Today, as the world celebrates Mother’s Day, spending millions of dollars on cards, gifts, and flowers, it is worth reflecting on our values regarding rural mothers' lives.
Mothers in the country’s rural areas have been living in horrific conditions for many decades. All one has to do is to read up on the latest statistics available on the country’s maternal mortality rate and one’s doubts about this will evaporate. One in every 170 women in Pakistan has the lifetime risk of maternal death. Each year an estimated 515,000 women die from complications of pregnancy and childbirth and another 15 to 18 million women suffer long-term injuries and disabilities. According to the United Nations Population Fund, Pakistan has one of the highest maternal mortality ratios in South Asia. Without a mother, babies are also dying.
In Punjab, 6,000 mothers die annually due to pregnancy-related complications and around 50% of maternal mortality in Pakistan occurs in Punjab. This was stated in the Pakistan Health and Demographic Survey-PDHS 2017-18.
According to a study published in ResearchGate, situation in Baluchistan is much worse with maternal mortality ratio 560/100,000 lives births and eclampsia being the third important cause of maternal mortality after haemorrhage and sepsis.
A few years ago, according to the officials, some 1,800 women out of 100,000 died due to pregnancy-related complications in remote areas of the Khyber Pakhtunkhwa province because of poor health-care facilities. They also said the Maternal Mortality Ratio (MMR) alarmingly high in remote districts such as Shangla, Buner, Upper Dir and Lower Dir and Fata due to non-availability of trained attendants.Even in urban areas of the province, the MMR, according to officials, was 450 per 100,000 births.
Sindh has been the most progressive out of the four provinces. In 2013, Sindh’s overall maternal mortality rate was 276 deaths per 100,000 live births. However, rural mothers have also been suffering in Sindh because of a weak healthcare setup. The youngest mothers are the poorest and least literate, living in the undeveloped areas where they have little or no access to healthcare.
Maternal deaths occur due to pregnancy-related preventable causes like haemorrhage, hypertensive disorders, sepsis, obstructed labour and unsafe abortions. The ratio of death due to anaemia and consequences of anaemia is high in the rural population.
It is increasingly difficult for rural mothers to reach a hospital and by the time they manage to get there a lot of them put themselves through severe health risks. One of the major reasons behind recurrence of maternal deaths in Tharparkar district is the failure of primary and secondary healthcare resources to provide adequate treatment to the ailing mothers, compelling them to rush to Mithi civil hospital, and thereby stretching its already scarce resources to the limit.
There are two ways to strengthen the health sector, one, a substantially improved public healthcare system and second, better regulation of private entities. A partnership of both ways, however, will be the best. A comprehensive approach is needed to improve maternal health, mainly by improving and upgrading facilities at district hospitals. The lack of professional norms among service providers is the major cause perilously compromising the quality of healthcare in Pakistan.
Most of these deaths — both maternal and newborn — are preventable with the help of evidence-based and affordable solutions. Similarly, precious lives can be saved if there are enough properly trained, competent and supported primary healthcare workers, serving in the communities and in a functional health system. In our villages, for instance, the presence of skilled, authorised and supported midwives and lady health workers (LHWs) can make all the difference. These frontline soldiers have a huge role to play in providing primary health care services and protecting mothers from complications of pregnancy and childbirth.
We need to employ more skilled birth attendants and invest more heavily in their training. In addition, we need to remember that skilled birth attendants cannot function without a back-up support system which takes into account both training and tools.
In the current scenario, it seems that the government alone cannot handle such an enormous burden, therefore many organisations and associations, especially civil society, must come to the fore to boost government endeavours in strengthening the healthcare infrastructure. Non-governmental organisations and civil society can play a role in spreading the message.
The survival rates for mothers in Pakistan heavily depend on the creation of a robust and effective healthcare setup. Therefore, the need for effective strategies for delivery of healthcare to rural women is paramount and requires a study of maternal perceptions and experiences of the healthcare system. Potent measures are essential if we want to increase the quality of care that mothers get in at least some of the more remote regions.
(Kashif Shamim Siddiqui)