my first delivery at the city hospital, women from my village questioned me
with surprise that why did I go to the city hospital for the delivery when it
was possible at home? They said that if they could have deliveries at home, why
said 25-year-old Shabnam* to me. For Shabnam, who lives in a village of Sindh
province, delivering babies in a hospital is a privilege that most other women
living in the same village do not have. She belongs to a family that has their
own transportation and can afford the expenses to take women to well-equipped
hospitals in big cities. For the majority of the women, delivering babies at
home and seeking the help of unskilled midwives is a common and affordable
half of Pakistan’s entire population lives below the poverty line, with women and children suffering the
worst in this scenario.
Also read: ‘Millennium
goals missed because of low savings’
Pakistan’s key social indicators – education and health – have been showing
progress over the years, the maternal, infant and child mortality rates still
do not meet the 2015 MDG target.
on all levels has witnessed gradual decline, yet the curbing of infant
mortality rates has remained a hard nut to crack, staggering way behind the
year 2014 came with adverse influence of the problems that Pakistan has been
facing for a long time now. Amid the web of natural disasters and terrorism,
Save the Children (UK) declared that Pakistan has the highest first day deaths and still births in the world — another blow to the country's failing
report further disclosed that about 40.7 per 1000 babies are either still borns
or die within 24 hours of their birth, due to lack of available skilled care,
one of the reasons which has exacerbated the situation in rural areas where the
majority of the country's population lives. This unskilled care comes from
local elderly women calleddaai(s), who are usually
illiterate and lack scientific training.
obvious fact is access to health and education in villages depends on the
village's proximity to these facilities. The more isolated the village, the
more are its people dependent on daais. But even in the case of villages not too far
away, the proximity is not helpful if they are not physically connected with
Read on: Health managers
‘lack’ knowledge of neonatal mortality issues
main cities in rural areas are supposed to be connected with villages via a web
of connecting roads, but this web is very weak in rural Sindh, where the
majority of villages are deprived of proper roads. As a result, transportation
becomes almost impossible, blocking the flow of social services into the
villages and constraining villager’s lives.
situation is even worse in the northern districts of the Sindh province, known
for having a rigid and tribal culture where tribal clashes are common. Dr
Safiullah, who had been working with Save the Children (US) as a medical
officer in Shikarpur district until September 2013, narrated the situation:
"During my job in STC, my team and I encountered several
problems in accessing villages without 'pakka' roads – we could never reach the
villages that did not have any roads at all. Although those villages were not
very far from us, the absence of roads made our access impossible.
"These cut-off villages have a very conservative culture
where women are not taken out for healthcare; neither can any doctor or nurse
visit them, as there is no pathway to reach these scattered communities."
Explore: Fatal conception
Maternal, Neonatal and Child Health (MNCH) program has been launched to address
the deteriorating situation of maternal and child health in Pakistan. Funded by
the government of Pakistan and other renowned international organisations such
as DFID, USAID and UNICEF, the programme has been showing progress in terms of
capacity building, particularly in the Sindh province.
very first cohort of 1500 community midwives has been deployed in different
areas of Sindh. These midwives are trained through intense training of
anti-natal, natal and postnatal care from registered nursing schools and are
ready to undertake the practice in their own communities after receiving their
Sahib Jan Badar, the provincial head of MNCH program in Sindh is very hopeful
about the future of the MNCH program, she elaborated the current ongoing
efforts to control first day deaths:
MNCH started five years ago, we just had nine nursing schools, now the number
has reached to 25, which is very encouraging. Almost every district has one
nursing school in order to train local women as midwives. Once our midwives are
ready to practice in their respective communities, we provide them with the
birthing station – a small labour room – at their houses.
equipment in the birthing station is provided by the MNCH program. Our midwives
are also trained in dealing with umbilical cord infections, the second most
prevalent cause of first day deaths. Some of our midwives deliver 40 babies in
a month without any death. We also train our midwives to document all
deliveries and keep a record. They are required to send these records every
month and we maintain it online."
See: Thar deaths,
scary diseases overshadow health legislation in 2014
the biggest challenge to the MNCH program is still the same: to reach out to
the scattered communities in the rural areas where, due to a lack of literacy,
it is difficult to recruit educated young women – the basic selection criterion
program also requires sustainability; patronage from the provincial government,
provision of vehicles and other relevant facilities, as well as monthly
salaries to midwives. This is how the targeted pool of midwives to spread
services to vast areas can be ensured.
changed to protect identity