Alhadine Ahmed, 28 years old, visits the Government Health Clinic in the village of Babrio Jat, Thatta, Sindh, Pakistan on July 2, 2011. She is 9 months pregnant. Her 7 month old child died of diaherra. She is at the clinic because she is malnourished. She walked 2 hours to the clinic. – Sam Phelps/Dawn.com

Beads of sweat trickle down Havi Ameen’s face as she sits silently observing what’s going around her. The 22 year old is heavily pregnant but it’s hard to tell because her belly is so small. She shifts her dupatta to cover her stomach as women and children swirl around her.

When Havi starts talking she becomes animated and uses her hands a lot, her eyes dance around the room as she explains her points forcefully. It’s as if she’s been waiting for a long time to speak, waiting a long time for someone to listen to what she has to say.

“We women loose sleep when we hear we are pregnant. We should be happy, but we know the reality of having a baby, we have to do everything by ourselves,” says Mavi.

I am in a remote village in Bassrio Jat To in Misri Baran, an hour away from Thatta, Sindh, visiting the only medical clinic in the area for miles and miles. The clinic is run by international health organisation Merlin in response to the 2010 floods in Pakistan. Before the floods people in the area had not seen a doctor for years, unable to afford transport to travel to Thatta for healthcare.

The clinic is heaving with women and children seeking treatment for malnutrition and health check ups. On average 200 patients a day attend the clinic. Almost all are women and children. The atmosphere is intense and the air heavy as more and more people arrive squeezing in to any space they can find in the clinic. Mavi is keen to tell me more about her life

“I gave birth to 10 children but only seven survived. I am eight months pregnant. I am weak from being pregnant. We are uneducated people, we feel this a lot. We don’t have any way of making a proper living, of sending our children to school. My husband says so what if we are poor, if Allah provides us with children, Allah will provide us with food for them too. I’m tired of having children and if I had my way I wouldn’t have anymore.” Women around Mavi nod in sympathy and tell her they understand how she feels.

Women wait to be attended by health workers at the Government Health Clinic in the village of Babrio Jat, Thatta, Sindh, Pakistan on July 2, 2011. – Photo by Sam Phelps/Dawn.com

Women in rural Sindh have little control over their lives. Due to poverty families prefer to marry their daughters off once they hit puberty, the crude reality is a married daughter is one less mouth to feed.

Dr Asmat, Merlin’s Country Health Director says early marriage and multiple pregnancies are taking a heavy toll on women’s health.

Women face complex health problems. The health issues are interlinked with a lack of access women have to education, employment, basic human rights and freedom.  As a doctor I approach health issues holistically. I’m working to put in place interventions that will have an immediate impact on improving women’s health and lives.”

Merlin in collaboration with district health authorities is implementing an integrated health and nutrition program with a focus on setting up Reproductive Health services to address nutrition and health needs of mothers and women. The organisation has prioritised focusing on antenatal and natal healthcare and improving the skills of birth attendants so they know how to deliver babies safely.

Family planning programmes have been rolled out across Pakistan for many years in the Punjab and even in KPK. Women openly discuss the issues with their husbands and the women in the family. This is not the case in Sindh.

Dr Sakeena Jaffri is a gynaecologist but now works with Merlin as a nutrition specialist. “On average a woman will give birth to seven children. Not all the children survive, some may die in the womb, and others are born stillborn,” she says.

“The women are weak, they don’t have enough food to eat and their bodies are unable to cope. I think in order for things to change women need education. When I talk to women they are eager to learn about how to improve their health and the health of their family,” she adds.

The women trust Dr Jaffri, they tap her on the shoulder trying to get her attention, and others wait quietly to talk to her. “A woman will wake up at 6am and have a cup of tea and then head off to the fields where they work for hours and hours. They return home and walk to collect water. They carry the water back and then they return to the field and work for the rest of the day. In the evening they may eat one roti with potato or chilli or lentils. The women will eat after they have fed their husband and children.  This is the reality of many women’s lives here,” she explained.

Literacy levels are low in rural communities and it’s very rare for a village to have a school. A group of women surround me and talk passionately about their desire for their children to attend school and have a better life than the one their parents have provided for them. I’m struck by the anger in their voices “Our lives will only change if we have a school in our village. We want more for our children than what we have. Our condition will only change through education,” says one woman.

Shaista Aziz is a freelance journalist.

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