Women as mothers - Rural Mothers!
Women as mothers - Rural Mothers!
(Written by: Kashif Shamim Siddiqui)
Mothers in Pakistan’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.
With 157 deaths per 100,000 live births, Punjab has the lowest MMR; followed by KP at 165; then Sindh at 224; while Balochistan has the highest, at 298 maternal deaths per 100,000 live births. The lowest MMR of all regions in the country is in Azad Jammu & Kashmir at 104 deaths, while in Gilgit-Baltistan it is 157. This data indicates that though health services and women’s access to them might have improved in Punjab and KP, leading to the decrease in overall maternal mortality rate, Sindh and Balochistan still have a lot of ground to cover in terms of improving and enabling adequate service delivery in this area.
Deprived rural mothers have badly 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.