Making Us Visible (MUV)

A culturally appropriate maternal and child care handbook, a scientifically proven self-care tool to reach marginalized indigenous mothers and their children in Bangladesh for ensuring their safe motherhood and childhood.

Infant and child mortality rates are still high and poor maternal health remains a challenge in a conflict-affected place called the Chittagong Hill Tracts (CHT) in Bangladesh, where healthcare is difficult to access. The CHT is home to more than 15 historically marginalized Indigenous communities. The CHT region still has the highest infant mortality rates in the country, “standing at 63 deaths per 1,000 live births, against the national average of 49 deaths per 1,000 births. Under Five mortality rates are 85 deaths per 1,000 in the CHT, compared with a rate of 64 deaths per 1,000 nationally”. Indigenous communities in Bangladesh are the most underprivileged ones in the country, and they have been dealing with serious mistreatment for many decades, including not being able to study in own languages, different systemic health disparities, sexual violence against indigenous women and girls, eviction from ancestral lands and cultural exploitation, etc. These have resulted in chronic poverty, generational trauma, and limited access to quality education, healthcare, and to own ancestral lands. These people have the lowest literacy rates, the highest rates of malaria-related deaths, the highest rates of pregnancy, and newborn mortality, the highest diarrheal deaths, and higher rates of anemia and malnutrition. Many indigenous communities live in remote areas of the CHT, where nearby medical facilities (if available) are often under-equipped and understaffed or not even available within 30-50 miles.

Our motto is “Inform, Educate & Empower” by creating mass awareness in the community and root level where community volunteers will be trained on using the MCH book, will participate to provide health information, and educate the girls and mothers. The MCH handbook is a printed health information book and a self-care tool that can be used at home by everyone. We also aim to develop a mobile application and translate the book into more than 15 indigenous languages to eliminate the language barrier. We focus on social inclusion by incorporating traditional knowledge and technology. The mobile application will contain information on mental health management for mothers and animations on indigenous children’s stories and folktales. Through exposing their own language and culture, indigenous children will be raised in the wisdom, knowledge, and love of their ancestors, which results in thriving mental health, which improves academic performance, self-esteem, and socioeconomic success.

Our solution will serve nearly one million historically marginalized indigenous communities living in Bangladesh. Indigenous women experience twofold discrimination due to their ethnic and gender identities, and they experience significant inequities in accessing healthcare services, including indigenous-focused health intervention programs. The maternal and child handbook (MCH), we will develop will focus on integrating intercultural healthcare approaches that will help to reduce such inequities and inequalities for pregnant indigenous women, children, and their families. Indigenous women’s poor experiences of accessing healthcare services have been contributing to this group having the worst health outcomes in Bangladesh. This book will endorse the human security approach, enabling individuals and communities to have more control over their own health and ensuring the quality of lives of mothers, children, and families. This book will help indigenous mothers to be better decision-makers about their children's health and nutrition, which will enhance marginalized indigenous people's general health in Bangladesh.

We are working under the guidance of Prof. Shafi Bhuiyan PhD MBBS, MPH, MBA, Dalla Lana School of Public Health, University of Toronto, Canada.  He is advising us for the  MCH Handbook content development support along with his global research team & International committee on the MCH handbook.

Our project is being coordinated by Rani Ukhengching Marma, ceremonial queen (Rani) for the Indigenous community of Mong Circle (Khagrachhari District) Chittagong Hill Tracts (CHT). She brings more than six years of engagement experience in an Indigenous setting and has been working intensively with the goal of improving the lives of underprivileged groups, with an emphasis on youth empowerment, education equity, community participation, and indigenous health. She was nominated as a finalist for Commonwealth Youth Award in 2017 for her steadfast public service. She also coordinated the project “Learning English Pathway to Progress” successfully funded by the U.S. Department of State to develop English skills among 300 minority Indigenous students from the Chittagong Hill Tracts, Bangladesh to improve their academic performance while reinforcing the benefit of strong English language skills in the globalized economy.

 We will collaborate with Mong Circle Chief’s office, a traditional govt institution of indigenous people from the Chittagong Hill Tracts, govt hospitals and local indigenous student organizations.

 We have a strong connection to the indigenous people, a dedicated group of volunteers who can work on the ground for their own people. We have a strong advisory committee that will advise us in preparing the health information booklet. This will be a project for the indigenous people by the indigenous people.

Since, 2015, we have been working to combat stigma related to sexual and reproductive health in one of the remotest parts of the Chittagong Hill Tracts (CHT) where more than 13 underprivileged Indigenous Communities make up only 1 percent of the overall population of the country. To eradicate period poverty and reinforce the dignity of those impacted by inequality, we are working with young and adolescent girls from marginalized Indigenous communities on sexual and reproductive health, access to hygiene, sanitation issues.

While engaging in community level discussion we found out, discussing about menstruation, women’s sexual health, teen pregnancy, infections, contraceptives, and using sanitary napkins are often considered taboo. Often lack of knowledge about menstruation acts as an obstacle to women’s empowerment such as dropping out of school. Because they are ashamed of speaking out about their abdominal pain and lack of access to hygiene products and water during their menstruation period can’t express their problems related to their adolescent health.

Child marriage is still an alarming issue in the indigenous communities, they get married without any prior knowledge of motherhood, self-care, and the nutrition of themselves and their babies. Hence, a big portion of the population is affected by malnutrition from very early age impacting the whole community’s health.

  While designing the MCH handbook we have been in continuous consultation with the indigenous community, midwives, and indigenous doctors. Our solution will have contents that are indigenous-friendly and impact the whole community to solve a big public health problem. 

Our solution is the first of its kind in Bangladesh for the indigenous people, which focuses on culturally appropriate indigenous contents such as food habits, cultural aspect of rest planning for mothers, document the health records and information on pregnancy, delivery, neonatal and childhood periods, and child growth and immunizations. The majority of indigenous women are not even aware of the fact that for a safe birth and healthy children, pregnant mothers must do at least four antenatal check-ups. In Khagracchari, one of the districts of CHT, only 17 percent of mothers go to their doctors for these vital visits, according to data from Real-Time Monitoring, according to UNICEF.

Through introducing MCH handbook,  we will support indigenous women and families to address 3Ds, i.e., delayed decisions, delayed transportation, and delayed seeking care. Family and health providers’ communication and collaboration would be improved. As a result, facility-based quality services will be increased. Therefore, zero home delivery will be achieved which is one of the leading targets to address the SDG goal no one is left behind.

Our MCH handbook will be full of contents on prepartum, and postpartum nutrition, newborn nutrition, and self-care which can significantly improve the nutritional status of indigenous women and children. Because around 49 percent of children in the CHT suffer from stunting, which is much higher than the national average believes that both a continuum of care and family empowerment is necessary to improve the health and well-being of the mother and child.

Our approach is a community participatory action approach where the handbook will bridge the information gap for a healthy society. Very few in the CHT can access nutrition supplements such as iron-folic acid (IFA) tablets which prevent the physical deformation of the child in the womb. For many decades the indigenous communities suffer from many deprivations in the health care system due to challenges posed by their unique demography, socio-economic situations, and diversities in culture and customs. And our solution will act as a catalyst to empower indigenous women and families for an equitable and healthy society

There are three districts in the Chittagong Hill Tracts. We will implement the usage of books in one district first from March 2023 in collaboration with a govt hospital in a union of 300 mothers and later from June 2023, we will expand to another 200 mothers in another district. We will collaborate with community health workers to observe and assess behavior and improve situations after using the book. We will advocate for social cohesion through equitable holistic maternal and childcare in remote indigenous communities by using the book.

We will design a user-friendly mobile app on the MCH handbook making it more accessible in 15 indigenous languages. The app will be designed in a way that it will register new moms and babies, which will be immediately linked to a government portal. Every mother and kid should have an account, and the doctors or nurses can fill out the health information in the portal each time they go for a checkup. Thus, a significant data gap for indigenous mothers and their children can be filled, and this information can be used for future research to help these underserved populations. Hence, we will try to build up a strong connection with the health ministry of Bangladesh.

We will aim to build partnerships with nonprofits and UN agencies working who are working on the health sector in CHT for greater impact

Currently, we are not using any technology since it’s in the development stage, but later we will use audio-visual media while we will conduct community awareness sessions. And will create a software and mobile application for the digital version of the MCH book.

We have not launched out solution yet, but we expect to serve 700-1000 mother and children next year

We might face some cultural barriers while implementing the project because the first book won’t contain practices of all 15 indigenous communities.

We would need funding support to implement the project and make it sustainable.

Since many areas of CHT and indigenous people don’t have access to the internet, we have to design the mobile application in a way that it can be easily accessed after being downloaded on an android device without the internet to learn the contents.

We are partnering with Dalla Lana school of Public Health from University for Toronto, International MCH handbook team, the Office of Mong Chief, Khagrachari District (CHT) and other indigenous youth organizations

Our business model will be a subscription business model and we will charge the customers a recurring fee for access to the MUV mobile application instead of a one-time expense for getting access to different services. This recurring fee will be often paid monthly or yearly, and the customer is often given the choice of which frequency to purchase at. Besides providing service, we will keep the minimum subscription charge but a larger target audience. Such as one dollar profit from one family the profit will turn into 1 million when one million families will subscribe to the model!

MCH is a scientifically proven handbook, besides making apps we can print and sell to the local community. 

We will look for sustained donors who support maternal and child health such as Bill and Melinda gates foundation or other local funders in Bangladesh. 

And making a subscription list to receive revenue every month from the mobile application.