemic like this one, where she feared for her own life as well as that of her patients.

When health officials reported COVID-19 positive patients, residents were panic-stricken and overwhelmed by movement restrictions and worries about losing their jobs and a steady income.  Despite their families’ concerns for their lives, Kazol and three other midwives stayed back in their workstation and continued to offer services.  

In mid-2020, Kazol performed a complicated case of child delivery on an apprehensive 19-year-old mother who did not want to come to the health center fearing that she may get the COVID-19 virus.  The expecting mother gradually calmed down when she entered the center and saw that sufficient health safety measures were in place, including hand washing stations  with soap and water at the entrance and indoors and hand sanitizers for patients and service providers in check-up and labor rooms which are used frequently during physical investigation.  The center also supplies masks for women going into labor and personal protection equipment (PPE) for health care providers.  Kazol gave a mask to this mother and followed all hygiene protocols as she accompanied the young patient to the delivery room and wash area.  Wearing PPE, Kazol helped the baby receive skin-to-skin care from the mother, including breastfeeding within the first crucial hour after birth.  Hearing about how well Kazol handled the situation, other women who needed health services felt confident enough to visit the center. 

“We take all the precautions handling every patient so that at least they feel safe and comfortable with our continued services,” said Kazol, recognizing that patients and health care staff are concerned about the pandemic and pay attention to hygiene.  “There is so much work to be done here, there is no time to pause now; life does not take a pause.  Every birth matters, every life matters,” she added.  “We are midwives, and this is our job.”

Kazol’s Upazila Health Complex generally provides an average of 100 antenatal care visits, 30 deliveries, and 40 postnatal care services each month, but the number of services provided in April was about half.  But Kazol remains hopeful, as the visits and services have started increasing after USAID-funded Maternal and Newborn Care Strengthening Project mobilized local resources to ensure that the health facility has required safety measures to keep health professionals and their patients safe during COVID-19.  With this support, the USAID-funded project helped prepare them to tackle the pandemic situation while continuing essential healthcare services. 

Fear of COVID-19 is high, as is the number of preventable maternal deaths in Bangladesh.  As a frontline health professional, Kazol believes it is now her duty to fight these two health challenges together.  She counsels patients with information to prevent COVID-19 and ensure a safe motherhood experience for all.