By Juliette Terzieff
Sunday, August 22, 2004
Pakistan's high maternal mortality rate is a reflection both of the lack of hospitals throughout the country and the low status of women. A new government plan seeks to remedy the lack of medical care in rural areas.
MUZAFFARGARH, Pakistan (WOMENSENEWS)--When complications arose at the end of her second pregnancy, Fatima Khan became the first woman from her extended family to seek out medical treatment from a hospital
"Like my mother-in-law, mother, and aunts, I gave birth to my firstchild at home," the 29-year-old says cradling her younger son, Inam, now 2-years-old, in her arms. "But the second time, as soon as the pains started, I knew something was wrong."
On top of excruciating pain that far exceeded her first experience with birthing, Khan began bleeding and running a very high temperature.
Fortunately for Khan, her husband had seen government and aid organization advertisements in newspapers and on television extolling the benefits of modern medicine and agreed--over his sisters' objections--to seek out trained medical professionals.
When she arrived at a hospital in Multan, about an hour away from her home just outside Muzaffargarh in the Punjab province, she was seen quickly by the doctors. They soon realised Inam was in breach position and immediately ordered a Caesarean section.
"All the doctors and nurses were very kind and helpful. They behaved in very proper ways . . . and if I know anyone who is having problems I will tell them to go for care," Khan says.
Khan and her family may be convinced of the benefits of modern medicine, but they are in the minority in a country where traditional belief holds that birthing is best done at home. The belief, which is particularly strong in rural areas, contributes to the country's high rate of maternal mortality and is a reflection both of the lack of hospitals throughout the country and the low status of women. But a new government plan seeks to remedy the lack of medical care in rural areas with new hospitals, mobile clinics and public awareness campaigns.
"In rural areas, you will find only a handful of women who seek care outside of the home," says Lahore-based social worker Humaira Quereshi. "Not only over possessive men, but also elder females in families are highly resistant to turning their young women's private matters over to outsiders."
United Nations figures published in 2001 indicate that 515,000 women around the world die annually from preventable maternal causes. As a region, South Asia, home to 155,000 of those annual deaths, ranks second only to sub-Saharan Africa.
"For every woman who dies, approximately 30 more suffer injuries, infection and disabilities in pregnancy or childbirth. This means that at least 15 million women a year incur this type of damage," says a United Nations Children's Fund report.
Estimates of Pakistan's maternal mortality ratio vary wildly from 340 per 100,000 births up to 700 per 100,000 births, with rates significantly lower in the urban areas. Health workers here estimate that around 30,000 women a year die from pregnancy related causes.
That means 1 out of every 38 women will meet her death as a result of pregnancy.
"Generally speaking the position of women is very low, especially in rural areas," says Ome Kalsoom Seyal, chair of Social Youth Council Of Patriots, a community based nongovernmental organization working to raise literacy rates and promote health issues among central Punjabi females.
"Women are often prisoners in their homes. They have to wear what their men buy them, cook whatever food the men bring home, and rarely, if ever, leave the family's compound or farm," Seyal says.
In the villages of central Punjab where Seyal's organization works, female literacy is a dismal 10 percent and less than 5 out of every 100 women receives professional medical treatment during or after pregnancy.
As a result, in the villages outside Muzaffargarh, an average of 20 women out 100 will die or suffer debilitating physical repercussions from pregnancy or childbirth.
Like most health workers in Pakistan, Seyal believes illiteracy and ignorance are the largest hurdles preventing women from getting proper treatment.
"Some men will simply say 'it was written that she should die' and even if the wife had been taken to hospital doctors could not have changed God's will," she explained. "By contrast, most of the women understand the perils of their position but family and social pressure are against them . . . and even when they can convince their husbands that medical attention is necessary there are no local hospitals for them to go to."
Complicating the decision process is the lack of available hospital and clinics in Pakistan's rural areas. In the remotest areas of Balochistan and Northwest Frontier Provinces the closest hospital can be a 100 miles away.
"Especially in very poor villages we hear a lot of the men saying they simply don't have the resources to get their wives to a health care facility even if they wanted to," Seyal says of research conducted by 84 of her organization's volunteers. "Provision of health care facilities is the single largest need expressed."
But relief may be on the way.
Some 70 percent of Pakistanis live in rural areas where less than 30 percent of births are attended by trained health care providers (lower even than sub-Saharan Africa where the percentage is 42). To address this problem, the Pakistani government, with help from the United Nations, announced earlier this year a four-year, $30 million dollar Country Action Plan that will include measures to address the issue of access to proper health care.
Beside building hospitals in rural areas, the plan envisages creating mobile health units to travel into difficult-to-access areas, public awareness campaigns, and training workshops for community-based midwives and health care workers.
"We're talking about an issue where 99 percent of the deaths are preventable, so this something that the government should be watching very carefully and acting upon," says social worker Quereshi.
Seyal agrees: "The stakes couldn't be any higher. We're talking about securing our future."
Juliette Terzieff is a freelance journalist currently based in Pakistan who has worked for the San Francisco Chronicle, Newsweek, CNN International, and the London Sunday Times.
The Takemi Program in International Health
at the Harvard School of Public Health--
"Reducing Maternal Mortality Amongst Poor Pakistani Women In Urban Squatter Settlements: An alternate strategy"
(Adobe PDF format):
Journal of Ayub Medical College--
"Analysis of Maternal Mortality in A Tertiary Care Hospital to determine causes and Preventable factors":
New as of October 2003: Maternal Mortality in 2000 - Estimates Developed by WHO, UNICEF and UNFPA:
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