Among the hundreds and thousands of Rohingya refugees who have fled horrific persecution in Myanmar are some 70,000 pregnant women. As these expectant mothers linger in refugee camps in Bangladesh, a midwife named Tania Akter, with the United Nations Population Fund (UNFPA), is there to help them — to give them prenatal care, to offer family planning advice, and to ensure that their babies come safely into this world, though their lives have been overtaken by chaos.
UNFPA works across the world in disaster zones and in the countries with the highest maternal mortality rates, providing vital maternal health support, contraceptives, and medicines. Between 2017 and 2018, UNFPA distributed over 13,000 birth delivery kits, and reached more than 114 thousand women and girls with dignity and hygiene kits in Rohingya refugee camps.
In 2015, Tania was among the first midwives to graduate from Bangladesh’s three-year diploma course in midwifery, which was established in 2013 by the Bangladesh government with support from the WHO and UNFPA. The program was launched with the intention of combating high rates of maternal deaths in Bangladesh, where less than half of all deliveries are overseen by a skilled birth attendant.
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Tania now supervises other maternal healthcare providers at facilities in and around Cox’s Bazar, a port city in Bangladesh that has been flooded with Rohingya refugees. An ethnic Muslim minority, the Rohingya have suffered staggering violence and systemic rape at the hands of Myanmar’s majority Buddhist population. The UN has called the situation in Myanmar “a textbook example of ethnic cleansing.” But as Rohingya refugees surged across Bangladesh’s borders, Tania found herself caring for an especially vulnerable population of pregnant women. Here, she describes her work on the front lines of an ongoing humanitarian crisis.
(This article was lightly edited and condensed for clarity.)
Midwifery is a challenging profession in Bangladesh and also a new profession in Bangladesh. I didn’t know what my place in the community would be, how the community would receive me. But I loved taking on that challenge. As a [female health care provider], I am able to physically help other women.
There are many doctors, nurses, and other medical professions here, but midwives only provide services for pregnant women and newborn babies: ante-natal care, post-natal care and care during labor. We also provide temporary family planning methods, like condoms, oral pills and injections.
I completed a three-year midwifery course, during which time I trained in normal deliveries and emergencies; I know how to manage initial stabilization and then refer for higher medication. After finishing the course in 2015, I worked for one year as a midwife in cyclone-affected areas in Kutubdia, Bangladesh. I [then moved on to] Rohingya refugee camps: first as a midwife, now as a midwife supervisor.
Every day, I go to all the centers where the midwives provide care and I consult with them. If they have faced any problem, they can phone me, night or day. We provide 24-hour service, seven days a week.
We have 68 midwives who work with the Rohingya refugee women. The refugees give birth in our sub-centers, which have a separate room for delivery, ante-natal and post-natal care. They need more care than normal pregnant women because many of them have walked for many days to get here, and they don’t take any food. We can give them iron tablets, folic acid tablets, calcium vitamin tablets and IV saline to ease their dehydration. We also provide them with a delivery kit: two towels, soap, scissors for cord-cutting, gloves. We tell them, “Bring the kit with you when you start your delivery.” And if they can't come [to the health center for the birth], they can use the kit for infection prevention.
When I was working as a midwife at a sub-center in [the refugee camp] Balukhali last September, one mother arrived in the early morning. She had just delivered a baby girl on the way to Bangladesh, and locals took her and her baby to our sub-center. What can I say? She was so weak and so dehydrated. She and her family had walked for four days to get here, and in four days they only consumed a small amount of water and some dry foods.
After I got them settled, I took a history from the husband and he told me that all their family members were killed in Myanmar. Only he, his wife and two children were still alive in this world. He started crying. The mother was also very depressed. She told me that she has nothing in Bangladesh—no living place, no food, no shelter. I made sure they had food, and I prayed that things would be better for them.
Many of the mothers we see are young, but some have [as many as] 14 children. The teenage mothers—and especially the mothers who are having their first babies—need the most care. We counsel them on how to give birth, and we [educate] them about birth spacing.
We can also provide clinical management and psychosocial counseling to survivors of gender-based violence, though it’s not easy for victims of rape and other violence to communicate with us. They don’t want to express [their trauma]. If we see a mother or a girl who looks very depressed, we try to establish a relationship with her. And if we find out that she was raped, or her husband beat her, we can provide clinical management, psychosocial counseling and refer for higher medication or higher treatment.
As a midwife, I can say that no day is normal for me. We are always ready to provide service in any emergency, and anything can happen at any time. But this isn’t bad for us. We all enjoy it. A refugee woman is very helpless. As a girl and as a midwife, I am able to directly communicate with her, maintain her privacy and establish a relationship with her. I provide care when she needs it most.
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