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Farida Begum, at her 25, gave birth to her second baby boy seven months ago at her home. She did not go to any healthcare facility during her pregnancy and post-pregnancy period and does not know the weight of her baby yet.
“My mother-in-law told me that the baby would become sick if I take him to the hospital to measure his weight,” she said.
Like Farida, the majority of pregnant women in Palashbari upazila under Gaibandha district refrain from visiting hospitals during their pregnancy period, are deprived of nutritious food and resort to many superstitions that led to them giving birth to low weight babies. None of these mothers are aware of the weight of their children.
According to data provided by the Civil Surgeon’s Office of Gaibandha, 395 deliveries took place in Palashbari Upazila Health Complex in 2020. Of them, 300 infants were born with low weight, which is 76 per cent of total birth at the hospital.
This is almost three times higher than the national average and five times higher than the global average in low weight birth.
According to World Health Organization (WHO), national prevalence of low weight birth was 27.8 per cent and global prevalence was 14.6 per cent in 2015. The prevalence of low birth weight is 17.3 per cent in Asia, and in Southern Asia, it is 26.4 per cent.
“Many people are living under the poverty line in the district, where 31 per cent of the landmass is char. Health workers face difficulties to go to these remote areas leading to an increase in the number of low weight birth,” said Gaibandha Civil Surgeon Dr AM Akhtaruzzaman.
“The government is trying to overcome the situation and we are on the right track. If the government and non-government organisations work together, we will get a positive result soon,” he said.
“There are 22 ministries involved with the nutrition sector. All these ministries are taking initiatives to achieve the goal, especially in achieving Sustainable Development Goals (SDGs),” he added.
Non-government organisation Gana Unnayan Kendra Chief Executive M Abdus Salam blamed crop patterns in the area for being partly responsible for malnutrition.
“Non-food crop portion is very high here. Now the effort from government and non-government organisations is at its peak. We are also working with farmers to make their homestead a source of nutrition by growing fruits and vegetables,” he said.
Reasons behind low birth weight and its consequences
According to WHO, when a baby is born weighing less than 5.5 pounds or 2500 gram it is considered as low weight birth. Low birth weight infants are about 20 times more likely to die than healthy infants, the global agency said.
“A baby can be born with low weight for many reasons, but the main reason will be malnutrition. Vegetables, fruits, protein everything is needed in proper combination to give birth to a healthy baby,” Khaleda Islam, professor and director of the Institute of Nutrition and Food Science of Dhaka University, told The Business Post.
“Babies are born with low weight due to lack of proper antenatal care, lack of proper nutrition and mental or physical stress of a mother before and during pregnancy. Some babies are born low weight due to genetic reasons,” Dr Shohela Akhter, associate professor at the Department of Paediatrics of Bangabandhu Sheikh Mujib Medical University (BSMMU), said.
“Low weight birth is the biggest reason for infant and neonatal death. Low weight babies will suffer from pneumonia, breathing problems, repeated infections and other complications. They are born with immature organs, which leads to stunting and restrict physical and mental growth,” she said.
According to WHO, in per 1,000 live birth, 19 neonatal deaths and 25 infant deaths occur in Bangladesh.
The infant mortality rate is the number of children that die under one year of age in a given year, per 1,000 live births and neonatal mortality rate is the number of children who die under the age of 28 days in a given year, per 1,000 live births.
“11 per cent of neonatal death occurs due to low weight birth,” Bangladesh National Strategy for Maternal Health said.
Of 395 deliveries, 10 babies were born dead in Palashbari Upazila Health Complex.
According to Bangladesh National Nutrition Council, in Gaibandha District, 39 per cent of pregnant women did not attend at least one antenatal care during the pregnancy period, 46 per cent did not initiate breastfeeding within one hour of birth, 29 per cent of children aged under five is underweight. The stunting rate of the district is also higher than the national and regional average.
Superstitions playing a vital role
Rupa Akter 18, from Katuli village of Kishwargari union of Palashbari, is in eight months of her pregnancy. She never went to any healthcare centre in the last eight months.
“Elderly people of my family and community told me not to eat duck, eggs, mrigal carp fish, hilsha, fry fish, great snakehead, brinjal, and some other vegetables during pregnancy. I am obeying their suggestions. I believe what they are saying, they are saying it from their experiences,” Rupa told The Business Post.
“If we eat less the size of the baby will be small, which will reduce our pain during delivery,” said Farida Begum from Katuli village.
Like Rupa and Farida, the majority of pregnant women believe in these superstitions. The Business Post interviewed 18 mothers in Katuli village. Of them, only three went to the hospital during pregnancy and after giving birth.
Crops need to be diversified
According to the Agriculture Extension Office of Gaibandha, the district had 326,205 hectares of arable land in 2019-20. Of them, vegetables were cultivated only in around 11,962 hectares, which is 3.66 per cent of total arable land. Only 730 hectares of land were used for growing vegetables in Palashbari district in Rabi crops season.
“Huge area of Gaibandha district is char area. Farmers cultivate mostly nuts and pulses and that is one season. Integrated farming is needed there, where sheep and duck can be grown with the crop to meet protein demand along with vitamin,” Dr Md Akteruzzaman, professor at the Department of Agricultural Economics of Bangladesh Agriculture University, said.
“The most useful task will be homestead gardening. If the households use whatever space they have to cultivate vegetables and fruits, people will get adequate vitamins. That can meet the target of SDG of Zero hunger, ensure sustainable consumption and production pattern, and ensure good health” Akteruzzaman added.
“We need to develop crop and vegetable varieties which will contain zinc, beta carotene and other nutrition in food,” he added.
Gaibandha DAE Deputy Director and Gaibandha Agriculture Officer Masudur Rahman claimed that the district is self-sufficient in cereal crop production, but still lags behind others in vegetable production.
“The government also put emphasis on agriculture and food security. We are especially putting emphasis on fruits and vegetable cultivation at the homestead. The district will achieve SDGs on time,” he said,
Officials pointed out that 400 gram per capita fruit and vegetable intake is the standard but the district’s per capita fruits and vegetable consumption is 354 grams. As per FAO recommendation, per capita 35-gram sugar intake is needed every day. The district’s sugar consumption is three grams per day.
The poverty rate is high
The poverty rate is 47 per cent in Gaibandha according to the household income and expenditure survey of 2016. So it is tough to buy vegetables from the market, which comes from other parts of the country.
“We eat meat once a year. We can afford fish only for several days,” Nasima Akter, 25, who just gave birth to a baby, said.
Nasima’s husband is an agricultural labourer. Describing the poverty situation of her family she said, “We cannot eat many things due to poverty.”
“This area of the country is suffering from malnutrition and poverty for decades. Poverty and remoteness is the factor here for achieving success,” Gana Unnayan Kendra’s Abdus Salam told The Business Post.
