Over 36,000 among 200,000 newborn children in Pakistan lose their lives annually due to premature births, while another over 8,000 babies die because of complicated deliveries. On top of that, about 5,000 neonatal children expire in the first month due to various infections.
Maternal mortality ratio (MMR) is the annual number of female deaths per 100,000 live births attributable to pregnancy related causes. This ratio estimates the probability that a woman will die while giving birth. According to Pakistan Demographic and Health Survey, this rate was 276 in our country in 2006-7. It hasn’t been measured since.
Neonatal mortality rate (NMR) is the number of deaths of newborn children (under 28 days of age) among 1,000 live births. Following are some of the national maternal and child health indicators for 2012-13:
|Maternal mortality rate (MMR) /100,000||276||275||227||314||785|
|Neonatal mortality rate (NMR) /1000||55||41||63||54||63|
|Under 5 years mortality /1000||89||70||105||93||111|
|Infant Mortality (IMR)/ 1000||74||58||88||74||15|
|Skilled birth attendance||52%||48%||52%||60%||17%|
Pakistan did not meet its Millennium Development Goal of lowering the neonatal mortality rate to 40, it being 55 per 1,000 live births. It also missed its target for maternal mortality rate. These aims have now become part of Sustainable Development Goals (SDGs), but planning to achieve these goals is still off track. A maternal, neonatal and child healthcare programme is now being implemented by the federal government in almost every district of Khyber Pakhtunkhwa (KP).
Dr. Hidayatullah, provincial monitoring and evaluation officer of Maternal, Neonatal and Child Healthcare Project (MNCHP) programme, told Independent Project Reporting (IPR) that this programme was initiated in 2006 and a PC-1was prepared to support maternal, newborn and child healthcare and provide facilitation in postnatal challenges.
For the purpose of implementing the programme, the federal government allocated PKR 2,770 million per year for KP as its share from 2006 to 2012. Dr. Hidayat informed IPR that the programme made a good start the first year, but hit road snags during the ensuing period due to problems with funding, of which 50 per cent was granted by the Department for International Development-UK (DFID) and the other half by the federal government.
“During this time, 1,828 women were imparted training through enrolment in 23 community midwifery schools (CMWs). Thereafter, 88 rural health centres (RHCs) and 18 tehsil headquarters (THQ) hospitals were granted basic and comprehensive services,” Dr. Hidayat added.
For this purpose, 106 women medical officers (WMOs) and 106 lady health visitors (LHVs) were hired, but the programme suffered a lot due to lack of funds, the doctor said. He explained that although the training was completed and about 1,637 girls passed their exams from Pakistan Nursing Council, it took them over two years to deploy because only 32 per cent of the total budget up to June 2012 was released. No more training was offered after that.
“Only 1,440 females out of the total number of trained personnel were deployed and are working in the communities. This has contributed towards completing birth stations all over the province, where antenatal, delivery, postnatal and referral cases of a complicated nature are dealt with by trained community midwives. All cases are reported online periodically. In 2014-15, these midwives carried out 26,000 deliveries, while previously these were undertaken by untrained people. Moreover, more than 200,000 checkups of expecting women were carried out, while another 40,000 postnatal examinations were also done,” said Dr. Hidayat.
Thirty-six years’ old housewife Haleema from Khalid Khan Garhi, who has a long and arduous experience of pregnancies, told IPR that unskilled birth attendants did not take care of hygiene during deliveries, because of which many women suffered from heavy bleeding and even lost their lives. But now, doctors and trained attendants take better care of patients’ hygienic conditions, she added.
Haleema, who is illiterate, was married off even before attaining puberty, and is the second wife of her husband. She’s got a record of many unwanted pregnancies, and told IPR that her husband did not believe in birth spacing. Four of her babies died in the third trimester of her pregnancy. Due to psychological and physical problems associated with so many pregnancies and domestic violence, she now wants to undergo hysterectomy (removal of the uterus) to get rid of the problem once for all.
A report by the Department of Health maintains that 59 per cent of deliveries are still being carried out at home by unskilled birth attendants, increasing the risk of maternal and neonatal mortality. The report shows that approximately 800 women die daily from preventable causes related to pregnancy and childbirth, while 99 per cent of all maternal deaths occur in developing countries.
The report reaffirms that maternal mortality is higher in rural areas and among poorer communities. It also points out that adolescent women face a higher risk of complications and death as a result of pregnancy than older women. Skilled care before, during and after childbirth can save the lives of women and newborn babies.
However, 38 per cent of women in KP do not receive any antenatal care (ANC). The situation is worse in rural areas where 42 per cent of women do not avail of ANC. Seventy-three per cent of women from the poorest sections of society have deliveries at home in KP.
Professor Tabish Hazir, head of paediatrics at the Children’s Hospital, Pakistan Institute of Medical Science (PIMS), Islamabad, argues in a research paper titled ‘Tracking Neonatal Mortality Trends in Pakistan: The Challenges and Way Forward’, published in the Journal of the Society of Obstetricians and Gynaecologists of Pakistan (JSOGP), that “Pakistan has the third highest neonatal deaths in the world today. What is more disturbing is the fact that there has been very little change in neonatal mortality in the last 20 years. In 1990 the neonatal mortality in Pakistan stood at 54 per 1000 live births and it stands at 55 according to Pakistan Demographic and Health Survey 2012-13.”
”Although we have made some progress in reducing our under-5 mortality but this trend has had no impact on reducing infant deaths in first 28 days. These trends are worrisome and it is important that we take stock of this situation in order to identify the reasons for this failure to improve neonatal mortality indicators and find practical and cost effective solutions which can be implemented within the existing framework of health services in Pakistan,” he writes.
“If we look at the leading causes of neonatal mortality in Pakistan, roughly one thirds of these deaths are due to prematurity/low birth weight, another one due to birth related complications such as birth asphyxia and third one due to neonatal infections. Roughly these three causes contribute to almost 90 per cent of all neonatal deaths,” quotes the article.
Dr. Tabish believes the situation to be unfortunate because not only these deaths are preventable, but also low cost and effective interventions are available.