UNICEFBangladesh NewsletterIssue 9, May 2008

Content:

UNICEF’s hand-washing campaign launched on World WaterDay 3Slum dwellers lack sanitation infrastructure and hygieneknowledge 4Children unite to build a safe school 6Injury Prevention Initiatives in Barrister Para Village 7The Plight of orphaned children, three months after Cyclone Sidr 8Folk theatre explains how to prevent bird flu 9School theatre promotes hygiene practices three months afterCyclone Sidr 10Birth registration programmes reach out to indigenous groups 12

Community unites to prevent maternal death 13A mother saves her 10-year-old daughter from child marriage 14Women and girls speak about child marrige 15

Sessions resume at the adolescent centre in Kolpara. The building lost its roof last year during Cyclone Sidr.

Editor: Christine Jaulmes (cjaulmes@unicef.org)

Editorial Team: Kathryn Seymour & Arifa S Sharmin

Cover Photo caption:Azit Parva helps a young woman with herbirth registration forms (See story, page 12)

Cover Photo:Naser Siddique/UNICEF

Design & layout: Syed Makhlesur Rahman/UNICEF

June 2008

© UNICEF/Kathryn Seymour

Let’s go, go, goTo wash both of our handsWe’ll use soap or ashTo wash both of our hands

“Jai, jai, jai” is the new catch-cry forBangladesh. Meaning “Let us go, go,go”, the first line of UNICEF’s newhand-washing campaign song haseveryone going to wash their hands.The campaign was launched as partof International Year of Sanitationactivities on World Water Day.

Performed by children from ShishuAcademy, the catchy tune hadpeople dancing in their seats at theofficial launch, attended byrepresentatives from the Governmentof Bangladesh, UNICEF and otherdevelopment partners. The songfeatures in several television andradio spots that are being broadcastacross Bangladesh. The campaignwill continue over the next twelvemonths.

“I don’t really notice music, but Ireally like this song,” says Afredi,aged twelve, on first hearing the tune.

Kangalini Sufia, a celebratedBangladeshi folk-singer, features inone of the television spots.Addressing parents across thecountry, she says “Before eating,please make sure to wash bothhands. This will ensure good healthfor you and for your children.”

Recent research demonstrates that 53per cent of pneumonia cases and 50per cent of diarrhea cases could havebeen prevented by proper handwashing with soap or ash. Around100,000 children under the age offive die of diarrhea every year in

Bangladesh. The hand washingcampaign will help Bangladesh toachieve the millennium goal ofreducing by two thirds the mortalityrate among children under five.

Donor: DFID

Hand washing statisticsThe launch of UNICEF’s hand washing campaign coincides with therelease of a new study, commissioned by DPHE and UNICEF with fundingfrom DFID, that examines hygiene and sanitation habits across Bangladesh.The results show that there is a significant gap between people’s knowledgeand their actual hand washing practices. (See graph below.)

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UNICEF’s hand-washing campaignlaunched on World Water Day

YES%

0

10

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30

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ObservedReported

Beforeeating

Beforepreparing food

Aftercleaning

child's faeces

Afterdefecation

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51

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<1 <1

Do you wash your hands with soap or ash?

Singers from Shishu Children’s Academy perform the theme song for UNICEF’s hand washing campaign at the launch.

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Source: SHEWA-B Health Impact Study Baseline Survey Draft Report March 2008.

Nine-year-old Ruman constantlysuffers from diarrhea, fever and

vomiting. Ruman has never been toschool because his mother is tooworried about his health.

“I am sick all the time,” saysRuman. “Even today I have hadsome diarrhea.”

Ruman lives with fourteen familymembers in a small house in theHossainpur Uttar slum in Sirajganj, asmall city in central Bangladesh.Perched along the ridges betweenseveral canals, the slum smells offeces and the garbage that litters thepaths and waterways. Diarrhealdisease is a big problem for the family.

“Someone or other is always sick,”says Ruman’s grandmother Hasina.“As soon as someone starts to getbetter, someone else falls ill.”

Latrine waste mixes withdrinking water

All fourteen family members use thesame latrine, which comprises twoconcrete footholds above an opendrain. The concrete footholds havebeen built into the slab thatsurrounds the family’s water pump.

This arrangement means that the fountfor the family’s drinking water is onlytwo feet from the hole which drainstheir urine and faeces into the canalbehind the house. According to IrinSultana, Engineer of Sirajganjmunicipality, their water and sanitationarrangement means that the family isprobably pumping contaminated water

for household use. This constructionis illustrative of widespreadignorance of proper sanitation.

Hasina says that she wishes thefamily had an improved latrine, yetshe does not seem to understand thetrue impact that a hygienic latrinewould have on the family’s healthand finances. “My husbands earns solittle that we can’t afford to put in abetter latrine. If we were sick lessoften perhaps we could afford it. Wespend a lot every month on oralsaline and other medicine from thepharmacy.”

“There is a lack of motivation to putin latrines and change theirsanitation habits because people are

not aware of the intensity of thedanger,” says Shah Alam, a SlumDevelopment Officer in Sirajganjmunicipality. “They have neverreceived the education which wouldmotivate them to change.”

In response to this lack of crucialknowledge, which contributes tochild morbidity and mortality,UNICEF, with funding from the UKDepartment for InternationalDevelopment (DFID), is launchingthe urban component of theSanitation, Hygiene Education andWater Supply in Bangladesh(SHEWA-B) project.

Already successfully implemented in

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Slum dwellers lack sanitationinfrastructure and hygiene knowledge

Toilet using behaviourRecent surveys in rural Bangladesh show that 77 percent of people defecate in the open or in unimprovedlatrines.

Open defecation exposes children to feces in theireveryday environment. Diarrhea, typhoid and otherdiseases are spread by bacteria in feces.

Unimproved latrines contaminate water sources andallow flies and other insects to make contact withexcreta. From there, the insects carry bacteriaresponsible for a number of diseases in human beings.

Latrine Use

10%

23%

67%Improved latrines

UnimprovedlatrinesOpen defecation

Ruman, his mother and sisters Sharmin (3)and Jasmine (2) stand beside the pump andlatrine, shared by fourteen family members.

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Source: SHEWA-B Health Impact Study Baseline Survey DraftReport March 2008

rural areas, SHEWA-B will providehygiene education and sanitationplanning assistance to 30 millionpeople across the country. Theseactivities have been proven tostimulate local demand for bettersanitation and hygiene and empowercommunities to take control of theirown sanitation facilities and hygienebehaviors. The urban componentfocuses on small municipal citiesthat do not qualify for rural waterand sanitation programmes and havepreviously been overlooked bydonors targeting metropolitansanitation problems.

Kitchen next to a Sewer

Walking around, one sees many moresanitation arrangements and practicesthat prove how crucial the SHEWA-BUrban project will be to the well-beingof children and their families.

Feroz Ali Shekh, who also lives inHossainpur Uttar slum with hisyoung family, does not have a latrineof his own.

“I use my neighbour’s toilet. We alsouse his well,” says Feroz. “We facefrequent health problems. I know thatmy two small children are getting sickbecause of the poor environment. Theopen latrines in the neighborhoodmight be a reason.”

Feroz’s house sits on the bank of acanal, next to the latrines of hisneighbors. Many of these latrines areimproperly constructed. Holesdeliberately broken into the backs ofthe latrines spew raw sewage intothe canal, instead of containing thewaste to decompose in an anaerobicenvironment away from insects.

Feroz and his family also contributeto the unsanitary conditions behindthe house. “We throw all our rubbish

into the canal. We are purposefullyfilling it up with whatever we can find- rubbish, waste, anything - so that wecan gain more land. The canal used tocome up to the door, but we’veextended the bank by two meters.”

Feroz has built the householdkitchen on the reclaimed bank. Allof the family’s meals are preparedon the edge of what is, essentially,an open sewer.

Open Defecation

Close by in Dhanbandi PurbaDakhin, another Shirajganj slum,boys and men defecate in the openthroughout the day. Children splasharound in the neighbourhood pondsthat serve as toilet, grazing pasturefor cows and playground.

“The culture in our place is to wakeup very early and go to the bank ofthe river,” says Mohime, a day-laborer and resident of DhanbandiPurba Dakhin. “There, all in a row,we do our business.”

Floods in September 2007, whichlaid waste to much of the riversideslum, destroyed all of the sanitarylatrines in the area. Now womenmust wait until nightfall to relievethemselves without being seen.

Although the Department of PublicHealth Engineering (DPHE) hasmade significant progress inrestoring sanitation levels after theflood, Md. Jamanur Rahman,Executive Engineer of Sirajganjdistrict estimates that almost 30 percent of people in the district do nothave access to sanitary latrines.

“People here know that things are

bad,” says Shah Alam. “But theydon’t understand what ‘bad’ meansor what the benefits would be if theyimproved the situation.”

Community Development

UNICEF is currently working withthe Government of Bangladesh innineteen districts to identify thoseurban areas most in need ofsanitation improvements.

Following the model of the ruralprogramme, SHEWA-B Urban willtrain community hygiene promoters(CHPs), usually young women fromwithin the selected slumcommunities, to educate theirneighbours about the health andfinancial benefits of sound hygienepractices and proper sanitationfacilities. Besides conductinginformation sessions in schools,courtyards and markets, CHPs willmaintain hygiene and sanitationmaps that mark all the houses, waterpoints and latrines of the local area.These maps are used by thecommunity to plan for sanitationimprovements.

The project will also provide fundsfor the construction of water points,waste treatment facilities and newlatrines for the hard-core poor. Thelocal community must decidewhether communal latrines, publiclatrines or individual latrines aremost suitable for their situation andmust match all funds received.

The municipal government ofSirajganj has identified slums such asHossainpur and Dhanbandi PurbaDakhin as priority areas where theproject will be implemented whenCHP activities begin later this year.

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Latrine waste and garbage spills into thecanal behind Feroz Ali Sekh’s house.One young neighbour (on the left) fellinto this water during the floods in 2007.

Children play in Dakhin slum where,moments before, two boys defecated inthe pond.

The Sanitation, HygieneEducation and WaterSupply in Bangladesh

Programme (SHEWA-B)is the largest intensivehygiene, sanitation and

water improvementprogramme everattempted in a

developing country. Itwill reach an estimatedpopulation of 30 million

people.

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Last year, school students carryinglong rods of bamboo were a

common sight in the streets ofBrommogacha village in centralBangladesh. The teachers and pupilsat Brommogacha GovernmentPrimary School were collectingmaterials to build a very long fence.

Now complete, a sturdy bamboo fencesurrounds the school buildings andplaying field. On the northern side,the fence sits atop the steep banks ofthe Ichamati River. Several childrendrown in the Ichamati every year.

Arun Debnath, headmaster of theschool, says, “During the rainyseason, children used to throw stonesinto the river from the play ground.”The playground sits directly above asteep cliff which drops directly intothe river. “It was a very dangerousplace for them to be.”

Worried about the children’s safety,the school’s teachers decided to askeach child to bring one bamboo polefrom home if they had any to spareto use for a fence. The teachers wereamazed and encouraged at theenthusiasm with which the childrenbegan their collection.

Brommogacha is one of 371 schoolscurrently involved in a UNICEFpilot programme, run in conjunctionwith the Centre for Injury Preventionand Research, Bangladesh, toprevent injury deaths amongchildren. Injury is the leading killer

of children over the age of one inBangladesh, claiming the lives ofover 30,000 children each year.Drowning accounts for almost 60per cent of these deaths.

The School Safety component of theprogramme supplies students fromclasses one to eight with grade-specific books on safety and injuryprevention. Teachers are trained toinclude these subjects in theirlessons. Every Thursday is ‘SafetyDay’ and students spend one hourstudying the books that weredeveloped by UNICEF, with supportfrom the Netherlands NationalCommittee.

“We read an injury book yesterday.Our book is about how to preventdrowning, how to preventfire and what to do aboutfalling trees,” says Shornaof class five. She explainssome of the life-savingtechniques to use whensomeone is drowning.

Everyone in thecommunity is starting tonotice the children’s newinterest in safety. UnionParishad Chairman, GaziAnisur Rahman, says“Children are now morecareful when they cross aroad. They haveencouraged their parentsto build fences near pondsand around cooking fires,

and to put sharp things out of reach.”

Older children from the local highschool have started to conduct safetysurveys of their own homes. Theirinjury text-books also include firstaid and disaster preparednesslessons.

One of the teachers at Brommogachareceived first aid training under theproject. UNICEF also supplied afirst aid kit to the school. Studentsfrom surrounding local schools, thatdo not have School Safetyprogrammes, have heard about thisteacher, the medical kit and theinjury prevention initiatives. Manyof them have started to come toBrommogacha for emergencyassistance and advice.

Being part of the injury-preventionproject has brought other advantagesto the school. Last week they won aset of sport equipment from theCentre for Injury Prevention andResearch, Bangladesh, for theirinventive safety programs. Kausar,of class five, is very proud of the T-shirt that he received at the injuryrally on the same day.

UNICEF, the Centre for InjuryPrevention and Research,Bangladesh, The Alliance for SafeChildren and the Government ofBangladesh are currently monitoringthe School Safety programme inschools like Brommogacha, with aview to incorporating injury-relatedsubjects in the national social studiescurriculum.

Donor: Netherlands NatCom

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Students of Brommogacha village in front of the fence that they helped to build.

Children unite to build asafe school

Nipa reads to the class about water safety, from atextbook produced by UNICEF.

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Swimming lessons, a life-saving intervention

Five-year-old Akash lies on hisstomach in the dirt. He reaches outhis arms and paddles his legs in thedust. He is showing the residents ofBarrister Para how he pulled hisbrother Shaba (4) from the pond,rescuing him from drowning.

“I started yelling for help and pullingon him,” says Akash. “I learnt thisduring swimming lessons.” Akash istaking swimming lessons as part ofUNICEF pilot programme, run inconjunction with the Centre for InjuryPrevention and Research Bangladeshand international NGO The Alliancefor Safe Children, to prevent injurydeaths among children.

The village is very proud of Akash.The survival of his younger brotheris proof that the hard work of thechildren and the swimming teacheris paying off.

Lunchtime at the safe crèche

Studies show that most child-injuriesoccur in the morning, when womenare busy with household chores and unable to properly supervisetheir children.

Parents in Barrister Para no longerhave to worry about these injuries,thanks to a village crèche thatprovides care for thirty children underthe age of six, between 8 am and 1pm, six days a week. The crèche isanother pilot initiative of UNICEF’sinjury prevention programme.

The children play different clappinggames and a local version of pass-the-parcel, sing songs and take turnsdancing. “When the children arenew, they are a little nervous, butthey soon get involved,” says crèchemother, Kamrun Ahar.

Three-year-old Shikhon smiles andsays, “We learn here, so it’s good tocome.”

Four-year-old Rishma explains, “Ilike to come because we can all playtogether.”

Rishma’s mother Anguri has broughta big pot of kejeree - a mixture ofrice, lentils and vegetables - for allthe children to share for lunch. Eachday of the month, a different motherbrings lunch for all of the children.This system was developed by themothers themselves as it allows thechildren to remain an extra hour atthe crèche and ensures that they geta healthy meal every day.

“I am glad Rishma is here,’ saysAnguri, ‘because I want my daughterto be safe. I want her to learn things.I work at the clinic so am notusually at home in the morning. Hersiblings are much older and have lefthome so there is not one else to lookafter her.”

Memorials warn against thedanger of injury-relatedchild death

Above a rubber tree in the mainstreet hangs a sign which reads“This is Lisa’s tree. We are shockedby Lisa’s death.” Lisa was visiting

her grandparents when she wanderedaway from the house and drownedduring last year’s floods. She wassix years old.

There are several trees like this, withsmall white plaques, planted aroundthe village. Commissioned by aninjury prevention committee madeup of local people, the trees are partmemorial and part cautionary sign.

Whenever a child dies in BarristerPara, the whole community meetswith the committee for a socialautopsy, to discuss the death andidentify any changes in behavior orenvironment that might preventsimilar accidents. The trees are partof this process.

Lisa’s father believes that thisstrategy is working. He says, “Weare more careful now. We watch Tuli[Lisa’s younger sister] whenever shegoes near water and we have madesure that the fireplace is safe.Whenever people see the tree, theyremember how important safety is.”

In her father’s arms, Tuli reaches outto grab the branches of Lisa’s tree,reminding her family exactly whatthey have lost.

Donor: Netherlands NatCom

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Injury prevention initiatives in BarristerPara Village

Injury is the leading killer of children over the age of one in Bangladesh, claiming over 30,000 lives each year.Drowning alone accounts for around 18,000 of these deaths. UNICEF’s Injury Prevention Project has piloted manyinjury-prevention activities especially those that prevent drowning. The following stories profile three of these life-saving interventions in Barrister Para Village in central Bangladesh. The research component of the project willconclude in December 2008. Based on the key findings, roll-out plans will be developed with the Government.

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Children, each between three and fiveyears of age, gather in the doorway oftheir new crèche.

Tuli and her father with the memorialtree that memorialises her older sisterwho drowned last year.

Twelve-year-old Shobuj used tolive in a small house in

Kathachira village, Barisal division.He used to go to the local school,where he had nearly finished classfour. Occasionally he helped hisfather, the local carpenter, with hiswork. His father’s income, thoughmodest, was sufficient to support thefamily. Sometimes Shobuj helped hismother Kohinoor, busy at home withhis three younger brothers. Somedays he just played with his friends.

Cyclone Sidr, which ravagedKathachira village and thousands ofother communities in south-westernBangladesh last November, changedShobuj’s life forever. His father wasone of over 3360 victims killed bythe cyclone. The family housewashed completely away.

In Barisal division alone, 534children lost one or both of theirparents. 293 of these children losttheir fathers and are now entirelydependent on their mothers. Female-headed households are oftenmarginalized in Bangladesh, so thesechildren face difficult futures.

During the weeks following the

cyclone, Shobuj helped his unclesand his mother to build a new tinshanty for the family. “Everythingwashed away,” says Shobuj. “Butwe, and our neighbours, found someof our old belongings around theplace.”

When school re-opened, Shobuj didnot return to class. Now the malehead of a family, he needed to earnmoney to help his mother supporthis three younger brothers. “Beforeat school, I was feeling good,” saysShobuj. “Now nothing is good.”

Shobuj began fishing in the river forlarger fish and searching theshallows for baby shrimp called‘bona’ in Bengali. The tiny shrimpare about two centimetres long, onemillimetre thick and transparent. Ittakes at least one full day to collect100 of the shrimp fry. A fishermancan sell these for 25 Taka (36 UScents), but this is not enough moneyto sustain a family.

“I am feeling helpless,” says Shobuj,“because I have no choice but towork for my family and we stillneed help to survive.”

The family is eating only one or twomeals a day, depending on thesuccess of the oldest son when hegoes fishing. The family receivessome rice from the government asrelief support, but this is due tocease in April. They also received aUNICEF family kit.

“The family kit helps a lot,” saysShobuj’s mother. “The sari that I’mwearing is from the kit. I am usingeverything. The mosquito net hasbeen the most useful thing for us.”

The Ministry of Social Welfare ofthe Government of Bangladesh isworking with UNICEF in cyclone-affected areas to protect vulnerablechildren, like Shobuj. The currentplan allocates monthly cash transfersof 1,500 Taka (US$22) to thefamilies of all orphans, includingthose who have lost only one parent,which will help ensure their accessto education and health careservices.

As the country enters the recoveryand rehabilitation phase, socialworkers will assist families to accesssocial service facilities andlivelihood and income generationopportunities. UNICEF will alsowork with social services staff toensure that the situation ofindividual orphaned children isclosely monitored.

Donor: Government of Sweden

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The plight of orphanedchildren, three monthsafter Cyclone Sidr

Shobuj, his mother Kohinoor, and his three brothers are living off relief three months after the cyclone.

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Safura Khatun (50) built herpoultry farm on the roof top of

her building in Dhour village,Harirampur Union. She enclosed thearea with a wire fence and roofed itwith tin. She has 400 chickens.

It is midday when we reach Safura’shouse. She is busy with herhousehold chores. Her granddaughter Jhinuk (5) is feeding achicken and its chicks. A broody hensits on her eggs in one corner of thekitchen. Safura begins preparinglunch for her family.

“I started this business around 16months ago. My son and a small boyassist me to run the business.Initially, we made a very goodprofit, but over the last two monthssales have sharply declined. Peopledo not want to eat chicken meat oreggs any more because of the birdflu breakout,” says Safura.

Because of their access to media,community people are aware of thespread of bird flu in Bangladesh.The common response to theoutbreak is to stop eating chickenmeat and eggs, even though both aresafe to consume if cleaned and

cooked properly.Conversely, poultry handlinghabits - where the real dangerlies - remain the same asbefore. Chickens move freelyinside houses and backyards.Their feces are not removed.Backyard chicken rearing is verycommon in most of the householdsof this village.

Safura says that she is aware of howbird flu spreads and how to preventit. “I use separate clothes and a maskwhen I work in the chicken pens. Ialso clean my hands and legs withsoap after work,” says Safura.

While we are talking with Safura,Rajib (10) who assists Safura withthe chicken rearing, comes downfrom the chicken pens with a feweggs. He puts the eggs in a pot. Hedoes not wash his hands afterhandling the eggs.

“Anyway,” says Safura, “God willprotect us”.

Later that day, around five hundredmen, women and children assembleat the school ground to see a folktheatre performance on bird flu.

With the assistance of UNICEF, avolunteer group has staged the showto make people aware of thepotential risks of bird flu and helpthem understand how to prevent thedisease.

“I never knew before that justcleaning hands with soap can saveus from this disease,” says AminPatwary, a man in the audience.

Safura Khatun is also present. “Thisis the first time that I have heard indetail about the risks of bird flu andhow to protect from the disease,”says Safura. “This drama is an eye-opener to me. In future, I will ensurethat my son and my assistant useproper protection while working inthe farm.”

UNICEF is working with local folktheatre groups across Bangladesh.Together they have organized morethan five hundred bid fluperformances in different parts ofthe country, mainly in remotevillages that have been identified ashigh risk areas for the spread of thedisease. The messages delivered bythe folk theatre plays are alteredaccording to the local context andare presented in local dialects so thatpeople can easily understand.

Since last winter, Bangladesh hasbeen facing a massive breakout ofbird-flu in 47 out of 64 districts. TheGovernment has culled 1.5 millionchickens and organized masscampaigns to increase publicawareness on prevention against andprotection from bird flu.

Donor: Government of Japan

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Folk theatre explainshow to prevent bird flu

Villagers of Dhour village gather for a performance by a local drama troupe about thedangers of avian influenza. UNICEF has organized more than five hundredperformances in different parts of the country.

Rajib works in the poultry farm without wearingany protective equipment.

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Pushi is a very clean old lady. Shewashes both of her hands with

water and soap whenever she usesthe latrine. She also rinses out thelatrine pan when she is finished.Bulu, on the other hand, is a dirtyold man. He never washes his hands.After going to the latrine, he wipesthem on his trousers.

Bulu and Pushi are characters in thehygiene play put on by grade fivestudents at Gabtali RegisteredPrimary School in a remote villageof south-western Bangladesh.

Throughout the play, Pushi teaches ayoung girl about the importance ofgood hygiene. She explains that it isimportant to wear sandals in thelatrine and wash ones hands beforeeating. Conversely, Bulu provides abad example of hygiene behaviorwhen a young boy watches him usethe latrine and then eat his dinnerwithout washing his hands.

Student’s giggle as Bulu, played byeleven-year-old Mohamed Bashir,bends double, clutching his stomach.“I always have dysentery,” he

complains. “Oh, I have such pains inmy stomach.” Bulu collapses acrossa desk in the front row.

Pushi, played by eleven-year-oldSoneya, arrives and chastises the oldman. “It’s your terrible hygiene thathas made you sick, you silly man,”she says. Poor Bulu dies. But Pushishows no remorse, cautioning thechildren to practice good hygienehabits or meet the same end as Bulu.

The play is part of a hygiene andsanitation programme that UNICEF,with partners CARE, Oxfam, IslamicRelief and NGO Forum, introducedin districts affected by last year’sCyclone Sidr. UNICEF hascoordinated the response of UNagencies and NGOs working toprovide water, sanitation andhygiene relief following the cyclone.

Under UNICEF’s hygiene andsanitation programme, hygienepromoters conduct interactive sessionswith women and children in schoolsand courtyards to remind them of theimportance of good hygiene. 10,000families are being covered.

Nazrul Islam, a UNICEF ProgrammeOfficer based in the affected region,says, “After the cyclone, everyonewas concerned with getting reliefand rebuilding some form of shelter,so hygiene fell behind. People didn’tunderstand how important it was.That’s why these education sessionsare so important.”

“We learnt that the most importantthing is to use sandals at the latrineand to wash our hands afterwards,”says Mohamed Bashir. “It’s hardthough because before Sidr we hadlatrines, but now we are all going insmall holes dug in the ground or inthe open.”

The category four cyclone, which hiton November 15 2007, causedserious damage in Gabtali,destroying many homes and most ofthe latrines in the village.

Recognizing that a major problem isthe lack of sanitation facilities,UNICEF is supplying free latrines to4000 families, focusing on thepoorest and those in greatest need.Each latrine costs UNICEF 1540Taka ($22 US) per unit. Thisamount includes a 120 Taka ($1.75US) installation fee that usually goesto the family receiving the latrinebecause they install the ring-slab andsuperstructure themselves. It takesat least one full day to install alatrine. The labor payment is

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School theatre promoteshygiene practices threemonths after Cyclone Sidr

Bulu, played by Mohamed Bashir, teaches children about good hygiene

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important to many families who arerelying on small daily wages, earnedas casual laborers.

Many families lost other vitalhygiene supplies during the cyclone.In the struggle to get food, clothesand building materials, replacingthese supplies was often beyond thereach of local residents.

“Before Sidr,” says Soneya, “myfamily had better hygiene, becausewe had cloths to clean with and wehad a tubewell. Afterwards, we hadnothing.”

“After Sidr, we didn’t have money tobuy soap or cloths, so we used dirtyrags at our period time,” saysLovely, a young mother at aUNICEF courtyard session.

“Above all, we needed soap,” saysJahanara, another of the mothers.“We got this soap from UNICEF,along with sanitary supplies.”

UNICEF is providing 50,000sanitary towels and 50,000 bars ofsoap to women taking part in thecourtyard hygiene educationsessions. These supplies will cover25,000 households. Combining thisdistribution with the educationsessions helps people understand

that sanitary and hygiene suppliesare an investment in their family’shealth.

Hygiene promoter Renu says, “Notonly do people now have soap andclothes and latrines, but they are alsobecoming more aware. Thanks tothe education sessions, theirhousehold environments are slowlyimproving.”

“We learnt a lot from the hygieneworker and from our teacher abouthygiene,” says Soneya. “We aretrying to follow it at home. Welearnt the play and some hygienepoetry and some songs.”

She and several other children breakinto tune:

Oh my sister, oh my brother, improveour sanitation.Before we use the latrine, we takeshoes.After we use the latrine, we usewater.If the water is safe, our health isgood.All together, we have good hygieneand good sanitation.

Donors: Government of Belgium,USAID, Government of Japan,CERF, Consolidated funds fromNational Committees

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A hygiene promoter leads an interactive session on household hygiene as a part of a UNICEF programme for cyclone affected families

Students of Gabtali Primary School sing about good hygiene and safe water.

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The yard outside the communitydevelopment centre is littered

with brightly coloured sandals - eacharound four inches in length. Frominside the cool and shady doorwaydrifts a choir of young voices. Thechildren, all between the ages of 3and 6, are singing a song about howthey should look after their teeth,their hair, their fingers and theirclothes.

Azit Parva Tripura who runs thecommunity development centre hasalso been learning anew how to lookafter the young children ofGanjapara. As part of UNICEF’sbirth registration programme, shereceived training on the importanceof birth registration in safeguardingchildren and their rights.

All of the pre-school children at thecentre are registered with birthcertificates thanks to her efforts. “Icollected the forms from the councilfor all the children,” says Azit. “Tofill them in and find out about theirbirth dates, I used theirimmunization cards.”

Birth registration is a particularlyimportant issue in Ganjapara and theother villages of the Chittagong HillTracts, a region in the south-east ofBangladesh where over 50 per centof the population come from 13ethnic minority groups. Universalbirth registration, which theGovernment and UNICEF hadhoped to achieve by the end of 2008

but now believe will only becomplete by 2010, will help toensure that these minority groupsachieve the same rights as all othercitizens of Bangladesh.

Almost 100 per centregistration

Azit also encourages the mothers toregister their entire families. Hermessage is getting through. Almostevery man, women and child in thevillage have registered over the lasttwelve months.

“It was a little difficult for us to fillin all our forms,” says Makra, amother of four. “So we took the helpof one boy in our village who is welleducated. We registered ourselvesand our three oldest children.”

“My husband collected the formsfrom the union council,” saysManuching. “We are five familymembers and all of us are registered,except my last child, Kyashe. Hewas born after we registered. Wewill register him soon, as soon as hegets his first immunization.”

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Birth registration programmes reachout to indigenous groups

Manuching with her son Kyashe, one ofonly two children not yet registered inGanjapara.

Azit Parva Tripura with her para centre pupils, whose birthdays she registered.

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Shilpi Khatum (19) nearly diedgiving birth to her first child

two months ago. She survivedbecause a local community supportgroup for pregnant womenencouraged her family to seek early medical intervention. Despitesevere blood loss, doctors atShirajganj district hospital were able to save her life.

Around 12,000 women die duringpregnancy and childbirth every yearin Bangladesh. Only one in four ofthe babies born to mothers who diein childbirth survives the first weekof life.

A History of Maternal Death

Shilpi is the third wife of herhusband Alamgir. Both his first andsecond wives died in childbirth. Hissecond wife was Shilpi’s older sister.

Alamgir’s first wife died at theupazilla health complex after givingbirth to their son. Had the familysought medical care sooner, avoidingthe first delay of childbirth, she maynot have died. Postponing thedecision to seek treatment is commonamong pregnant women and theirfamilies because of the low status ofwomen, a poor understanding ofillness and complications, andeconomic difficulties.

A few years later, Alamgir’s secondwife, also in labor, died in the backof a rickshaw van on her way tohospital. The long process offinding transport and traveling to thehospital contributed to her death.Many women in Bangladeshcontinue to die because of thissecond delay, caused by thedistances that they must travel tohealth centres and the unavailability

and expense of transport.

A third delay sometimes occurs oncewomen reach a health centre and isprimarily a result of poor qualitycare or inadequate facilities.

Combating the “three delays” thatprevent pregnant women fromreceiving timely treatment is themain challenge for Bangladesh tomeet the millennium developmenttarget and reduce by three-quartersthe maternal mortality ratio.

Health facilities in many districts,including Shilpi’s home inShahjadpur, have vastly improved inrecent years. Much of this is thanksto UNICEF who trained staff andimproved obstetric care facilities in191 health complexes acrossBangladesh.

Birth certificates andtraditional records

The village headman, Kaylan KishorRoaza, and several other localleaders also received training onhow to encourage universal birthregistration within their community.Headmen are the traditional leadersof the Chittagong hill tracts.

“Since 2007, I have known aboutbirth registration,” explains KaylanKishor Roaza. “We have beenregistering everyone for the last tento twelve months. There has alwaysbeen a tradition that headmen keepall the information on births, deaths,marriages and other data on his

people. But with the growth of thepopulation, this became very hardand I could not cope anymore. Nowbirth registration is replacing theserecords and the system is muchstronger.”

Using the certificates

Local officials believe that peopleare adapting extremely well to thenew birth registration system. Ofthe 9400 residents recorded in theunion (sub-district) during the lastcensus, 9300 have been registeredand 6882 have received theircertificates.

“I wouldn’t feel like a proper citizenwithout my birth certificate,” saysRatnudes, a young mother.

“Initially, we thought that they werea burden to get,” says anothermother. “Now, we realise that theyare essential to have. Previously, Ineeded the headman or the unionchairman to accompany mewhenever I needed to do somethingofficial, so that he could formallyidentify me or my children. Now Idon’t need that. I am able to provewho I am on my own.”

Donor: Government of theNetherlands, European Commission

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About Birth Registration in Bangladesh

Current status • 9.8 % of children under five have a Birth Registration certificate.• 23 per cent of the total population of Bangladesh had been registered by

December 2007.

Why? Birth registration gives an official identity to children and helps protect them fromchild marriage, child labor, underage criminal prosecution and other abuses.

Community unites to prevent maternal death

Continued on page 16

Kolpnona was distraught when herhusband announced that he hadarranged for the marriage of theirten-year-old daughter Mukta to theson of one of his friends.

“In our family, we have only oneincome source,” says Kolpnona.“My husband thought that when ourdaughter grew up, a dowry would betoo expensive. Girls of 18 need atleast 40 to 50 thousand taka [725US] to get married. As our daughteris only 10 years old, she doesn’tneed a dowry, so my husbandarranged her marriage.”

Mukta too was very afraid. Shedidn’t want to leave her mother to goand live with the family of ahusband.

Kolpnana grew angry. She protestedagainst the marriage. “My husbandrefused to listen, saying that we werevery poor and could never afford hermarriage if we waited until she wasolder. Then he beat me.”

The next day, Kolpnana sought theassistance of the adolescent parents’group in her village. The group ofwomen meets every week at theadolescent centre, which runs life-skills education sessions foradolescents and their families. Thecentre is part of UNICEF’s KishoriAbhijan’ Project, which translates as“adolescent girls’ journey”. Both themothers’ and adolescents’ groupshad already run discussion sessionson the dangers of child marriage.

“After I asked the women to helpme, they all went together to speakto my husband,” says Kopnana.

“We said we would takeresponsibility for his daughter’smarriage if he waited until she wasolder,” says Fatema, a member ofthe group. “‘Don’t think about it,’we told him. ‘We will think about itfor you and when she is older we

will arrange a marriage where dowryis not required.’” Farzana, the coordinator of the groupalso threatened to file a lawsuitagainst the father if he did not calloff the wedding. This is not herpreferred tactic, but sometimes it isthe only way. “I have told the girlsand boys and their mothers to asktheir husbands and fathers to attendour sessions so that they too willlearn about child marriage and otherissues facing their children.Sometimes I visit the houses toinvite people, but the men rarelycome. Now we are trying to arrangemeeting times according to when themen are free.”

Mukta’s father finally agreed to calloff his daughter’s wedding. Muktaand her mother are now determinedto make sure that other girls in thevillage are also safe from childmarriage. “I would protest and go tothe parents group if I knew it wasgoing to happen to another girl,”says Mukta.

Already 130,000 adolescents acrossBangladesh have taken part in theKishori Abhijan Project and beeninvolved in life skills sessions onchild marriage. As part of theprogramme, parents and other care-givers of the girls, as well as localofficials and other influential peoplein the villages, are oriented on issuesconcerning adolescents and giventhe opportunity to discuss areas ofconcern and develop protectionstrategies. By 2010, the project plansto have reached 1 millionadolescents.

Donor: European Commission

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A mother saves her 10-year-old daughter fromchild marriage

After escaping a child marriage, Mukta(10) continues to attend the adolescentcentre where she learns about issuesfacing young people in Bangladesh.

Child marriage and the law in BangladeshThe legal age of marriage for girls is 18. 64 per cent of Bangladeshi girls are married before

they turn 18. 33 per cent of girls under 15 are married.

Dowry is illegal in Bangladesh. It remains common for a brides’ family to paydowry to the family of the groom. Dowry demandsoften continue after the wedding and failure to payfrequently results in violence against the bride.

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Women and girls speak about childmarriage

“My daughter is 10years old. She is now atschool. The legal age formarriage is 18, so only thenwill she be married”

Taslima has two daughters.

“If the daughter iseducated and she getsmarried when she is older than18, it is easier to marry herbecause she can get a job andearn money.”

Sharhinoor has two sons.

“If you marryyour daughter early, she willlose her health and all her childrenwill not be looked after. She will alsolose her chance for an education.”

Salma has a daughter and a son

“If my parents do not listen to meabout marriage, then I will takeassistance from older and moreinfluential people in the community,people that my parents will listento.”

Khushi (14) attends the adolescentgroup.

“When the proposalcame, I felt very low.

When the village peoplecame and stopped the

marriage, I felt very goodthat they cared for me.”

Jumar (12) escaped a childmarriage after theintervention of the

mothers group.

“When our daughters marry young, theygrow sick and skinny and their husbandsprefer other girls.”

Fatema has four daughters.

Photos: Salma Siddique/UNICEF

However, the uptake of antenatal andobstetric care in Shahjadpur andother centres remains extremely low.Consequently, UNICEF hasestablished the Community SupportSystem (ComSS) initiative whichworks to establish stronger linksbetween communities and their localhealth centre, and encouragepregnant women and their familiesto seek early and adequate medicalhelp during obstetric emergencies.

Saving Shilpi’s Life

When she fell pregnant, Shilpi wasvisited by a volunteer from the

village ComSS committee. Thevolunteer enrolled Shilpi in theirmaternal health programme. As partof this programme, Shilpi was giventickets for antenatal checkups at thelocal health centre.

When Shilpi went for herappointment in the fourth month ofpregnancy, the doctors said thateverything was going well. “Theytold me that when the pain starts, Ishould come to the health complex.”

When labor began, Shilpi’s familyignored this advice and called thelocal village doctor. Village doctorsare traditional healers who havelimited medical experience.

Fortunately, the doctor that attendedShilpi was a member of the villageComSS committee. Because of his

involvement in the ComSS initiative, he sent Shilpi directly to the local health complex as soon as he discovered that she wasin labor.

Shilpi traveled the half-hour journeyto the centre by the rickshaw van(tricycle cart) that is owned and paidfor by the village ComSS committee.The rickshaw van is reserved forpregnant women in labor orotherwise in need of emergencycare.

“It was tolerable sitting in therickshaw van because it was only theinitial stages of labor,” says Shilpi.“Even the delivery was fine. I feltthat people were paying goodattention to me at the healthcomplex.”

Problems arose in the third stage oflabor when Shilpi failed to deliverher placenta. The retained placentacaused severe blood-loss. Shilpineeded a blood transfusion, but theupazilla health complex did not havethe facilities for such a process. Anambulance was called to take Shilpito the Shirajganj district hospital.

“Shilpi was unconscious by the timewe got her to the hospital,” says hermother-in-law. “We had to make allthe decisions for her. We did notknow what to do when the doctorsaid she needed blood. First we triedto buy it, and then we called ourrelatives.”

After five days in hospital, Shilpiwas well enough to return to hervillage.

UNICEF is working with theGovernment of Bangladesh andNGO CARE Bangladesh to pilot theComSS project in six upazillas. Theprogramme aims to create anenvironment where women in laborare encouraged to seek immediatemedical assistance by educatingcommunity members on theimportance of obstetric care andmobilizing them to monitor andassist pregnant women.

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Continued from page 13

Community unites toprevent maternaldeath

Shilpi cradles her two-month old son

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