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Though the number of children who die before age 5 has declined significantly in the last two decades, the path to ending child mortality is long and hard to navigate. Nearly 7 million young children still die yearly, largely from preventable causes. What works and what doesn’t in the fight against child mortality? What will it take to go the last mile, and end preventable child deaths?  

Defying the odds: Bangladesh makes strides in child health

Counter to the common perception of Bangladesh as hopelessly impoverished, the country has dramatically reduced overall child mortality in recent decades.


EDITOR’S NOTE: This article is part of a GlobalPost Special Report titled “Step by Step,” about the many challenges faced worldwide in an effort to reduce child mortality. In the coming months, GlobalPost will examine this issue around the world. The project is supported through a partnership with the Henry J. Kaiser Family Foundation as part of its U.S. Global Health Policy program.


DHAKA, Bangladesh — When Hashi Akhter delivered her baby on a January morning in her thatched home in Dergram Village, she knew something was wrong right away. The baby was not crying.

She couldn’t breathe. Hashi had already been in labor much of the night. As morning broke, a relative went on foot to find a health worker near this remote village more than two hours north of Dhaka, Bangladesh’s capital.

“The mother told me, ‘You saved my child.’ Now she loves me very much.”
~Shefali Akhter

That decision saved the baby’s life. Shefali Akhter, a 24-year-old government health assistant, is also a skilled birth attendant with special training on neonatal asphyxia, one of the largest killers of newborns in Bangladesh. (Shefali has no relation to Hashi.)

Shefali quickly cleared mucus and fluids from the baby’s mouth so that she could take her first breath in the “golden minute,” the small window of time in which decisions can mean the difference between life and death.

Shefali learned last year to treat asphyxia by clearing airways with a tiny plastic face mask, air bag, and suction device. She was part of a program called Helping Babies Breathe, an international collaboration with the American Academy of Pediatrics, the American aid agency USAID, Save the Children, the Laerdal Foundation of Norway, and others. The program has trained 20,000 skilled birth attendants in Bangladesh alone.

Counter to the common perception of Bangladesh as hopelessly impoverished, the country has made dramatic strides in reducing overall child mortality in recent decades. Bangladesh is on track to achieve Millennium Development Goals (MDGs) 4 and 5, which aim to reduce under-5 child and maternal mortality, respectively. In fact, Bangladesh is one of only eight countries to have reduced its under-5 mortality rate by at least two-thirds since 1990. 

In Bangladesh, deaths of children under age 5 decreased from 139 per 1,000 live births in 1990 to 46 in 2011. Compare that to 1970, when Bangladesh’s under-5 mortality rate was 239. Maternal deaths have also plummeted, from 800 per 100,000 live births in 1990 to 240 in 2010.

Bangladesh’s child and maternal health statistics are better than those in India, where the economy and resources far exceed those of its poorer neighbor to the East. How has Bangladesh come so far, and what are the challenges that remain?

In this upcoming GlobalPost Special Report, titled “The Seven Million,” correspondents in Africa and Asia will examine the progress and challenges that developing countries face as they fight to reduce deaths of the nearly seven million children under age 5 who die every year, largely due to preventable causes.

Laying the Groundwork

On a hot spring afternoon three months after the dramatic birth in Dergram, the 30-year-old mother, Hashi Akhter, lifts her healthy baby, Babli, from a bed occupying most of the one-room home. The girl yawns, eyes still shut mid-nap. Hashi eagerly welcomes the health assistant inside, and soon neighbors and children crowd under the corrugated metal roof to ogle the visitors.

Shefali, the health assistant, recalls: “If I was not present, perhaps the child wouldn’t survive. The mother told me, ‘You saved my child.’ Now she loves me very much.”

To keep more children like Babli alive and well, Bangladesh is focusing on programs like Helping Babies Breathe, launched in 2011. These programs aim to train more skilled birth attendants, spread prenatal and postnatal advice, and persuade women to give birth in clinics or hospitals rather than at home, where more than 70 percent of deliveries take place.

Newborns are particularly at risk in Bangladesh. For children under 5, 60 percent of deaths occur in the first 28 days of life. Most of those deaths are caused by infections, asphyxia, and low-birth weight.

But progress on child health has accelerated here in recent years. Kazal Begum, Hashi’s 50-something-year-old aunt, grimaces when remembering that in her day, women either had a normal birth without complications or died. A mother of four, Begum says her children were not vaccinated as infants. But things have changed dramatically within a generation. Child immunization coverage for diphtheria, whooping cough, and tetanus has reached 96 percent. In 2012 Bangladesh won an award for its outstanding work from Geneva-based Global Alliance for Vaccines and Immunization. There have been other changes too, including better awareness of hygiene and nutrition.