Contents

Abstract ..................................................................................................................................... 2
Introduction ............................................................................................................................... 3
Objective .................................................................................................................................... 4
Execution Summary.................................................................................................................... 5
Description of clinic: ................................................................................................................... 6
Name of Selected Local Clinic: .................................................................................................... 6
Urban Primary Health Care Services Delivery Project-Phase 2(UPHCSDP-2): Local Government
Division ...................................................................................................................................... 7
Observation of Safe motherhood components in Nagar Matrisadan(CRHCC), Shimantic
Partnership Area-5:Women Health Clinic ................................................................................... 8
1. Antenatal Care (ANC) as a component of safe motherhood in Nagar Matrisadan(CRHCC),
Shimantic Partnership Area-5 ................................................................................................. 8
As per as WHO FANC model is given below: ........................................................................... 9
Awaring about 5 Danger signs during Pregnancy ....................................................................13
2.Delivery Phase Observation in Nogor Matrisadan Clinic for A Safe Motherhood.......................14
3.Obstetric Care ........................................................................................................................15
4.Post Arbortal Care (PAC) .......................................................................................................16
5.Control of AIDS/HIV/STI as a Component of Safe Motherhood................................................18
6.Postnatal Care(PNC) Services in Nagar Matrisadan Clinic for Safe Motherhood .......................18
Facilities from the Women Health Clinic ....................................................................................19
Mental Health Care or Psychological Support.............................................................................20
Recommendations......................................................................................................................20
Conclusion.................................................................................................................................21
Abstract

Safe motherhood involves all the women receiving proper care or services and information they need
during their pregnancy period.The 6 pillars of safe motherhood include Antenatal Care(ANC),
Delivery,Obstetric Care,Post Abortal Care(PAC),Postnatal Care (PNC),Control of STI/HIV/AIDS.In this
primary healthcare clinic,the doctors or healthworkers tend to help their pregnant patients through their
primary healthcare services or instruments.In case of any obstetric complications or urgent issues,they
refer to Dhaka Medical Hospital or any other places.As a project for urban people,slum area's people are
benefitted.At their 30% free services,they help helpless mothers graetly who can't afford minimum wages
of healthcare services.The motto of this project is to reduce maternal and neonatal mortality and
morbidity. In recent times, the mortality and morbidity has reduced sharply. During this Covid-19,it was a
challenge to combat Coronavirus and ensure safe motherhood .

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Introduction
Safe Motherhood refers to all women access the service and information they require to safe and healthy
during pregnancy and childbirth.Six components of safe motherhood involves family planning, antenatal
care, obstetric care, post natal care, post arbortal care and control of STI/HIV/AIDS.Millenium
Development Goal-4:To improve maternal health,safe motherhood is the strategy that ensures all pregnant
women can receive their necessary services from their local clinic or health care provider s.In
Bangladesh,both governmental and non-governmental organizations are working hard for the betterment
of materna health.They are doing so by promoting and preventing activities .They also addresses factors
that lead to dealth during pregnancy, childbirth and post-partum.The goal of Safe Motherhood is to reduce
maternal and neonatal morbidity and mortality.

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Objective

● To know the purpose of the selected clinic's services providing for a safe motherhood
● To observe Antenatal Care(ANC)
● To observe delivery of a pregnant women
● To observe Postnatal Care(PNC)
● To observe obstetric care
● To observe post arbortal care
● To know how they control HIV/STI/AIDS
● To learn about the tendency of women in receiving provided services during their pregnancy
● To discuss the facilities for the unpreviliged pregnant women
● To know the percentage of free services to helpless women for their safe motherhood.

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Execution Summary
In order to get permission for conducting our feildwork in Nagar Matrisadan, Shimantic Partnership Area-
5,I went to Nagar Bhaban located on Fulbaria,Gulistan,Dhaka.I was asked to seek permission from Deputy
Director of UPHCSDP-2.And also in this whole process Md. Tanvir Hossain, Senior Program Officer(BCC
& Research),a kind soul,helped me a lot and my 3 classmetes too.Next I also got permission from
Dr.Sharmin Mizan, Program Officer (SD).At last,I got permission from A.F. Md. Alauddin Khan, Deputy
Director(SD) and assigned me to conduct my feildwork in their selected are.An e-mail was to Program
Manager of Shimantic PA-5.Finally,I and my partners ware successful.

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Description of clinic:

Name of Selected Local Clinic:

Nagar Matrisadan,Shimantic DSCC Partnership Area(PA)-5;According to permission from Project
Director of Urban Primary Health Care Services Delivery Project-Phase2(UPHCSDP-2),Dhaka North
City Corporation (DNCC).

Picture: Nagar Matrisadan, Shimantic Partnership Area-5, Women Health Complex.

Location: Opposite to Tilpapara Jame Masjid,Gaosia Selestika,Plot-A,Road no.-8,Block-A,Dhaka-1219.

Address of PA Headquarters:325,South Goran,Khilgaon,Dhaka-1219
Project Manager:Dr.
Structure:
E-mail:dsccpa05sm@gmail.com
Structure: There were medical officers,clinic manager, pediatrician as well as health workers.
Activities:All kinds of services included in safe motherhood(Antenatal Care,Delivery,Post Arbortal Care,
Obstetric Care,Postnatal Care,Control of STI/AIDS/HIV)
Project Duration:From 2012-to2023

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Urban Primary Health Care Services Delivery Project-Phase 2(UPHCSDP-2):
Local Government Division

This project is administered by the Ministry of Local Government Rural Development & Co-
operatives.
About 18 services are provided in this project, on the basis of the national expanded Essential Services
Delivery (ESD+) package of the government:

1. Antenatal Care
2. Delivery Care (NVD & CS)
3. Postnatal Care
4. Menstrual Regulation
5. Post Abortion Care
6. Family Planning Services
7. Neonatal Care
8. Child Health Care
9. Reproductive Health Care
10. Adolescent Health Care
11. Nutrition
12. Communicable Disease Control
13. Non-Communicable Diseases Control
14. Limited Curative Care
15. Behavior Change Communication
16. Diagnostic Service
17. Violence against Women
18. Emergency Transportation Service.

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 Picture: Urban Primary Health Care Services Delivery Project-phase 2

Observation of Safe motherhood components in Nagar Matrisadan(CRHCC), Shimantic

Partnership Area-5:Women Health Clinic

1. Antenatal Care (ANC) as a component of safe motherhood in Nagar Matrisadan(CRHCC),

Shimantic Partnership Area-5

● Registration: Firstly, a pregnant mother is welcomed and registered for her appointments and
facilities if she is eligible.
● Check-ups or Antenatal Appointments:
During pregnancy,as a part of Antenatal Care(ANC),in that clinic a pregnant mother is offered for frequent
and routined visits.The table below showing the time and purpose of the check-up.

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 Picture: Routined Check-up

As per as WHO FANC model is given below:

Phase of Pregnancy Visits

1st trimester Visit 1:(8-12) weeks

2nd trimester Visit 2:(24-26) weeks

3rd trimester Visit 3:32 weeks

Before Delivery Visit 4:(34-38) weeks

● Ultrasound Scans:
Cost:500 tk/-
In that Nogor Matrisodon clinic,I found Ultrasound Scans services providing to the coming pregnant
mother.
● A female doctor was in the duty of that section.

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 ● There was a ultrasound monitor and a bed to take ultrasound Scans for the lying mother.
Doctor in the duty helps mother learn about her child by analysing the ultrasound scans showing in that
monitor.

● History:
Doctor takes history of that seeking mother about her previous pregnancy history.In that case,the doctor
told us ,she asked her patient for
● Aclamsia
● Preaclamsia

● Physical Examination:
Doctor or health worker primarily exmines pregnant mother for ensure her safe pregnancy.
● Weight Gain:
A mother during his pregnancy period gains extra weight at least 10kg and it is normal.
If the mother don't gain weight properly,it is abnormal.
● So,Doctor always checks her pregnant patient's weight as a very important issue.
● Blood Pressure:
Doctor or health workers also take pregnant women's blood pressure whether it is normal or high or low.
● Normal blood pressure ensures a safety pregnancy.
● Eyesight:
● Doctor or healthworkers examine pregnant mother's eyesight.
● It is necessary to check their eyesight.

● Diagnostic or Pathological Examination:

For both pregnant women and general people,there are pathological tests facilities which is at reasonable
cost.Such as
● Pregnancy test
● Blood sugar
● Urine test
● Haemoglobin test
● Serum bilirubin
● Stool test
● Hepatitis-B test
● Cholesterol test

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● VDRL

Picture: Pathological services

● T.T. Vaccination:
● Pregnant mother to get T.T. vaccine during she is 6 months pregnant.
● If pregnant mother already has vaccinated by 5doses of T.T also she can get booster dose.
● If not 5 doses,1 dose at 6 months and the other at 7 months is provided to that pregnant mother.

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 Picture: Some Remarks during ANC, Delivery and PNC period.

● HaveReferring to Medical Hospital:

As this Nagar Matrisadan is a primary health care service,so it can't afford some urgent or serious
conditions.
In this state,Doctor refer her patients to Dhaka Medical Hospital or other healthcare institutes.

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Awaring about 5 Danger signs during Pregnancy
● Severe Fever
● Bleeding
● Delayed Delivery (More than 12hours pain)
● Convulsions
● Headache & blur vision

Picture:5 Danger Signs during pregnancy

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2.Delivery Phase Observation in Nogor Matrisadan Clinic for A Safe
Motherhood
● Normal Delivery: If a pregnant mother is in her normal pregnancy situation, then normal
delivery will be for her.
Cost: Cost is 1,200 tk. which is not much comparing to any other healthcare sectors.
● Delivery Scissoring: In case of any urgent condition, A pregnant patient is offered to get her
delivery scissoring.
Cost: Cost is 12,000 which is also reasonable for the welfare of mother and child.
● Delivery Planning & Preparation: Pregnant women's family members are asked to get some
savings for their child.

Picture: Delivery Planning & Preparation

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3.Obstetric Care
►A pregnant patient is asked primarily whether she has a history of-
● Anaemia
● Eclampsia
● Pre-eclampsia
● Previous pregnancy complications
● Abortion complication
►Emergency Obstetric Care(EmOC) components:
● Admistration of Anesthesia
● Administration of intravenous fluid
● Using a vacuum extractor or forceps
● Removal of Placenta
● Removing the products of conception following a miscarriage and abortion
● Clean and wash of Delivery wastages
►Comprehensive Emergency Obstetric Care(CmOC):
● Perform cesarian sections to delivery a baby
● Giving blood transfusion

As it's services are limited to primary healthcare,so the doctors help the patients in any obstetric
complications by referring to Dhaka Medical Hospital or any others.

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4.Post Arbortal Care (PAC)
The doctor as well as breifly described how they manage to provide post abortion care.
● Post Abortion Care (Medical Treatment): If any treatment is necessary.
● Post Abortion Care (Pack Service): If it is necessary.
● D & C: If it is necessary
● Avoiding unexpected pregnancy: To avoid any unwanted pregnancy, couples are suggested take
contraceptive methods such as-injection,pills,condoms,ligation.

Picture: Elements of Post Arbortal Care(PAC)

● Pregnancy gap:Couples are offered to have a gap after their first baby.

● Suggesting contraceptive methods:Health worker or counselor counsel the couples who seek
contraceptive so.
Family Planning:Women who come to take Antenatal Care, they are asked to take family
planning methods such as contraceptive
Short-termed:
For women:Pills, Injection
For men:Condoms
Long-termed:
For women:IUD, Implant

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 Permanent:
For women:Ligation
For men:Vesectomy
● Emergency Abortion for Congenital Anomalies: Fetus without head or brain(Anencephaly) in
2021,2019 were found in ultrasound scans and brought into emergency abortion.

Picture: Contraceptive Methods

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 ● Counselling Adolescents:In discussion with Doctor,many adolescent take emergency pills or
unprescribed medicine to avoid unwanted pregnancy that lead to death in early ages even.So,
counselling is the best way to aware them.

5.Control of AIDS/HIV/STI as a Component of Safe Motherhood

In my discussion with doctor,she tole me some issues which is increasing recently in this generation or in
this morern time and how they try to combat them.
● Counselling Adolescents :Many Adolescents are in the highly risk of HIV/AIDS/STI.
● Creating Awareness:To not to involve in any unsafe intercourse .
● Moral Values:They try to educate them.
● Sex Education:They try their best to given unaware people sex education.

6.Postnatal Care(PNC) Services in Nagar Matrisadan Clinic for Safe

Motherhood
● Check-Ups: Follow up check regularly.
● Postnatal Family Planning: Couples are offered postnatal family planning methods.

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 Picture: Postnatal Family Planning Discussion.

● Kangaroo Mothering: Infant's

● Breastfeeding Corner:For privacy of mother,there was a breastfeeding Corner.

Facilities from the Women Health Clinic

This is a project from City Corporation
for the people who can't afford healthcare services.So,here are some facilities for the welfare of these
helpless people.

# 30% mother can get their healthcare services free of cost:

● Mother who can't afford minimum cost of healthcare services,they can easily take their primary
healthcare services for free.
● They have the opportunity to get their ultrasound scans.

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 ● They get their check-up without any visit cost.
● In any complication,they get suggestions from doctors.
● They can do their diagnostic examination for free.
#They get many supplements for free-iron
● #Emergency Ambulance:
This primary healthcare service provider Nagar Matrisadan always have preparation for any obstetric
complications or further risky serious issues.
Here 2 Ambulances are ready for the serious pregnant patient's.

● During COVID-19:During COVID-19,it was a challenge to ensure safe motherhood and combat
Coronavirus.
● Free supplements: Vitamin-A,Iron tablets
● Free vaccination:T.T.,MR
● Free test:Via test

Mental Health Care or Psychological Support

The most neglected issue but the most important is pregnant mother's mental or psychological state.Often
arrangements with family members or mother-in-laws or husbands to counsel them about mental health of
their pregnat family member.
Sex Revelation often creates problems.Doctors try their best to sort out that kinds of problems.

Recommendations
● Increase manpower to serve in safe motherhood
● More space

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Conclusion
Safe Motherhood is the way to fulfill MDG-4, in order to improve maternal health. Moreover, mother
who are going through their pregnancy period should have priorities to any other cohorts in our
community. Therefore, many projects of both governmental and non-governmental organizational have
been launched to serve the helpless pregnant mother who are a big part of our population. Finally, for the
welfare of our next generation, we have to increase manpower dedicated to serve for safe motherhood.

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