LAHORE: In 2014, eight newborn babies died at the Sargodha District Headquarters (DHQ) Hospital on a single day. In the next few days, 21 babies died.

The Punjab government called it ‘criminal negligence’ and launched a probe into deaths.

The hospital appeared to need more staff and facilities such as oxygen tanks, and that babies were brought in too late – usually from private clinics -- and many of them were born ‘weak’, while others suffered because of lack of care.

Sargodha DHQ Hospital doctors said such cases happened all the year round but were not always reported. Infant deaths are not limited to even though it records the highest number (53 deaths per every 1,000 live births). It is then closely followed by Multan (50), Faisalabad (49), Sahiwal (45), and Dera Ghazi Khan (39), Gujranwala (36) and Lahore (35) do not fare any better, despite the latter being an urban centre. Rawalpindi has a record of 26 deaths per 1,000.

A medical staff member of Sargodha’s Maula Bux Hospital says that the situation of pregnancies and newborns in and around the district is grim.

“Women do come for regular checkups, but we also get women from far flung areas who come only once, or only when a situation has become serious,” says the staff officer.

A multiple indicator cluster survey-2017-18 by the Punjab Bureau of Statistics shows that 41, of every 1,000, infants who are born, die within four weeks of their birth, while 60 out of every 1,000 infants die before they even reach their first birthday. Dr Shahida Nazir, senior registrar in the Mayo Hospital, says that there is a lack of awareness among mothers regarding healthcare – their own and their babies’. At birth, she says, neonates (or newborns) are generally not always breastfed thanks to persistent marketing of formula feed.

“It is not just women from the high income groups who tend to rely on formula feed, it is women from middle and lower income groups who are also doing this,” she said. In Punjab only 42 percent of the infants are exclusively breastfed till six months, although this is strongly recommended for optimal nutrition, immunity to diseases and maternal bonding. Early initiation is also rarely practices.

Dr Shahida says malnutrition is a very big factor for neonatal deaths.

At least 1,200 children under five years of age die every day in Pakistan and majority of the deaths are caused by malnutrition.

The second biggest cause for infant deaths from diarrhea, and other waterborne diseases.

Along with this, there is a severe lack of trend of vaccinations, and Dr Shahida says it is much less than what the Government poses it is. While this is how babies are affected directly, a large chunk of the problem lies in the fact that women themselves do not receive proper care during pregnancy.

Access to a health centres, especially in rural areas, is minimal.

There are few trained medical staff present in rural or remote areas.

Haseena Bibi, 35, says in her last two pregnancies, she only took the advice given to her by her family’s elder women.

She did not have any health check up till delivery. Both babies were lost.

Now she is expecting again but is set upon getting regular check ups. Part of the reason is being pushed by a lady health worker from her area. Saima from District Toba Tek Singh says that BHUs and RHCs lack facilities and staff, and it is upto them to spread awareness to women.

“For more than half of the women, good healthcare is a luxury,” she says. “Some families do not allow women to get modern medical advice. Others have to travel great distances in order to get basic medical attention. Most babies are delivered at home in unhygienic circumstances with the help of midwives who know no better. ”

This is where the lady health workers step in, filling in the gap, but these workers have issues of their own transport and access to remote areas.

Published in Dawn, April 4th, 2019