A Ripple Effect for Women in Bangladesh

Jennifer Wilen didn’t think twice about eating papaya and banana slices from the same plates used by dais, Bangladeshi traditional birth attendants, considered at the bottom of the social strata in that country.

Then she met eyes with one of the dais, who stared back at her, incredulously.

“My son won’t even drink from a cup I’ve used,” the woman told their translator.  

That was just one of the eye-opening experiences that Wilen, who graduated last year from the ETP and Nurse Midwifery programs, encountered last fall during her month-long project in the Southeast Asian nation. Wilen and Laura Zeidenstein, DNP, director of the Nurse Midwifery Program at CUSON, spent four weeks in Bangladesh investigating ways to reduce maternal death during childbirth, a clinical project funded by a pilot grant from The Center for Children and Families, spearheaded by the center’s director, Mary Byrne, PhD. The project was a collaboration between CUSON and Gonoshasthaya Kendra (GK), a healthcare NGO in Bangladesh.

Although the maternal mortality rate (MMR) in Bangladesh has halved in a decade, it still stands at 240 deaths per 100,000 births in 2010, according to the World Health Organization. By contrast, in the U.S., the MMR in 2010 was 12.7 deaths per 100,000 births, according to the CDC.

To address this issue, Zeidenstein and Wilen spent the month stationed at GK’s Savar Hospital, in a suburb of the capital city Dhaka, conducting educational workshops for GK’s paramedics — healthcare workers trained by the NGO who deliver comprehensive services to patients across the country — as well as to the traditional birth attendants (TBAs) who deliver more than 80 percent of Bangladeshi babies in the home. TBAs in Bangladesh are typically middle aged, poor village women.

Both groups covered topics including newborn care, the mechanisms of labor, maternal positioning, and the physiology of the placenta.

“It was really interesting for us to learn about their cultural beliefs and practices that may influence birth outcomes,” said Zeidenstein. “For example, blood, particularly placenta, is considered unclean, which contributes to the TBAs low status in society.”

Wilen agreed: “The TBAs are considered lowlier than sewer workers,” she said. “But they don’t feel bad about their status and are proud of taking care of women during childbirth, which is considered a sacred event in this Muslim culture,” she added.

The other key component of the project involved Wilen and Zeidenstein conducting videotaped interviews of the TBAs to capture their stories for ethnographic research. They accomplished this task, something that has never been done before, with Nasrin Siraj, an anthropologist and interpreter.

“These women were thrilled to be interviewed,” said Zeidenstein. “It made them feel respected for this vitally important job they do.”

Zeidenstein was first invited to Dhaka by GK in 2011 to work with TBAs in collaboration with CUSON. She had an existing relationship with the clinic and the country: As a teenager, her father, George Zeidenstein, headed the Ford Foundation’s first program in newly-independent Bangladesh and the Zeidensteins lived in Dhaka for several years in the 1970s. She still speaks conversational Bengla, and has maintained close friendships with people there for four decades.

After the Program Director’s 2011 trip, she invited Wilen, who was then her student, to return to the country for the independent study project.  

“Jennifer entered the midwifery program with a strong global perspective, already aware of the similarities of women’s status in developing countries around the world,” said Zeidenstein.

Prior to entering CUSON, Wilen’s international experience included starting a family planning program and training TBAs as a Peace Corps Volunteer in Burkina Faso, creating an adolescent health program in two Burmese refugee camps along the Thai-Burmese border as a Global Health Fellow, and serving as a Program Officer for Africa for the International Women’s Health Coalition.

Despite her extensive global experience, Wilen, who earned a Master’s of Science in Public Health in Developing Countries from the London School of Hygiene and Tropical Medicine, did not realize the extent of the challenges facing women in Bangladesh — and for Western women who came there to work.  

“Of all the places I’ve been to, this atmosphere was the most difficult for women,” said Wilen, who explained that it is not customary for women in Bangladesh to move freely outside of their home. “There were no women vendors in shops.  The streets were vacant of any women, except for the occasional female walking behind a man with her head down.”  

Still, despite the challenges they faced, namely, severe restriction of movement outside of the safety of the GK compound, the two women believe their project has not only improved maternal outcomes in Bangladesh, but also positively impacted the lives of the TBAs. 

Zeidenstein and Wilen are committed to continuing the project, and Zeidenstein is exploring funding sources to resume their trainings and interviews with the dais, as well as evaluate the project’s impact on improving MMRs.

Already, Zeidenstein and Wilen instinctively know their work made a qualitative difference.

“The first step was to let the TBAs tell their stories,” said Wilen, who graduated from CUSON last December and works as a midwife at Woodhull Hospital in Brooklyn.

“By talking to these women, we allowed them to realize that we both do the same thing—attend births. They realized that not only did we have things to teach them; they had things to teach us.  That was so powerful,” said Wilen.

“Overnight we might not see changes in their status or in mother’s outcomes, but these changes have a ripple effect—they start small and grow into something big.”