August 26, 2004

Villages in Karachi’s suburban areas lack health facilities for pregnant women. Jan Khaskheli reports on the role traditional birth attendants, otherwise known as dais, play in assisting births

Women living in Karachi’s 2,000 suburban villages are without healthcare facilities. Traditional Birth Attendants (TBAs) take care of pregnant women as no skilled nurses are available. Surprisingly, there is no government hospital or NGO in the area to provide assistance to these women.

Only five basic health centres are present in 104 villages of union council Gabopat, Keamari town, but they don’t have maternity wards. “In recent years, 50 women have died in Abdullah Goth and three neighbouring villages.” said Mohammad Khan Bhand, an area activist.

According to reports, two to eight TBAs are present in each village. Murad Bibi, 53, of Abdul Rehman Goth, Hawkes Bay says “I have become a midwife because the community required somebody to help women during deliveries. This is not my traditional occupation. I have acquired knowledge through practice and now have eight years experience. Having facilitated more than 100 women including eight mothers who gave birth to twins,” she understands the complications and can vaccinate the patients. “In case of emergency I go to the hospital along with the patient.”

Parsa, 50, of Ibrahim Hydri in Bin Qasim town, said: “I have 25 years experience. I do not remember how many births I have assisted. I know the traditional methods of treatment for pregnant women.”

Kulsoom, 58, of Dabla Goth, located near Korangi fish harbour, said: “I have been in this field for 34 years and have helped at least 250 expectant mothers. I learned this skill from my mother-in-law who was an expert birth attendant. The people of the area know me well and call me when there is an emergency. I cannot vaccinate or operate. I do not demand money. I accept whatever amount they pay.”

Masi Rukkan, 74, has been in this field since the last 40 years, “I do not remember how many births I have aided but I know that I have a lot of experience as I once helped eight mothers on the same day. My grandmother was a renowned midwife in the area and after her death my mother entered this field. I learned about it from my mother. Headache is a common problem for expectant mothers. I always advise such a patient to be admitted at a major hospital.”

Rukkan has been trained in facilitating birth by two organizations but she doesn’t understand what she has been taught and only practices the traditional mehod of child birth.

Some NGOs have tried to educate the TBAs but in vain as the outcome of training has been mostly unsatisfactory. They do not have equipment to weigh the baby at the time of delivery. They are not able to to learn the right position of babies and how to solve other complications.

Aga Khan Hospital doctors working to implement a mother-care project in the coastal localities feel that the response from the villagers is not encouraging. “People don’t like to go to the main hospitals for treatment and as a result many lives are lost. We provide them vehicles free of cost and ensure them that doctors receive them at the hospital where the mother and child are treated properly, but all that is in vain,” said a doctor.

Hawa Jat, aged 30 of Chashma Goth, was suffering from anaemia and was brought to a local hospital where doctors advised her relatives that she be quickly taken to a proper hospital, but the ignorant parents took her to another private hospital where doctors demanded Rs10,000 for the DNC test. They could not afford this amount and had the test performed by a TBA. She is still in bed and facing complications.

In Ibrahim Hydri, fisherwomen prefer to call a nurse from the nearby government hospital for deliveries. The family pays Rs500 for a son and Rs300 for a daughter.

Saeeda Ramzan, a nurse at a private clinic in Cattle Colony, says it is difficult to portray the real situation existing in the suburban parts of Karachi. “Poor women have to pay a high price all because of the government’s negligence. For instance, 90 per cent people depend on government healthcare centres, which face shortage of medical staff, equipment and medicines. All rural healthcare centres are open only for a few hours daily. If there is an emergency where do these people go if the centre is closed?” said Saeeda Ramzan. She believes that traditional midwives are unable to understand birth complications and hence it is risky to use them for this purpose.

According to a report, on average four million births occur every year in the country. About 80 per cent of deliveries take place at homes and 95 per cent of the deliveries are handled by TBAs while the rest are taken care of by skilled birth attendants. Doctors believe that deaths occurring due to complications of pregnancy and childbirth are strongly associated with inadequate medical care at the time of delivery. This problem can be solved if attention is paid to it by the authorities.

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