Maternal Health in PakistanMaternal health in Pakistan has been a major issue over the years and has consistently shown many negative outcomes. This suggests that the women of Pakistan are not receiving the attention they require in their months of pregnancy. In 2020, the maternal mortality rate was 154 per 100,000 live births. And as of 2021, Pakistan’s infant mortality rate was 53 per 1,000 live births. The prevalence of low birth control, alongside a disorganized medical system, creates an atmosphere of risk and danger for expectant mothers.

Norway-Pakistan Partnership Initiative

Established in 2009 by U.N. agencies UNICEF, WHO and the United Nations Population Fund (UNFPA), the Norway-Pakistan Partnership Initiative (NPPI) aimed to reduce barriers that prevented pregnant women from accessing safe and reliable medical care in the province of Sindh. This involved strengthening health care systems through better support and using flexible financial approaches to improve the provision of maternal health care.

The project ended in 2013 with underwhelming research that assessed the impact of the NPPI. The overarching narrative was that the project had an insignificant effect on the participating communities. Although there have been some improvements, the rate at which pregnant women are accessing health care has only increased marginally. Despite this, reports indicated the following successes from the NPPI:

  • Support for female health workers: The NPPI created functional community networks in 80% of the participating villages.
  • Creation of an incentive scheme: The rollout of a successful voucher initiative saw 35% of pregnant women using the vouchers to seek medical care.
  • Provision of support and outreach services: All female and community health workers received full training in newborn, infant and child health care.

A Decade Later

A decade after the end of the NPPI, checking back in to assess how maternal health in Pakistan has weathered the recent years, especially through the pandemic, reveals the following. Approximately 20% of all deaths among women of childbearing age are due to pregnancy complications, specifically hemorrhaging and sepsis. The COVID-19 pandemic has also profoundly impacted maternal health in Pakistan. With a sudden lack of available hospital beds, many women found themselves unable to access the medical attention they required as they carried to term. Delays in emergency services and poor organization in facilities have also directly impacted increased maternal and infant mortality.

Rurality and Education

An intersection between education and location has also been identified. In a 2019 study, researchers with the National Institute of Population Studies linked low education levels and rural localities in Pakistan with poorer maternal health outcomes. Maternal mortality was 26% higher in rural areas compared to urban counterparts. Additionally, significantly more women in rural areas are less educated than women in urban spheres. About 96% of educated women sought medical care during their pregnancy compared to 50% of uneducated women. These recent maternal health indicators and contributing factors suggest that education and rural access to medical facilities need to be targeted in future interventions to improve maternal health in Pakistan.

National Committee for Maternal and Neonatal Health

Established in 1994, the National Committee for Maternal and Neonatal Health (NCMNH) is dedicated to reducing the high maternal mortality rate in Pakistan. Its goal is to advise policymakers on effective policies that reduce and prevent maternal and neonatal deaths. So far, the committee has:

  • Assisted the Ministry of Health in the development of the Maternal Health Section policy in 2001.
  • Introduced WHO technologies, including post-abortion care in Pakistan.
  • Established a skills lab, or a medical facility that conducts skill training, equipped with modern medical technology to complement the abilities of Pakistan’s medical professionals.

Bakhabar Noujawan Course

Currently, the NCMNH is developing a course to promote and educate young girls on reproductive health. This is a crucial factor that directly correlates with poor maternal health indicators. Aimed at women aged 15 to 29, the Bakhabar Noujawan course involves educating students about how to maintain and navigate reproductive health. The vision is that participating in this course will contribute to these women’s credit in their educational institutions while encouraging them to become more involved in their own health.

Looking Ahead

Despite the persisting challenges, efforts to improve maternal health in Pakistan have shown some promising developments. Initiatives like the Norway-Pakistan Partnership Initiative have supported female health workers, implemented successful voucher systems and provided comprehensive training. Also, the establishment of the National Committee for Maternal and Neonatal Health and the upcoming Bakhabar Noujawan course demonstrate an ongoing commitment to reducing maternal mortality and improving reproductive health education. Overall, these initiatives hold the potential to make a positive impact on the well-being of women in Pakistan and pave the way for a healthier future.

– Ariana Mortazavi
Photo: Flickr

Stillbirths in Pakistan

Pakistan is the sixth largest nation in the world, with a population of more than 193 million and growing. Unfortunately, Pakistan also ranks third in the world for the number stillbirths amongst Pakistani women—43 out of 1,000 pregnancies result in stillbirths.

The majority of Pakistani mothers who experience stillbirths come from low- or middle-income communities where mothers lack access to preventative care. Recently, positive solutions have been developed in Pakistan that will directly impact the health of pregnant women and increase the survival rate of newborns.

What is Being Done?

Preventative care for mothers in Pakistan who live in rural areas is a major concern. In 2015, only 26 percent of pregnant mothers in rural areas made it to at least four antenatal care visits. This number reaches 62 percent for mothers in urban areas, increasing the conversation concerning stillbirths in Pakistan.

The Mother and Child Survival Program (MCSP), with help from the the Pakistani government, recently developed a Family Planning 2020 Program that hopes to bring a balance in health care to families in rural areas in Pakistan. This is a forward leap from the government’s decision to give pregnant mothers cash stipends to pay for preventative care needs such as visits to proper health care professionals, ultra sounds and basic medical examinations.

Initiatives Targeting Stillsbirths in Pakistan

Jhpiego, an international nonprofit organization, joined resources with the Maternal, New Born and Child Health Services in a five-year initiative that provided quality care to mothers in Pakistan. In a report provided in January of 2018, the program was declared a success and moved the country in the right direction to continue lowering stillbirths in Pakistan.

The program first provided updated training to medical staffers, healthcare professionals and volunteers in hospitals and healthcare facilities, which ensured that quality delivery services were provided to expecting mothers. On the community level, midwives and female health workers also received skill development training that helped them meet the needs of local pregnant women.

The program also went as far as assisting pregnant woman with transportation to antenatal care appointments and with emergency obstetrics needs. Under this provision, trained volunteers transported expectant mothers at call. Some served as ambulatory transports. It was reported that more than 2,000 drivers volunteered, providing transportation services to pregnant mothers.

In 2017, Ammi, a program founded by natives in Toronto, set up a voicemail message service that allows mothers in Pakistan to call and get healthcare tips about their pregnancy. The tips range from advice on prenatal supplements to what vaccines to receive. For support throughout their pregnancy, expectant mothers can provide their child’s estimated due date and a service woman will make calls to them during the week with pre-recorded messages that contain healthcare advice and tips.

Where Do Things Stand?

An estimated 665 stillbirths happen to mothers, young and old, in Pakistan every day. The neonatal mortality rate for Pakistani women in rural areas is 62 deaths to 1,000, with 23 percent of pregnancies ending in stillbirth. Fortunately, assistance is growing.

Organizations like MCSP, Jhpiego and Ammi, which continue to provide preventative mother-child health care services and maternal care education to expecting mothers in Pakistan, will go on to deescalate the number of stillbirths. It is of the utmost importance to keep maternal health care in Pakistan in focus until stillbirths in Pakistan no longer become the norm.

– Naomi C. Kellogg

Photo: Flickr

Doctors Without Borders in PakistanSince 2004, the well-known international humanitarian aid organization Doctors Without Borders, also known as Médecins Sans Frotières, has responded to urgent healthcare needs in the Kurram district in Pakistan. Doctors Without Borders in Pakistan focuses primarily on mother and child health and delivering medical care to rural parts of the country, urban slums and areas afflicted by conflict, including isolated tribal areas.

The tribal districts are among the poorest areas in Pakistan, still operating under an extremely harsh legal system implemented by colonizers more than a century ago.

In Kurram, a district within the Federally Administered Tribal Areas (FATA), Doctors Without Borders teams have been providing inpatient and outpatient care for children, treating parasite infections, attending to women during pregnancy and birth and offering emergency treatment services. The organization has been present in the local hospitals, Sadda and Alizai, since 2008.

In Sadda hospital, Doctors Without Borders operated the outpatient department for children under the age of five as well as the inpatient department focused on treating severely ill children up to 12 years of age. In addition, the hospital housed a newborn unit catering to premature babies and complicated births. The organization also facilitated emergency referrals to tertiary care hospitals when necessary by means of ambulance services and medical transfer staff.

The Alizai hospital, with the aid of the international doctors, was responsible for caring for children under 12 in an outpatient department and observation room. In 2016, the Sadda hospital alone admitted 1,946 patients and treated 414 patients for cutaneous leishmaniasis, a skin infection caused by a parasite. 736 children were also admitted to the newborn unit.

Doctors Without Borders in Pakistan has continued to work in this impoverished area of the country amid increased militancy, including American drone strikes targeting members of terrorist groups such as Al-Qaeda. Sectarian militant attacks primarily targeting Shiite Muslims still plague the area.

Local officials have remarked that Doctors Without Borders provided crucial care in areas that have some of the poorest health services and lowest literacy rates in the country. However, despite continued appreciation from officials and patients in these areas for the work of Doctors Without Borders in Pakistan, the Interior Ministry of the country has ordered that the aid organization leave the Kurram tribal region.

Although Doctors Without Borders was one of 25 international aid agencies that signed an agreement with the government of Pakistan formally granting it permission to operate in the country, Pakistan has been cracking down on international aid agencies in recent years. The Pakistani government has cited the medical charity’s failure to renew their certificates to operate in volatile areas, such as the Kurram tribal region, as the reason for asking the organization to withdraw from the area.

Catherine Moody, the country representative for Doctors Without Borders in Pakistan, expressed sadness over the decision to halt medical services in the Kurram district after 14 years of work. Nevertheless, the organization has stated, “We will, as much as possible, continue to provide obstetric and newborn care to the women of FATA through the MSF women’s hospital located in Peshawar.”

Additionally, Doctors Without Borders will carry on offering free outpatient, emergency and maternal healthcare in other FATA districts, as well as care in other provinces of the country while they continue trying to renew their work certification to provide services in Kurram.

Richa Bijlani

Photo: Google