March 2, 2006

Maternal mortality is an indicator of women’s status in any country. Pakistan’s rate is one of the highest, believed to be 360 to 600 deaths per 100,000 deliveries, writes Irfan Shahzad

The cell phone’s insistent rings awoke a friend early morning, a few days ago. He was shocked to hear from one of his family members that a cousin had died the previous night, and that the funeral prayers were in the afternoon.

What could have been the cause of her death? He kept asking himself as he drove towards his destination. His cousin had died while delivering her seventh child. More disturbing was the fact that her death was due to sheer neglect.

Throughout her pregnancy, she did not have a medical examination. The belief that matters pertaining to women, like the birth of a child, should be kept within one’s home, prevented her from visiting a doctor.

She was in an age-group where pregnancy becomes difficult. However, until the last stages of the pregnancy, her husband did not even think about taking her to a doctor. He, instead, brought a dai (traditional birth attendant) to manage the childbirth.

“This is an attitude problem,” comments Shazia Sajid, a doctor and social worker. “I have personally come across a number of such cases. Her husband must have been mindful enough that she was no longer of the child-bearing age,” questions Dr Sajid.

The woman who died was one of the thousands of unfortunate Pakistani women who die every year due to pregnancy related complications. There is hardly any reliable data available on the maternal mortality rate (MMR). But it is estimated that one maternal death occurs in Pakistan every 20 minutes.

Maternal mortality is an indicator of women’s status in any country. Though it is not a Pakistan-specific phenomenon, ours is one of the worst cases, with the rate believed to be as high as 360 to 600 deaths per 100,000 deliveries. About 15 per cent of all pregnancies end up in complications.

“Maternal Mortality Rate (MMR) in Pakistan is the highest even by the standards of the South Asian region,” says Dr Mushtaq Khan, head of National Health Policy Unit, Ministry of Health.

Reduction in MMR is an important target within Millennium Development Goals because the issue of women’s health and maternal (as well as child) mortality is closely linked with the country’s sustainable development.

The question is what should be done to tackle this problem? Difficult access to quality maternal and child care services and lack of skilled birth attendants are identified as major hurdles. Majority of those involved in the social sector development, both in the government and NGOs, believe in further raising the level of awareness as the primary requirement.

Khalida Saleemi, Director, Struggle for Change, a Islamabad based NGO supports “door to door campaigns,” throughout the country. “Programmes related to maternal and child healthcare should not be seasonal,” stresses Saleemi.

The sociologist does not rule out the role of Traditional Birth Attendants (dais) altogether. “Dais should be trained properly and provided with necessary items in areas where modern healthcare facilities are not available,” she opines.

Some social workers, however, believe in introducing some kind of punitive measures for the culprits of such neglect. “We have seen the awareness-rut for long. Those not paying heed should be taken to task,” demands one activist.

The government says it is prioritising the improvement of maternal health and child survival. A landmark public health forum entitled ‘Achieving the Millennium Development Goals for Maternal Health and Child Survival in Pakistan’ was organised some time back.

At the conclusion of the forum, a document called “Islamabad declaration” was adopted. In this declaration, the government, with support of its partners, pledged to implement a National Maternal and Child Health Programme, prioritising child survival, neonatal care interventions and skilled attendance. It also called for institutional and management reforms, strengthening of the healthcare delivery system, monitoring, advocacy, community organisation and social mobilisation. One hopes that it just doesn’t end there.

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