KARACHI, July 28 A persistent lack of government commitment to the cause explains why the country has not yet been able to significantly reduce the number of its maternal and neonatal deaths as many developing countries have successfully done with limited resources.
Donor agencies involved in a number of projects related to maternal and newborn care in the country can never succeed unless the government shows interest. Efficient investment in midwifery is necessary to make motherhood safe. The government must acknowledge midwifery as an independent profession and legislate to raise and secure midwives' status.These were some of the key observations made by speakers at a seminar held to mark the International Day of the Midwife. The programme was organised by the Midwifery Association of Pakistan (MAP) in collaboration with the Pakistan Initiative for Mothers and Newborns (Paiman), USAID-funded project at the Jinnah Postgraduate Medical Centre (JPMC).
Giving some national statistics, Prof Dr Sadiqua N. Jaffery, president of the National Committee for Maternal and Neonatal Health (NCMNH), said around 15,000 mothers died every year due to pregnancy-related complications. Most of these deaths occurred due to the PPH (post partum haemorrhage) within 24 hours of birth.
“Over 50 per cent of the total maternal deaths in the world occur in six countries. Pakistan is at the third number of the list that includes India, Afghanistan, Ethiopia and Congo. The current maternal mortality rate (MMR) is 276,000 per 100,000 live births.
“Of the four million to five million births every year in the country, 250,000 newborns die. Seventy per cent of neonatal deaths take place in the first week of life. Sixty-five per cent of births take place at home by traditional birth attendants,” she said.
The high morality rate of mothers and newborns was directly linked to maternal and neonatal care, she added.
Presenting data on provinces, she said maternal mortality was much higher in rural areas than urban areas (319 versus 175 per 100,000 live births).
“Balochistan is on top (785 deaths per 100,000 births), followed by Punjab (227 per 100,000 births), Sindh (314 per 100,000 births) and Khyber-Pakhtunkhawa (275 per 100,000 births),” she said.
Citing the examples of Sweden, Sri Lanka, Syria, Yemen, Iran and Thailand, she said those countries had strengthened their health system and set an example in successfully reducing maternal and newborn mortality.
Midwifery, she said, was the backbone of maternal care and could effectively save lives of mothers if provided with needed support through medical supplies, a functional referral system and a regulatory mechanism that empowered them to work efficiently.
On Pakistan's progress on millennium development goals on maternal and newborn health, she said the government pace was very slow and if the country moved at the current rate, the goals wouldn't be achieved.
Midwifery — a neglected area
Making a strong case for good quality midwifery practices, Imtiaz Kamal, the head of MAP, said there was a dire need to invest in producing skilled midwives.
“A number of midwifery schools operate in the country. In fact, their numbers are more than nursing schools'. But, unfortunately, I have not yet come across a single girl from these schools who is competent and skilled enough to practise independently,” she remarked.
The reason for this state, she explained, was the absence of midwifery tutors and the lack of opportunities being provided to midwives to harness their skills.
“Generally, nursing instructors are heading these institutes and most students pass their examinations without getting a single chance to handle a delivery at a health facility,” she said, adding that midwifery was an independent profession and must be recognised as such.
“Midwifery can't be learnt in classrooms. I see no hope for a future change unless this approach is rectified,” she said.
Stressing the need for government commitment, she said the association's contributions were like a drop in the ocean and a substantive change could come only with government help.
Dr Shershah Syed, noted obstetrician, strongly criticised successive governments for their apathy towards issues related to public education and health, and said there was little hope things would change at the government level.
“There are simply no tutors for midwifery available in the country. The government has never made an effort to provide midwifery students with proper literature. It was the Pakistan Medical Association that printed books in Urdu for students.
“With the support of foreign donors, around 1,925 midwives from across the country have so far been trained in Karachi. The government has no credit for this. Even the money with which the Punjab government bought books on midwifery from the PMA was given by the UNFPA.”Speaking about government efforts, Dr Sheeba Raza of the NMNCH programme, Sindh, said that so far 256 midwives had been trained under the project and the government planned to train 1,960 midwives by 2012 in the province.
Dr Samrina Hashmi, representing the PMA, spoke about the contribution the association had made to raise the status of midwifery in the country.
JPMC director Prof Dr Tasneem Ahsan, Clara Pasha, currently providing expertise to MAP, Dr Sheeba Raza, deputy director of the NCMNH Sindh, Dr Iftikhar Mallah of Paiman and Amna Mazhar of Ipas, an NGO helping train healthcare providers, also spoke.