Poor women, some with newborns or young children, in Bangladesh today are lucky to have access to ADB-supported primary health care centers and other health facilities in six cities across the country. Not so long ago, many of these women who live in nearby slums would not have ever imagined stepping inside a clinic—if there even was one—and if they did, probably would not have received adequate care. But things have changed for the better. As we witnessed during our visits to several project sites and urban and peri-urban areas, increased access to health care has dramatically improved maternal health in Bangladesh. The maternal mortality ratio (MMR) has dropped from 322 per 100,000 live births in 2001 to 170/100,000 in 2013. This figure, though, cannot yet lead to contentment. The country still suffers high stunting rates for girls due to malnutrition as well as inadequate knowledge about personal hygiene, and the threat of violence disproportionately affects women and girls and directly affect their overall health status. Still, the decline in MMR from 2000 to 2013 indicates progress. ADB has contributed to this through its support to the Second Urban Primary Health Care Project, a widely popular urban health program whose gender-related success is attributed to 3 actions:
- Pro-poor targeting. Since women dominate among the poor, this helps to boost access to health care for those who need it the most. We used participatory poverty assessments based on social and economic indicators to identify poor households, especially those headed by women, to be provided with free health services. We also set up effective systems with female staff in place that encouraged women patients to visit more frequently, and monitor the how households use the services.
- Working with NGOs and the private sector. This is to ensure that health care reaches the right communities in the right way. This strategy was effective in expanding healthcare coverage to poor communities, and providing employment and leadership opportunities for women in the health sector. Private voluntary organizations and secondary and tertiary public hospitals were able to provide sustainable high-quality services more effectively and efficiently.
- Gender Action Plan. Developing a project-specific plan in coordination with the local government helped identifying the constraints to women using health services and being employed in the health sector, and galvanized actions to address these obstacles.
Other ways to reach the poorest women included locating health care facilities close to poor urban households, holding courtyard meetings and providing door-to-door counseling to encourage good practices on hygiene, and infant and reproductive health. Good data management was essential for designing and implementing gender-inclusive policies and programs. All this actions contributed to reducing MMR in the project area by 41%, cutting child malnutrition by 10%, and slashing under-5 deaths by one-quarter, among other achievements.
Of course, more can be done to achieve true gender equity in health care in Bangladesh. Improving women's health isn’t just about treating mothers or future mothers. Younger women have different needs to mothers, and men also need to be drawn into the discussion about safe delivery, contraception or family matters. It would also be worth further exploring partnerships with NGOs to see if they can get more involved, particularly in promoting women's roles and decision-making powers at home and within the community. They could also be a conduit to encourage more women to take health care jobs at all levels, which may, in turn, make other women more willing to seek treatment.