The Marie Stopes Clinic Society (MSCS), part of
the Marie Stopes International Partnership,
was established in 1988 in Chittagong,
Bangladesh, to provide sexual and
reproductive health care and education. Since it
began, MSCS has grown to include 23
comprehensive health clinics throughout the
nation and an additional 46 "mini-centers" in
urban slums. MSCS offerings include family
planning education and services; ante- and
post-natal care; female sterilization;
vasectomy; primary health care; youth
services; prevention, diagnosis, and
treatment of sexually transmitted infections;
and STI/HIV/AIDS awareness-raising
initiatives.
As the population and
reproductive health indicators in the box
suggest, MSCS’s education and services are
needed. Bangladesh’s population growth and
total fertility rates remain high, despite an
increase in the use of contraceptives from 45
percent in 1994 to 54 percent in 2000 (60).
Infant and maternal mortality also pose a
challenge, as do other reproductive health
problems.
MSCS recognizes that
poverty causes poor sexual and reproductive
health, and vice versa. Therefore the
organization seeks to reach the very poor, who
are most in need of services. Tanya Huq
Shahriar, Knowledge and Social Development
Manager of MSCS, reports: "Around 80,000
clients per month come to our clinics and
mini-centers. They are urban poor and
vulnerable. This includes the homeless, young
people and women of slums and shanty towns,
sex workers, drug users, men having sex with
men, factory workers, etc."
Dr. Yasmin Ahmed, Managing
Director of MSCS, says: "We have developed
several innovative programs to reach and
serve. We hope these programs will reach the
poorest of the poor. There are many obstacles
to reaching them, but the first challenge is
to identify them. This is not easy. There is
so much to consider, and not all is obvious
to the outsider."
Identifying the Very
Poor
International and national
definitions of poverty often fall short of
identifying those most in need of care,
because they do not take situational nuances
and circumstances into consideration. For
example, income conventionally has been used
as a measure of poverty, and households
falling beneath a certain threshold level
have been considered poor. Yet a family may
have an income level higher than the defined
threshold but be pushed into poverty by other
factors, such as a large number of dependents
or a major illness in the family. Thus a more
holistic approach is needed to identify very
poor households. Determining which factors
should be taken into consideration is a
difficult task. Dr. Ahmed, Ms. Shahriar, and
their team designed a strategy in which they
turned to the poor for
answers.
Ahmed explains: "When it
comes to extreme poverty in slums, it varies
so much and there is no one criterion which
you can use to measure. So we looked at the
research. Some sources use income, some use
household access. Each was right in its own
way, but none captured the whole spectrum of
poverty. That is why we decided to go back to
the community and actually ask them to grade
their own poverty."
BANGLADESH:
POPULATION AND REPRODUCTIVE HEALTH
INDICATORS
Total population,
2004
. . . . . . . . . . . . . . . . .
. . . . . . . . . . 149.7 million
Projected population, 2050
. . . . . . . . . . . . . . . . .
. . . . . 254.6 million
Life expectancy (male/female)
. . . . . . . . . . . . . . . .
61.0 / 61.8 years
Contraceptive prevalence: any method
. . . . . . . . . . . . . 54
percent
Contraceptive prevalence: modern
methods
. . . . . . . . . 43
percent
Births per 1,000 women ages
15-49
. . . . . . . . 117
per 1,000 women
Maternal mortality ratio
. . . . . . . . . . . . . 380 per
100,000 live births
Infant mortality
rate
. . . . . . . . . . . . . . . . .
. . . 64 per 1,000 live births
Average annual population growth rate,
2000-2005
. . 2.0
percent
Total fertility rate, 2000-2005
. . . . . . . . . . . . . . . . .
. . . 3.46 children
Births with skilled attendants
. . . . . . . . . . . . . . . . .
. . . . 12 percent
Health expenditures, public
. . . . . . . . . . . . . . . 1.5
percent of GNP
Source: UNFPA,
2004
Participatory Knowledge
Development
Those closest to a
situation generally have the richest and most relevant
knowledge. Ahmed points out: "We used volunteers who were
actually members from the same slum. We said, ‘You go ahead
and grade households according to whatever you think would be
the criteria. Just remember to note why you categorized each
household as you did.’ We sent our volunteers out … to all the
houses in the slums. They categorized them into four groups.
Then we had a debriefing session with
them.
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