Regarding generalizability of this study’s findings, a number of factors need to be considered. First, long- term exposure of DSS residents to demographic surveil- lance and public health interventions could render the DSS population quite different from other populations in terms of the recall and reporting of information in a survey. However, in our analyses, only one of three indi- cators of such potential “contamination” showed evi- dence of such an effect—98 % of births had complete date information in the DSS area versus 91 % in the ad- jacent non-DSS villages. Though significant, this is not a major difference that would render the DSS population unique relative to other populations. As a result, the study’s findings are likely to be applicable to other con- texts, at least within rural Bangladesh. It is important to note that validation studies like this can only be done where demographic surveillance has been in place for a number of years.
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staffed by medical practitioners . There is anecdotal evidence to suggest that women consider an ultra-sound to be an integral part of an ANC check-up. Private facilities are more likely than public or NGO ones to be equipped to provide ultra-sound services which may be contributing to the recent shift in preference for doctors when seeking antenatal care. However, the poorest three quintiles in both urban and rural Bangladesh were most likely to seek ANC services from the public sector in 2010 when they did seek care. The second largest increase was in use of CHWs, a cadre of outreach workers belonging mainly to NGOs. The threefold increase observed in use of CHWs for ANC in both urban and rural areas is suggestive of an increased use of the NGO sector. These providers have no formal medical training to provide ANC which raises potential concerns about the quality of ANC provided. The prelimin- ary findings from the 2013 Bangladesh Urban Health Survey (BUHS) show that non-MTPs are less likely to provide urine and blood tests and an ultra-sonogram, three out of the five essential components of ANC .
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with an identity rooted in the land. They can recognize and recall their villages by the seasonal smell of the crops, trees, flowers or livestock. As Jackson said, “each fragrance, in its time and season, characterized particular parts of the … [place] and connected those places with specific events and practices important to community life” (2011:608). In this thesis, I highlight the land and struggles for it as a symbol of agrarian or indigenous identity. Whenever the government tried to use agrarian lands as raw material for aggressive development initiatives, especially in northern Bangladesh, the peasants faced state brutality. In spite of that, the peasants never stepped back, but rather showed their political consciousness (Smith 1989:11-12). Land is also important in Phulbari for another reason: that is, class relations in rural Bangladesh are based on land ownership (Chowdhury 1982:6). These relations of production are not only economic; they have deep socio-political roots and impacts. For example, a parcel of land is not just a natural resource in Phulbari; rather it is at the heart of relations between ten to fifteen individuals and the families of owner, sharecropper, wage labourer, retailer, transporter, etc. Therefore, when the land of Phulbari was under threat, all groups in these relations had a strong basis for unity, unlike other movements for electricity or wages. Which acts are resistance? When the majority of a community participates in a movement, it is harder to document which act is not resistance, even after nine years. Seymour thinks individual or group resistance against superior power is certainly intentional and conscious (2006:305), while James Scott argues that everyday resistance can be extended to include informal, invisible or unorganized actions (1985:255). In Phulbari, I found that the protesters avoided the shops of those people who they thought did not support the movement (see page 53). If I had missed everyday informal resistance, I would have misunderstood the movement because subtle daily protests were going on even if there were no demonstrations. Therefore, following Scott’s prescriptions I participated in the daily performances of community life, especially at evening gatherings in tea stalls, and the Friday prayers (Jummah). People from Phulbari usually gather in traditional street tea stalls after the dawn to dusk agricultural activity. People from all classes participated in this social gathering and discussed various social, political, religious, and subsistence matters, which reflected their points of view. In addition, after the weekly Friday prayers, people discussed amongst themselves the burning issues of the previous week and sought to solve anxieties in a communal manner.
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To fully understand the process of change, Chen (1997) details two types of variables: the key participation variables (i.e. demographic profile of the client, household dependency ratio and the economic portfolio mix of the household) which are designed to measure the different levels of contact that a woman might have with various services offered by micro enterprises; and the mediating variables (i.e. social norms such as gender division of labour, gender norms of behaviour and gender allocation of resources), which are thought to affect the direction and strength of the relationship between participation in micro-enterprise services and impacts on individual level. This framework is useful because it reflects the culture and context of rural Bangladesh for measuring women‟s empowerment.
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Our findings show similar higher risks of perinatal deaths associated with APH and probable PIH as reported earlier from Bangladesh  and elsewhere [11, 16]. Mamun et al.  examined the patterns of maternal complications during different stages of gestation and their association with perinatal deaths using data from a community based clinical trial. After adjusting for poten- tial confounders, the study documented that perinatal mortality was 2.7 times higher (95% CI 1.5–4.9) among women who had hypertension during pregnancy and 5.0 times higher (95% CI 2.3–10.8) among those who had ex- perienced antepartum hemorrhage . Two facility based studies, one conducted in South Africa and the other in Northwest Ethiopia demonstrated higher risk of stillbirths with hypertension and antepartum hemorrhage [11, 16]. Allanson et al. reported  that APH was significantly more common in women who had stillbirths (16.3%)
Migration is not a simple process and the way migration benefits individuals and families is never straight forward. It has varied consequence on the lives of migrants and their families left behind. It is hence important to notice the stratified nature of Bangladeshi society in order to understand the impact of migration on individuals and families. The main point of view is that there exists marked difference among people in the society in terms of income, education, skills and opportunities (Rozarioand Gow, 2003). Afsar (1998) observes that whether migration is beneficial for migrants and their families depends on their age, education and gender. At Char Khankhanapur and Degree Charchandpur migration experiences and their effects are not homogenous. As I have noticed, migration means either wellbeing or illbeing depending on individual or family’s relationship with migrants. For instance, while migration can be beneficial for some particular male members of family like father, brothers or sons and female members like mothers, daughters and sisters, it can be a source of disappointment and difficulty for wives, specially who are younger in age. Gulati (1993) has found similar experiences among the rural women of Kerala, India who are left behind by the migrant men to West Asia and to Gulf countries. She shows that often migration seizes younger women’s control on economic assets including the money sent as remittance by their husbands whereas at the same time it provides older women (mothers of migrant men) with greater autonomy in economic terms. She further shows a basic correlation between increased demand of dowry and migration in her study. Siddiqui (2003) also identifies migration as a negative event in the lives of Bangladeshi migrant families in terms of emotional and educational crisis for children left behind and breaking down of stable marriages. To understand the diversified impact of migration on families and individuals at Char Khankhanapur and Degree Charchandpur I have focused on the economic, social and psychological consequences of migration. In the economic sense I have highlighted the changes occurring at the village economy led by the transformation of the agrarian sector. At social terms my point of analysis has been to see how migration affects social relationships and at psychological level I have emphasized on the emotional effects of the process of migration.
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This study focuses on individual level impacts. Therefore, the unit of analysis chosen is individual people, and involves interviews with rural women, ICT trainees and members of ICT projects. This is an effective way for collecting original data and for measuring attitudes and the impact of ICT intervention in women’s life. The research model is designed in such a way that it illuminates all spheres of women’s life and identifies what data to collect for analysis. Taking the concept of women’s empowerment as agency, resource and outcome in mind (Fig. 1), the research model was developed taking the pathways of Chen’s  consolidated framework and Lennie’s  technological change to measure empowerment.
of these important MNH services [24, 25]. However, the nationwide coverage of key MNH services remains critic- ally low, as only 31% pregnant women attend at least four ANC visits, 37% of births occur in health facilities and 36% women receive PNC from a medically trained pro- vider within the first two days after birth . Only 5% of women who give birth outside of a health facility receive PNC from a medically trained provider within the first two days following birth . These figures clearly dem- onstrate that the potential for improving MNH through increasing utilisation of these key services has not been fully leveraged to date and remains one of the keys to ad- vancing the survival and thriving of women and newborns throughout the country. Multiple factors operating at each level of delay in the three-delays model contribute to low utilization of skilled MNH services. Increasing the utilization of these services in Bangladesh will require a comprehensive approach, including efforts to expand the availability of quality health services, while simultan- eous taking action to increase demand for and access to these services. Promoting the involvement of husbands is a particularly promising strategy for overcoming the first two delays: the delay in deciding to seek care and the delay in reaching services once the decision has been made.
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In short, the Safe Motherhood Promotion Project was implemented by the Directorate General of Health Services (DGHS), Ministry of Health and Family Welfare, Bangladesh, supported by Japan International Cooperation Agency. Under the project, a communitybased intervention was designed to study the impact of limited postnatal care (PNC) services on recently delivered women in a rural community. In order to evaluate the intervention, a baseline survey was conducted in June 2010 in six out of eleven randomly selected unions (sub subdistrict) of Monohardi Upazila (subdistrict) of Narsingdi district, situated about 75 km northeast of the capital, Dhaka. All the households of the selected unions were surveyed to identify women who had a live birth within 1 year prior to data collection. The household survey yielded 675 eligible women, of whom 510 (75.6%) had home delivery. This study analyzed the data collected from women who had a live birth at home (n = 510).
Patronage: Apart from agricultural risk sharing practice there is another risk sharing relationship between the rich and poor. In this patron-client relationship, wealthier people provide financial and non-financial support to the very poor in exchange for regular labour and other services (Platteau 1995). Access to credit and transfer of physical assets guarantees the continuation of the relationship as well as risk sharing. Whether such patron-client relationship is redistributive or exploitative depends on the attitude of the patron as the poor clients have very little things to compensate for large contribution of the rich. In addition to labour services, clients may provide other services such as small gifts, transfer of information, and political support. A patron may act benign and paternalistic or very stringent in dealing with the poor. In Ausha, the patron-client relationship is gentle where patrons are generous in financial and non-financial dealings and the poor are sincere in exchange. Group discussants argued that rich people are always supportive, they never charge interest on financial transactions and sometimes they do not ask for repayment when borrowers are extremely needy. In Bhadeshwari, patrons are more professional and they charge interest in financial dealings with the poor. An extreme version of the patron-client relationship is ‘bonded labour’ in which clients enter a long-term labour contract with the master. The common scenario in Bangladesh is as follows. Rich people in rural areas, mostly landowners or moneylenders, provide loans to individuals in difficulty. If the debt is repaid on time, the debtor is free. However, sometimes debt cannot be repaid because of high interest rates (10-15 percent per month) that keep accruing in principal at a compounding rate. At times, the amount of debt exceeds what the debtor can ever hope to repay. As a result, the debtor is forced to sell his land and other productive assets to repay the loan and thus falls into extreme poverty. There is no alternative to selling labour to avoid starvation. In an extreme case, the creditor will seize the debtor’s land and buy his future labour at a very cheap rate until the debt is finished in exchange (Fafchamps 1999). Such an extreme case is non-existent in the villages under study. According to the respondents, “We do not face such crisis. We do not take what we cannot repay.”
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The maternal diet plays a vital role in foetal growth and development, which continues to influence the infant’s health status throughout their life and future generations. In developing countries such as Bangladesh, the maternal diet is limited and malnutrition rates are high, most often due to underlying economic, cultural, political and environmental factors that determine complex human behaviours, including food consumption practices.
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Diversification of livelihood activities minimizes households’ vulnerability to shocks by reducing income variability. Livelihoods of rural Bangladesh is encompass both farm and non- farm activities. This study investigated the patterns and extent of diversification of livelihoods in rural areas of Bangladesh. The study drew a random sample of 500 rural farm households in Bangladesh through a multi-stage random sampling technique. The primary data were collected using structured questionnaires coupled with interview schedules and the data were analyzed using descriptive statistics and Simpson index. Result revealed that remittance contributed highest to the household income followed by business and caste occupation, and rice farming. Furthermore results showed that rural Bangladeshi households have diversified their livelihood activities at medium level. The small and medium landholding households are more likely to diversify their livelihoods compared to the functionally-landless and large landholding households. The implication is that non-farm employment opportunities should be expanded to combat poor households’ vulnerability to shocks and income fluctuations. It is also suggested to give more attention to functionally-landless households for increasing and diversifying their income.
of rural women in different homestead production areas and thereby increase production. Various NGOs are working with the government to enable their patrons and beneficiaries to advance into higher standards of living. Many of them run motivational programs for the women. These programs have become a platform for women to ascertain their rights and voice their opinions. Despite the government’s initiatives to increase awareness, ensure political and social rights, and participate in different income related activities and empowerment my view is that the government should be more sincere, active, and provide proper attention to upsurge the awareness of vulnerable and underprivileged women by totally instigating the initiatives. Cooperation between the government and NGOs can accelerate the improvement of women’s livelihoods. Opportunities are growing for NGOs throughout the developing world to work with governments to improve the quality of lives and help poor women. As women’s attitude was favorable, proper extension strategy may help in boosting homestead vegetable production, which can ensure better nutrition and economic benefits. Hence, homestead vegetable production can play an imperative role in changing social and livelihood issues.
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The study utilized data from a research protocol that was approved by the ICDDR,B Ethical Review Committee, which is an internationally recognized ethics review committee. Data for this study were collected from patient prescriptions (N = 2,587) written by village doctors during 2008 and 2010 at Chakaria, a typical rural area in Bangladesh. The survey involved collection of data on patients’ symptoms of sick- ness, listing of medication prescribed, and village doctors’
The efect size of the PLA community mobilisation on blood glucose is surprising, especially in the absence of major quantiiable changes in behavioural indicators related to diet, physical activity, and care seeking. We therefore did several additional data checks and sensitivity analyses to identify alternative explanations for the observed efects. However, our results are robust to examinations for sampling errors, enumerator efects, measurement biases, and response bias. Furthermore, the observed efectiveness of PLA on mean population blood glucose measures suggests that our indings are not an artefact of blood glucose cut-of values used. The efectiveness of the intervention on normoglycaemic individuals adds to the evidence of PLA efectiveness in the general population and not only high-risk individuals. Overall, therefore, our indings are compelling, but replication is needed in other populations in Bangladesh and elsewhere.
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The present pilot study from a rural community of Bangladesh reports the relationship of taste- perception of the degree of iron present in the groundwater sample and the actual concentration of iron. It further examined the level of agreement between various raters about their perceptions of iron in the water, to determine whether in this setting taste-ratings by individuals has the potential to develop into a reliable tool for assessing levels of iron in groundwater. The study also compared the perception of the villagers of the level of iron in groundwater samples with the actual concentration of iron in the waters, using a modified version of a tool which had been used elsewhere in Bangladesh (Merrill 2009). Our finding of a positive relationship between the villager’s perceived iron level and the actual amount of iron in the groundwater is in agreement with the other studies conducted in Bangladesh (Merrill 2009; Wendt 2016).
When tapping options from kin-based relations become difficult or non- existent, choosing the location of re-settlement with wife’s or husband’s more distant paternal kin becomes an increasingly common phenomenon. reportedly, a good percentage of the current re-settled resident households are uthuli (Indra & Buchignani 1997), and most of them are resident with such kin. Elsewhere in Bangladesh uthuli often have a strong subordinate client relationship to their landlord/patrons. Uthuli is a Bangla word that means landless, partially dependent poor people who had been allowed to place their houses on the land of others rent-free. Landlords demand agricultural labor, household service, and political support in exchange for a house plot. In contrast, over the last generation, uthuli patron-client relationships in mainland Kazipur have become both more common and more reciprocal. They are now extensively used by the poor to provide mutual aid in times of deep personal crisis. More than three- quarters of uthuli-patron relations in Kazipur are between kin (patrons often being little better off than their clients). In contrast to the prevailing patrilineal bias, they are usually dependent on the kinship claims and entitlements of displaced women, rather than those of men. It is found by the field survey that, living on the embankments or as uthuli is a mark of loss of independence and honor, and some women and men feel this stigma particularly acutely. rates of marriage discord and breakup do appear to be markedly higher among displaces (Indra & Buchignani 1997).
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own land, 4.7 per cent among non-agricultural labourers, 4.3 per cent among farm labourers, 4.1 per cent among service employees and the lowest, 2.4 per cent, in the "other" occupational group. As already mentioned, in our study area, and in Bangladesh as a whole, wealthy people generally take an additional wife. It is true to say that businessmen and land owners are the wealthy people in Bangladesh societies. It should also be noted that although most of the women in the rural areas of Bangladesh are described as housewives they spend a considerable proportion of their day in productive agricultural work, performing such tasks as animal care crop processing, etc. (Cain,Khanam and Nahar, 1979:416). Hence probably there is a tendency among the farmers to marry a second wife who will help with agricultural work.
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12. Ronnenberg AG, Wood RJ, Wang X, Xing H, Chen C, Chen D, Guang W, Huang A, Wang L. et al. Preconception hemoglobin and ferritin concentrations are associated with pregnancy outcome in a prospective cohort of Chinese women. J Nutr. 2004; 134:2586–91. 13. Ahmed F. Anemia in Bangladesh: a review of prevalence
As we have seen in the literature review, health care is a service to be provided socially. Social role in provision of this basic service is particularly important in a country like Bangladesh. Substantial resource commitment in this sector is necessary. But the current level of resource allocation seems hardly adequate. Of the total financial outlay,during the Second Five Year Plan (SFYP) period,6.01 per cent is devoted to health, population control and family planning. Share of health is 2.96 per cent. Expected private sector investment is 0.46 per cent. (Table 5.5 shows the sub-sectorwise allocation from 1975-76 to end of the SFYP, 1984-85.) Average annual allocation to health during SFYP period is Taka 119 crores, a substantial increase from Taka 37.33 crores in 1975-76. But given the rate of population increase and the high rates of mortality and morbidity, it is not enough in terms of expensive western-style health facilities. 5.5 Implications for Health Planning
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