IN his recent address to the nation Prime Minister Shuakat Aziz said the maternal death rate in Pakistan would be reduced by imparting proper education to birth attendants and making them more skilled. For some inexplicable reason, it all smacked of political rhetoric. A brief analysis of maternal healthcare in the country would, perhaps, put things in their correct perspective.
More than 300 years ago when Queen Mumtaz Mahal died after giving birth to her 14th child due to severe haemorrhage, her husband, King Shahjahan, was utterly devastated. In memory of his beloved wife, he decided to build Taj Mahal. The king was not aware of many women who were dying on a daily basis because of anaemia, haemorrhage, infection and other such causes. The fact of the matter is, he didn’t much care about the issue, despite the fact that in those days it was unusual for a queen to die while giving birth to a child. And the king spent millions to build a monument to his wife.
Round about the same time, the Americans were building their Harvard University, and in the same period the king of Sweden was spending a massive amount of money to build the School of Midwifery at Stockholm to reduce maternal deaths in the country. In those days, the maternal death rate in Sweden was as high as it is today in Pakistan. The rulers of Pakistan are still not sure about their priorities. It would be a fallacy to think that they’re not aware of the problems of women in our country. They very well know how to deal with them. But, perhaps, they don’t want to learn anything from history.
These days 30,000 young women die during pregnancy. About 400 women suffer from complications like vesico-vaginal fistula, infertility, depression and loss of genital organs. Despite being a nuclear power, Pakistan is one of those five countries where the maternal death rate is highest in the world.
Non-availability of emergency obstetrical care is the main cause of maternal deaths in Pakistan. Our basic health units, rural health centres and taluka hospitals are not functional. Pregnant women living in villages reach these centres in the hope for receiving emergency care. After getting no treatment, they move towards the bigger cities or go back to the DAIE in their villages and die — or have dead babies because of the above- mentioned complications.
In the cities, pregnant women undergo treatment by virtue of the DAIE. In case of any complications, they end up in those maternity homes that are equipped with expensive equipments, but have no skilled personnel to provide the emergency obstetrical care. It is quite easy, and profitable, to construct buildings, complexes and get hold of expensive equipments, but it is very difficult to train people to run such projects. While in constructing such buildings and buying such equipments some people may accumulate a lot of money; but by providing training to the people, you can empower them and improve the system.
It is painful to see young women or mothers of five or eight passing away in front of you. One look at their fear-stricken faces will tell you about the miserable state of healthcare system in Pakistan. It would be an understatement to say that the death of a mother disturbs the whole family.
A few years ago, the then Malaysian prime minister Mahathir Mohamad started providing healthcare at the village level in his country. He ordered that all maternity homes should have basic equipments and highly competent midwives. Once he succeeded in providing resources and health professionals, he ordered that every maternal death be recorded in a ‘red book’. Whenever he visited a maternity home he would ask about the red book. As a result, every maternal death was taken seriously. All deaths were audited. The prime minister never visited any place that didn’t have the required resources and fired doctors, midwives and other medical staff who were not performing their duties properly.
The success story of Malaysia is the success story of its midwives. The country trained them, hired them with good packages, increased their social status and posted them to every village with necessary resources.
Consequently, the Malaysians began feeling proud of themselves among the league of nations. It was never a nuclear power, but had, and still has, the best maternal and perinatal mortality and morbidity rate in the Muslim world, readily comparable with that of the developed countries. Mahathir Mohamad, after his retirement, looks back at things and his people with satisfaction and does not have an inflated ego.
Pakistan needs 60,000 midwives to replace the traditional birth attendants. Such a programme would require one thousand midwifery tutors at well-organized schools. For students as well as qualified midwives, there should be a career structure. A good package/salary must be given to them, and their services should be made available to every pregnant woman in Pakistan.
The pregnant women of this country do not need thousands of half-baked MBBS, glorified quacks who are not trained to serve the people. They need an army of midwives who are ready to work in communities from the Northern Areas to city slums.
The government should take note of how much money it is spending in the public and private sectors to produce doctors. A majority of them, who are competent, leave the country for better options abroad and never come back. The doctors who want to join the BHUs, RHCs and THQs cannot work there because of the empty centres with no protection for doctors and health workers.
If the prime minister is serious about skilled birth attendants, he should exhibit some political will too. All professional politicians and political generals have shown their will by only chanting slogans, and that does not achieve anything. In the last 57 years, in fact, we have moved backwards.
It is high time Prime Minister Shaukat Aziz did something substantial instead of chanting slogans, holding press conferences and making hollow promises. He should prove his credentials by coming up with better results.
