World Health Day: Challenges to women’s access to healthcare in Bangladesh

"I'm Hamida, from Moricchya, Cox’s Bazar. When I was pregnant, I knew I wanted the best care for my first baby child. Although there was a private clinic nearby, I had heard that the Doctors Without Borders Kutupalong Hospital provided high-quality care, totally free. 

"Usually, my family has some reservations to seeing male doctors at the hospital as they prefer female doctors. I always accept their decision. We usually visit a nearby pharmacy if we have any physical issues as there is a woman who gives medication. This often keeps me away from seeking further medical care. However, financial barriers are another issue. We now have six people in my family. My husband is a farmer and drives a car sometimes. He is the sole earner in the family, and it's tough to take care of six people. Even my older father-in-law and mother-in-law visit a nearby pharmacy for medication as it’s cheaper."

"When the delivery date approached, my labor pain started. For four days, I struggled with pain, and my family was hesitating to visit hospital due to cost. My in-laws asked for delivery support from a traditional midwife for home delivery. She tried for days. I was suffering from pain and couldn't give birth to my baby. I got hurt during the process. Finally, the pain became unbearable, I got weak, and asked my mother,  who lives in the Courtbazar area of Cox's Bazar, to take me to Doctors Without Borders Kutupalong hospital. 

"Thankfully, Doctors Without Borders experts were there. I had a safe delivery and gave birth to a healthy baby girl! I'm so grateful for their care and expertise."

In Kutupalong hospital, we provide antenatal care, maternity care, and care for survivors of sexual and gender-based violence. 

"I'm Dr. Umme Salma, Doctors Without Borders doctor for the past two years. I see the firsthand challenges women in the Rohingya refugee camps and Bangladeshi communities face when they visit our facility for antenatal, maternity and post-natal consultation.  

"Many families in both communities aren't aware of the risks of home delivery or the importance of regular checkups. This leads to complications and delays in seeking medical help."

"Complications like retained placenta, hypertension, or the need for assisted delivery are frequently the result of late arrivals. This can be life-threatening. 

"At Doctors Without Borders, we provide essential care, but also make families aware of pregnancy risks and the importance of timely medical attention. We counsel husbands and wives to understand the needs of pregnant women. 

"Sadly, many mothers and babies lose their lives due to preventable complications. Raising awareness and improving access to healthcare is crucial."

"I'm Sumaiya Shimu Kakoli, a midwife working for Doctors Without Borders. At our Kutupalong clinic, I see a critical need: supporting survivors of sexual and gender-based violence. 

"Sexual and gender-based violence survivors need medical attention within 72 hours of an assault, but fear and stigma often prevent them from seeking help. They worry about shame and social isolation, leading to delays in treatment. Many people are unaware of the possibility of becoming pregnant after such violence."

"There are more difficulties for Rohingya women who are displaced from their motherland and took refuge in Bangladesh. Fear of being outsiders and limited movement within camps hinder access to health care.  

"We offer confidential services to all survivors, regardless of origin. Special sign like white flowers or the phrase 'Mashir Ghor' help women access care discreetly. We provide medical attention, counseling, and medication."

In the Doctors Without Borders Kutupalong hospital, we provide care for survivors of sexual and gender-based violence, and mental health and psychiatric services for both the refugees and host populations.  

"I'm Halima, a mom of three children from Goyalmara. Having access to healthcare made a big difference for my family.

"When I had my first son, there weren't any nearby hospitals for delivery in Goyalmara area. This meant a home birth. I know, it wasn't ideal."

"My husband works in a shop and feeds the whole family. Due to financial barriers, I usually don’t visit hospitals or clinics for medical treatment. This time, when I conceived, from the beginning I started visiting Doctors Without Borders Goyalmara facility as I was tense about the wellbeing of the baby due to my prior experience. Here Doctors Without Borders provides free medical care that also took away my worry about medical expenses. My baby was born here under the skilled medical personnel of Doctors Without Borders." 

In Doctors Without Borders Goyalmara Mother and Child hospital, our team provides sexual and reproductive healthcare: antenatal care, postnatal care, family planning, care for survivors of sexual and gender-based violence, and mental healthcare. 

"My name is Tayaba, and I am from Modhurchorra, Lambashia. I am eight months pregnant. This pregnancy has been difficult with high blood pressure, swelling, dizziness, and nausea. 

"The closest health center wasn't helpful, so I stayed home, unable to do chores. 

"The Doctors Without Borders clinic in Kutupalong is accessible only by local transportation, which is scarce. The long journey is especially difficult when you're unwell. Thankfully, my husband found transport on time. 

"My previous child died during a complicated delivery. The baby was in a breech position, and he was injured during delivery. A few hours after the birth, the baby passed away. This incident made me sad.  

"When I got pregnant for the second time, I decided to make this long journey for the well-being of my baby and myself. My health is improving, but challenges remain."

"My husband can't always afford the travel costs. He occasionally turns to purchasing medications from the nearby pharmacy to avoid the trip. 

"I understand that visiting a doctor is important, but it can be challenging due to the cost, lack of transportation, and lack of functional health facilities. I hope for improved healthcare access within the camps and more support for families like mine." 

"My name is Jamila (name changed). I work at the Doctors Without Borders clinic in Camp 15, Jamtoli. Women in this camp encounter numerous obstacles when attempting to access healthcare."

"Women who are educated understand the importance of healthcare and are more likely to seek treatment at the clinic. But illiterate women, especially those who are very sick, often don't realize the seriousness of their condition until it's too late. 

"Some women experience limitations from their husbands, even when they wish to visit the clinic. Their husbands don't understand the importance of healthcare or family planning and may not allow their wives to leave the house for check-ups. This can lead to delayed treatment and complications. 

"Despite these challenges, I see more and more women coming to the clinic, specifically for prenatal care. Doctors Without Borders Health Promotion Team also provides health education to women about diseases and healthcare options."

In the Doctors Without Borders Jamtoli primary healthcare centre, we provide 24/7 maternity, sexual and reproductive healthcare, comprehensive care for survivors of sexual and gender-based violence, and mental health services.  

"I am Risalat Binte Aalad, a councilor educator in the Doctors Without Borders Kamrangirchar project. Every day, I see women wrestling with the decision to seek help. 

"The first obstacle is simply realizing our existence. Women often come to discuss seemingly unrelated problems, and they don't know about the services Doctors Without Borders provides until we have a careful chat with them. But even then, fear creeps in.  

"These women live with shame, anxiety, and uncertainty all the time. They worry about their family's honor, about judgment from outsiders, and about retaliation from their abusers. Establishing trust is essential. They want to know that people will believe their stories, not question them."

"The influence of family is strong. Many women, even adults are also incapable of making decisions about their own health care. They lack trust or capacity to handle things on their own and feel uneasy about the effects.” 

In Kamrangirchar, Doctors Without Borders conducts more than 40,000 consultations for factory workers and their families. Doctors Without Borders has engaged with authorities to improve occupational health.

"My name is Anowara Begum, 40 years of age. I live in Balukhali Refugee camp as a housewife. Life here in the camp can be difficult, especially when someone gets sick."

"Another worry is money. Many families simply can't afford the cost of hiring a vehicle. The nearest Doctors Without Borders facility is in Balukhali, it doesn’t provide all kinds of services now, so for serious illnesses, we have to travel far, like to Kutupalong Hospital. Doctors Without Borders provides free treatment, but we have to struggle to cover the cost of traveling so far. 

"The biggest issue is the lack of medication available at nearby hospitals. They often diagnose conditions but don't provide the necessary medicines beyond paracetamol. This necessitates travel to the Doctors Without Borders hospital for many patients seeking more comprehensive treatment." 

"In the past six years, the number of patients needing hospitalization has significantly increased. There seems to be a strong emphasis on promoting only long-term family planning, and patients may not be fully informed about all their options. This lack of information can be discouraging for those seeking healthcare treatment."

The Doctors Without Borders Balukhali facility serves a large population of Rohingya refugees. In Doctors Without Borders Balukhali Specialized Outpatients Department (SOPD), our teams provide care for sexual and gender-based violence, sexual and reproductive healthcare and mental health services. 

"I am Nashima Pormin, coming from camp 22, Unchiprang, to seek treatment for my son. He is suffering from pneumonia. When he got pneumonia, I knew I had to act fast.  

"We have health facilities in our camp, but the care provided for children is not enough. At night, the closest health center is closed. Families are forced to wait until morning, risking their loved ones' health, especially for children. I observed that his situation is deteriorating, without wasting time we got him admitted here. I was afraid that if the situation got worse at night, I wouldn’t be able to take my child to the hospital."

"During the first few days of his sickness, I gave him traditional homemade medicine (heated oil). I thought he would get cured of this. However, when I saw no improvement, I immediately took him to the hospital. Doctors Without Borders support allowed me to focus on my son's recovery."

In Doctors Without Borders Goyalmara Mother and Child hospital, our team provides sexual and reproductive healthcare: antenatal care, postnatal care, family planning, care for survivors of sexual and gender-based violence, and mental healthcare.