ISLAMABAD, Jan 15: The UN agency for children has said that asphyxia -- an infant’s failure to begin or sustain breathing -- has become the leading cause of newborn deaths in Pakistan accounting for 88,000 deaths a year.
The State of World’s Children Report 2009 launched here on Thursday revealed that despite progress made in reducing deaths of under five, Pakistan was still in the unenviable company of countries with the highest rate of newborn deaths, ranking eighth, just behind Iraq and Afghanistan in Asia, with 216,000 babies dying within the first month of birth.Unicef’s representative Martin Mogwanja said the report was important for Pakistan because it focussed on two of its “most difficult and most important problems: the survival of mothers and the survival of newborn babies”.
Besides asphyxia, which has become a serious problem in the country because of births occurring outside healthcare facilities and where birth attendants are not trained in newborn resuscitation, other major causes of death include infections (20 per cent), pre-mature births (16 per cent) and pneumonia.
Although all these causes are difficult to handle, asphyxia stands out as the most complex and challenging problem. When newborn asphyxia occurs, the time for resuscitating is extremely short -- within the first two minutes after delivery. The remedy, therefore, is the presence of a highly-trained person during the birth, who can attempt resuscitation if such a situation arises.
For prevention and mitigation, the report stresses hygiene and good nutrition for mothers and birth in the presence of skilled attendants.The report said: “Among the major reasons for newborn deaths is that mothers do not get skilled care during pregnancy and childbirth because of lack of knowledge, lack of access to services and the low status of women in society contributing to harmful practices such as early marriage -- an important cause of premature birth.”
Early pregnancy is also a factor in low birth weight and premature birth -- both major causes of newborn death. Babies whose birth weight is less than 2.5kg have a 68 per cent greater risk of dying before their first birthday than those whose birth size is average or larger. The probability of dying in early childhood is also much greater if children are born to mothers who are under 18 and if they are born within 24 months of a previous birth.
Unicef’s report also links newborn survival to parents’ place of residence, province, income and education level. Under-five mortality rate is 28 per cent higher in rural areas than in urban areas. Similarly, babies born to uneducated mothers are nearly twice as likely to die as newborns compared to mothers who have received higher education.
The report also dwelt with the problem of maternal mortality, saying it had important bearing on new born deaths.
“It is increasingly clear that there is a close link between the health of mothers and children. In fact, if a baby loses a mother during the first six weeks, it is much more likely to die before its second birthday. Healthy mothers have healthier babies, and educated, empowered mothers can take care of themselves and their children most effectively,” the Unicef representative told reporters.
“One in every 89 Pakistani women dies due to causes related to childbirth, compared to one in 8,000 in the developed world,” the report says, adding that this brings the total to 10,400 maternal deaths every year. Pakistan has a maternal mortality rate of 276 per 100,000 live births.
The mortality figures vary greatly between urban and rural areas and also between the provinces. “There is a huge imbalance in these figures. In Balochistan, for instance, the maternal mortality is 785 deaths per 100,000 live births. This is nearly triple the national rate of 276 deaths per 100,000 live births. In rural Pakistan, the maternal mortality is nearly twice that in cities,” Mr Mogwanja said.
Besides deaths of women because of pregnancy or childbirth complications, for every mother who dies, 20 women are left suffering from severe injuries and lifetime disabilities such as fistula. This takes the disability figure among mothers to staggering 200,000 every year.
The Unicef representative criticised low spending on healthcare, especially on maternal and newborn healthcare.
It is estimated that quality basic health services need a per capita expenditure of at least $45 per year. Pakistan spends only $18 on health per person per year. Of this, only $4 is public expenditure, the rest is private.
The burden on the poorest parts of society, Mr Mogwanja said, was huge, and a medical emergency could leave families destitute.
Even the meagre amount set aside for health is not spent properly.
“Lack of supplies and equipment, absenteeism and inadequate training create a vicious cycle in which even meagre services don’t serve as many people as they ought to. Add to this lack of awareness, inefficiency and lack of accountability in both public and private health sectors, and we see why 72 per cent of women don’t get the four recommended antenatal check-ups, and 39 per cent don’t even go for one. Three-quarters of women don’t get any trained post-natal care in the critical first seven days after delivery, when most maternal and newborn deaths occur,” he said.
Deteriorating security caused by displacement and affected access to medical services, especially in areas of the NWFP and Fata, had further complicated the situation, the report says.
