From Silent Struggles to Informed Choice

A Midwife Brings Life-Saving Reproductive Health Services to a Woman on a Remote Island in Bhola

Bhola District, Bangladesh — On Char Kukri-Mukri, a remote island settlement at the edge of the Bay of Bengal in Char Fasson Upazila, access to quality health care has long been a challenge. Surrounded by shifting rivers and the sea, women here have faced distance, isolation and limited services. For years, the local Union Health and Family Welfare Centre (UH&FWC) remained under-utilized due to shortages of skilled providers and essential supplies.

Today, that is changing. Through a joint initiative of the Government of Bangladesh and UNFPA, supported by Global Affairs Canada (GAC), the deployment of trained midwives has helped transform the centre into a vital lifeline for women and girls on the char.

Across Bangladesh, an estimated 5 million women who want to use modern, voluntary family planning methods still face barriers to access. Addressing this unmet need could prevent up to 1.2 million unintended pregnancies each year and significantly reduce maternal deaths. Investments in family planning also generate wide social and economic returns, saving an estimated USD 14 in health and social costs for every dollar spent.

“Bangladesh is globally recognised for its progress in family planning, but sustaining these gains requires continued investment,” said Catherine Breen Kamkong, UNFPA Representative in Bangladesh. “Ensuring the presence of skilled midwives, along with reliable supplies of medicines and contraceptives, is critical to reaching women in hard-to-reach communities.”

Recently, Rekha, 44, came to the centre for a postnatal visit with her newborn. Fatigue lined her face. During a gentle check-up, midwife Nazneen Akter created a safe space for conversation. Gradually, Rekha shared her story. She had been pregnant seven times and had experienced three pregnancy losses. She had never received comprehensive information about family planning. Oral contraceptive pills were used inconsistently, and long-acting methods felt unfamiliar and intimidating. At times, overwhelmed and with few options, she resorted to menstrual regulation kits from a local pharmacy, without knowing, placing her health at serious risk.

Recognizing her vulnerability, Nazneen provided respectful, comprehensive counselling, addressing myths, fears and questions. Given Rekha’s reproductive history, Nazneen also recommended cervical cancer screening as part of routine reproductive health care. After informed discussion, Rekha agreed. When the screening result came back normal, she felt reassured about her health.

With trust established, Nazneen introduced long-acting reversible contraceptive options. She explained how the intrauterine contraceptive device (IUCD) works, its effectiveness, possible side effects and the fact that the method is voluntary and reversible. Based on Rekha’s informed choice and consent, the IUCD was inserted safely.

The change in her expression was immediate.

“Now I don’t have to live in constant fear of another pregnancy,” Rekha said softly. “I can focus on caring for the children I already have.”

On remote islands like Char Kukri-Mukri, the presence of a skilled midwife is a gateway to information, dignity, and the right to make informed decisions about one’s own body.