Safe Births Return to the Hills of Khagrachari

Khagrachari, Bangladesh - In the steep, forested hills of Khagrachari, where the nearest hospital is hours away, giving birth has long meant facing risks alone. For 27-year-old Fatema Akter, those risks once felt inevitable.  

“I delivered my first baby at home, with no trained help,” she recalls. “That’s just how it’s always been here. I had no other choice.”

Until recently, women in Keyangghat Union had no access to nearby skilled maternal care. The closest hospital was more than 40 kilometres away in Khagrachari Sadar, a journey over rough, narrow roads that often became impassable during rain or nightfall. For decades, childbirth meant doing it alone or depending on untrained attendants.

In late 2024, that changed. After 39 years without a single recorded safe delivery in the union, the local Union Health and Family Welfare Centre (UH&FWC) welcomed its first newborn safely delivered by two skilled midwives deployed by UNFPA’s implementing partner Green Hill, in collaboration with the District Family Planning Office.

“I was already pregnant with my second child when I heard the news from neighbours of midwives’ arrival at our health centre,” says Fatema. “Now, it is just a 40-minute trip instead of an all-day struggle.”

The midwives counselled Fatema on the risks associated with unassisted home births and the benefits of skilled care. Later, Fatema delivered a healthy baby boy at the Centre. “By the grace of God and with the help of the midwives, my son and I are safe. I still can’t believe how different it was this time,” she says.

Two midwives were deployed in November 2024 to the Keyangghat FWC that served the needs of  9,000 residents across 23 villages, including over 980 eligible couples. The midwives delivered 14 babies safely, conducted over 100 antenatal check-ups and nearly 500 general consultations, provided postnatal care to dozens of new mothers, and supported 82 couples with modern family planning services.

For 26-year-old Tushi Chakma, the change came too late for her first two children - she lost both of them shortly after birth. 

“We didn’t know where to go,” she says with sadness. “There was no care nearby.” 

When she became pregnant again, she sought regular antenatal care at the newly revitalised UH&FWC. In spring this year, with the midwives at her side, she delivered her son, Rijeng.

“Midwives stayed with me through everything,” Tushi remembers. “This place doesn’t feel like a clinic. It feels like family. This time, I held my baby and knew he would live.”

Midwives recruited from local indigenous communities have been particularly effective. As members of the same ethnic and linguistic groups they serve, they build trust and offer culturally sensitive care that respects traditional practices. Recognizing the value of local health providers, the Ministry of Chittagong Hill Tracts Affairs and UNFPA work together to expand midwifery education opportunities through dedicated scholarships for indigenous youth to ensure the long-term sustainability of maternal care in underserved areas.

“No maternal or newborn deaths have occurred since the service began,“ says Rupanta Chakma, District Coordinator for Green Hill, who has witnessed firsthand the barriers women face in these remote hill communities.

“There are no buses here, just rickshaws or auto rickshaws, and they stop after dark. In an emergency, families are stranded,” he explains. “Within just a few months, these midwives have done what hadn’t happened in nearly 40 years - they’ve made safe, free deliveries possible — right at people’s doorsteps.”

Local leaders now champion the service. Before, only families who could afford private transport made it to the hospital. The rest suffered in silence,” he says. “Now, people see the midwives as part of our community. Their work is saving lives.

Funded by Global Affairs Canada, this initiative illustrates how inclusive, community-based care can close persistent gaps in health equity. The focus on indigenous and hard-to-reach communities in the Chittagong Hill Tracts serves as a compelling model for expanding maternal health access in fragile settings.

UNFPA and Green Hill expanded midwife deployment initially to five UH&FWCs in Khagrachari. Two additional centres in Bandarban were supported in 2025. With sustained funding, this model could be scaled further, reaching unions where no maternal health services currently exist. 

The intervention supports Bangladesh’s national commitment to the 2030 Agenda and advances UNFPA’s global goal of achieving zero preventable maternal deaths. The return on investment is unmistakable as it results in lives saved, families empowered, and a renewed trust in public health systems.

For Fatema and Tushi, the change is already real. “When I heard my baby cry, I felt something I hadn’t felt before: hope,” Tushi says. “Now, when a child is born here, it means life. Not loss.”