3 in 4 Rohingya refugee babies are born in unsanitary bamboo shelters

COX’S BAZAR, June 3 – An estimated 75 percent of Rohingya babies are born in the unsafe and unsanitary bamboo shelters in which refugees live, based on an assessment by Save the Children. Home births in such conditions put the lives of both mother and baby at great risk. Save the Children is warning that hundreds of mothers and babies in the refugee camps could die this year of entirely preventable causes, if mothers don’t get proper maternal healthcare.

Data from Save the Children’s Primary Health Care Centre (PHCC) from July 2018 to April 2019 shows that of the expected 400 births in a community of some 20,000 people[1], only 119 babies were safely delivered in Save the Children’s properly-equipped health facility, with the remaining births taking place at home.

Save the Children’s assessment comes as the UNFPA (United Nations Population Fund) and CDC (Center for Disease Control) jointly release new data from the Rohingya refugee camps, which estimates that for every 100,000 live births, 179 mothers die from preventable causes related to pregnancy and childbirth – almost two and half times higher than the worldwide target for maternal mortality of under 70 per 100,000 live births[2].

Worryingly, The UNFPA/CDC study also found that half of all maternal deaths in the camps happen at home. This means mothers received no emergency care which could have been life-saving. Save the Children has heard anecdotally that some families don’t seek out care during pregnancy complications because they fear sterilization or infanticide based on their experiences in Myanmar and would rather keep the woman at home at all costs. Health care providers need to earn the trust of this community so that expectant mothers get the care they need when they need it. 

Home births put the lives of both mother and baby at serious risk, as unskilled birth attendants are often unable to identify or handle emergencies in time, and are unaware of pre-existing conditions with the mothers such as high blood pressure, diabetes, anemia and malnutrition, which can lead to complications during delivery. Also, the poor hygiene practices can lead to severe infections for mothers and newborns.

The maternal mortality rate paints a grim picture of the unhygienic conditions in which many girls and women in the camps deliver their babies. It also shows that despite the availability of free antenatal, delivery and postnatal care, more work needs to be done to dismantle barriers and encourage expectant mothers and their families to access healthcare.

The circumstances in which mothers give birth in the Rohingya camps must improve rapidly in order to save lives. That is why Save the Children is calling for:

• Rapid investment to make high-quality health facilities available for expectant mothers and their families.
• Expectant mothers in the refugee camps to have access to proper antenatal, delivery and postnatal care.
• Further consultation with community leaders to address traditional practices that prevent pregnant women from seeking proper medical care. 

30-year-old *Kortiza is a single Rohingya refugee mother who lives in a camp in Cox’s Bazar. All but one of her four children were delivered in the home. When she was pregnant with her youngest child, her husband left her. A few months later when she went into labour she was all alone with no one to help her.

*Kortiza told Save the Children:

“When I was giving birth to this baby, the pains were coming severely every 2-3 hours but I just couldn’t push. I was scared because I was alone and had no-one to help me with the birth. When I was pregnant here [in the camp], a woman from Save the Children was doing home visits. She told me about the facilities and the doctors at the clinic here and gave me a token and told me to come when it was time to give birth. I walked to Save the Children’s clinic from my home. It took me about 40 minutes with the pain. It might have been much longer for all I know.

“If I gave birth at home I had no midwife, no instruments to help, no-one to cut the cord, no-one to clean the place afterwards. Now I would suggest to other mothers that they should use all of the services here. I would suggest the pre-natal also. I will use post-natal services – my baby will have vaccinations at three months and I will get her checked. I also know about family planning services to prevent pregnancies, these are good.”

Dr Golam Rasul, Senior Health Programme Manager for Save the Children’s Rohingya Response, said:

“Kortiza’s story is not unique. Pregnant women in the refugee camps face tremendous challenges and barriers to accessing proper maternal and newborn care. Besides addressing the traditional practices that keep many Rohingya women in the home during and after the birth, we must invest in more special care for maternal complications and care for small, premature or sick newborn babies. This could help save hundreds of lives as this crisis becomes more protracted.”

ENDS

NOTES TO EDITORS

• Recent UN data found that 57 per cent of births in the Rohingya refugee camps take place in the home, though Save the Children’s recent assessment and other surveys in smaller areas in the camps suggest that number is likely to be much higher. Based on the current pregnancy rate of 2.4 per cent, this means that at least an estimated 12,450 live births will take place in the home in the next 12 months, increasing the risks to both mother and newborn.
• Out of the total number of deliveries (119) at Save the Children’s PHCC between July 2018 and May 2019, Save the Children health providers were immediately able to refer 36 women with delivery complications to higher-level health facilities for specialized care. At the PHCC, skilled providers promptly and adequately managed 24 maternal complications and 4 newborn complications, resulting in zero maternal mortality over this period. 11 percent of the newborns had low birth weight at delivery and they received the necessary stabilization and follow up care to ensure survival.
• Save the Children has successfully treated 24 direct maternal complications, including postpartum hemorrhage, obstructed labor, and pre-eclampsia at the primary health care center it supports in Camp 21. All babies born in the health facility received essential newborn care in accordance with WHO protocol and the Newborn Health in Humanitarian Settings Field Guide, including thermal care, infection prevention, initiation of breathing, feeding support, and postnatal care. For the 11% of newborns born prematurely or with low birth weight, skilled providers were able to initiate kangaroo mother care and support mothers to initiate breastfeeding. For babies unable to breathe on their own, resuscitation with a bag and mask is performed by trained providers. Community health workers educate Rohingya on the importance of facility-based maternal and newborn health care and actively facilitate referrals to the health facilities.
• Most maternal and newborn deaths occur during labour, delivery, and in the first 28 of a child’s life. The risk of stillbirth or death due to complications can be reduced by 20% through skilled birth attendance. 
• Majority of preventable neonatal deaths are due to:

1. Complications of preterm births.
2. Birth asphyxia.
3. Neonatal sepsis.
4. Pre-eclampsia/eclampsia.
5. Ante/post-partum hemorrhage.
6. Obstructed labour.
7. Unsafe abortion.
8. Puerperal sepsis/infection.

• Major causes of maternal deaths: