Pakistan July 06, 2006 Thursday Jumadi-ul-Sani 9, 1427
Who will save the dying mothers?
By Faiza Ilyas
The reasons for the growing number of maternal deaths are many; the most common among them is the absence of qualified and competent midwives at the time of delivery, since it is neither possible nor necessary for every pregnancy and birth to be managed by a doctor in a hospital
While conflicting opinions and party loyalties have so far prevented female legislators from becoming a strong force to counter discriminatory laws, one can’t help but wonder what has kept these women from joining hands for the cause of safe motherhood in the country.
The fact that Pakistan has one of the highest Maternal Mortality Rate (MMR) in the world should be compelling enough to bring all the female legislators, irrespective of their political differences, together on one platform. Their silence can be attributed to the fact that cases of death from pregnancy-related complications and childbirth –– which claim a life every 20 minutes in this country –– go unreported and thus society as well as the concerned authorities remain indifferent to the menace.
The reasons for the high number of maternal deaths are many, but the major reason is the absence of qualified and competent midwives at the time of delivery, since it is neither necessary nor possible for every pregnancy and birth to be managed by a doctor in a hospital.
A few centuries ago many European countries faced the same situation which developing nations are going through these days. Sweden was the first to prove that professionally competent midwives can bring down the maternal death rate without a high cost and without the use of sophisticated technology. It was realised that maternal health interventions are the most cost-effective investments in the health sector.
This important issue was the subject of discussion at a recently held seminar organised by the National Commission for Maternal and Neonatal Health (NCMNH), to commemorate the ‘International Day of the Midwife’. The speakers included Dr Sadiqua N. Jafarey, senior gynaecologist and President NCMNH, and Imtiaz Kamal, President, Midwifery Association of Pakistan (MAP) who highlighted the major impediments in reducing MMR.
The speakers emphasised the need for qualified and competent midwives to reduce MMR, which is closely associated with inadequate medical care at the time of delivery. To improve the situation, they said, the target area should be the training of dais and traditional birth attendants on scientific lines, as 80 per cent of deliveries in Pakistan take place at home and are handled by them.
“If the country wants to honour its commitments to the UN Millennium Summit Charter, it has to reduce child mortality and improve maternal health. It has to increase the percentage of skilled birth attendants from 20 to 90 per cent by the year 2015. The critical areas are the provision of skilled birth attendants (SBAs) for home deliveries, competency-based skill training of all birth attendants including doctors through a process of continuous professional development and an efficient health structure,” said Dr Jafarey.
Pointing out the reasons for the country’s failure in reducing MMR, Kamal informed the audience that for almost four decades midwifery education has not been given the attention that it deserves, with the result that today, despite having 156 midwifery schools in the country, there are hardly any competent midwives.
She said that the government received a great deal of funding from foreign donor agencies for the training of thousands of traditional birth attendants in the past, but the money went down the drain as there was no regulatory mechanism to supervise the midwives’ performances after training and they soon went back to their old methods. Secondly, schools of nursing and midwifery were opened without a proper curriculum, trained teachers, plans for their utilisation or a career structure. With such handicaps they could only serve as a source for cheap labour.
“Using students for services, and giving them monetary compensation in the form of stipend are two unfortunate legacies inherited from the pre-partition era which still continue. There is no future for a midwife even today in the government service as she starts and retires in Grade 6,” lamented Kamal.
She also elaborated upon some of the initiatives taken in recent years in the field. These include a situation analysis of midwifery training in Sindh and Punjab; commemoration of the International Day of the Midwife since 2002; formation of the Midwifery Association of Pakistan and active management of the third stage of a Labour Project being implemented in seven large institutions of Sindh and Punjab.
“The challenges ahead include analyses of the midwifery curriculum to make it client-centred and skill-based, a serious look at PC-I for community midwives to ensure competency-based training, immediate attention to train proficient teachers, approval of regulatory mechanisms for the practice of midwifery, sanctioning and appointing of teachers in all midwifery schools, developing mechanisms at the provincial level to regulate the education and practice of midwifery, and last but not the least, strengthening of health facilities as no midwife can save a life if she does not have back-up support of emergency care (obstetrical and neonatal),” she said.
Addressing the gathering, Marie Skarie gave the details of the USAID-funded project, ‘Pakistan Initiative for Mothers and Newborns (PAIMAN)’, under which community education and healthcare training would be provided to more than 2.5 million people across the country and support would be extended to rural health centres and hospitals in 10 districts of the four provinces. In Sindh, seven NGOs have been funded for the project.
One hopes that this project does not meet the fate of past projects and contributes a little towards materialising the dream that every mother has a healthy child and every child has a healthy mother at the end of each pregnancy.