Pregnant women in rain-hit areas at high risk
HYDERABAD: Pathani, an anaemic middle-aged pregnant woman, sits in a dingy room of a relief camp of Sanghar — one of the worst rain-affected districts of Sindh — for her medical examination by a mobile team of doctors.
She is expected to deliver her ninth baby. A gynaecologist advises her to take normal and rich diet till childbirth.The advice is not unusual because all gynaecologists give the same advice to expecting mothers for normal childbirth. But for Ms Pathani and her likes it seems extremely difficult because they are facing extraordinary times following a disaster triggered by recent monsoon rains in lower Sindh in August and September.
According to a recent assessment by the National Disaster Management Authority (NDMA), 8.9 million rain-hit people include 240,000 pregnant women and 1.36 million children.
Torrential rains have rendered expecting mothers more vulnerable to malnutrition. They are high risk cases and senior gynaecologists fear that maternal mortality rate might shoot up in Sindh this year because of the conditions these women live in.“You must take regular food daily till you deliver the baby,” Dr Anjum of People’s Primary Healthcare Initiative (PPHI) advises Ms Pathani as she listens to the doctor attentively and calmly in the camp’s room where conditions remain depressing.
”I had normal childbirth so far and hope this one too will be normal. But supply of food remains irregular and we are dependent on what is provided to us here,” she told the doctor.
Under present conditions antenatal (during pregnancy) care of expecting mothers emerges as a big issue for health providers.
Pregnant women with rural background even otherwise turn up in hospitals with symptoms of anaemia, hypertension disorder and social neglect that put them at high risk usually. Recent havoc visiting these rural settlements has led to more complications in cases of expecting mothers.
Chairperson of the department of gynaecology, Liaquat University Hospital of Jamshoro, Prof Dr Roshan Aara, said rain-hit women suffered from psychological trauma too. “Now they don’t have access to normal food. I fear pre-term labour cases among them,” she said.
Malnutrition would haunt them seriously and they were not able apparently to handle it on their own unless a serious initiative was taken (by the government and non-government relief agencies), Dr Roshan Aara said.
“There will be cases of newborns with low-weight due to malnutrition on mother’s part,” she added.
She pointed out that facilities even in tertiary hospitals remained below par even if there was no disaster. “Our hospital-based study indicates that we have 1000-1100 mortality per 100,000 live births among women,” she said.
According to her, 40 childbirths are reported daily at the hospital. “We have only six tables for childbirths,” she said.
She feared that mortality rate in Sindh might go up this year because of serious complications among displaced women.“There will be unsafe deliveries and abortions too,” she said.
Dr Pushpa Srichand, a gynaecologist, is of the view that these mothers would not have access to skilled birth attendants in camps or in tent cities set up in different rain-affected districts. They need to be shifted to tertiary hospitals if possible.
“Nutritional deficiency among mothers leads to high chances of low-weight among newborns and preterm labour can’t be ruled out,” she said.
Often, she added, rural women normally had anaemia and high blood pressure. “Bleeding before, during and after childbirth endangers lives of mothers,” she said. According to her, present situation is likely to aggravate conditions of expecting mothers.
Medical experts and health indicators rate Pakistan among the countries having high maternal mortality rate. As many as 276 women die per 100,000 live births in the country. Some doctors claim the figure is even higher in remote areas. According to them, maternal mortality goes as high as 700-1000 per 100,000 live births in remote areas.
Doctors describe postpartum haemorrhage (bleeding), malnutrition, infection and hypertension as main cause of mortality among pregnant women.
The maternal mortality has also become a social issue that society seriously needs to look into.
Expecting mothers like Ms Pathani continue to depend on medical assistance provided by mobile medical teams or any nearby health facilities, though most of the units are said to be dysfunctional. These mothers are hard pressed to fulfil their requirements of nutritional diet at this stage. Besides, their transportation to teaching or district-level hospital is a big issue.
Such mothers, presently homeless, have a tough time in relief camps. Doctors fear a lot unsafe childbirth this year.