The Maternal Mortality Rate (MMR) is a reflection of the health and developmental status of a country. Women in developing countries like Pakistan are 97 times more likely to die as a result of pregnancy, compared to women living in developed societies.
According to current estimates, Pakistan loses 14,000 women during child birth every year, translating into one death every 37 minutes. Eighty percent of maternal deaths are direct and preventable. Well-known causes of maternal death include hemorrhage, followed by hypertensive crisis in pregnancy. These direct maternal deaths can be averted with basic and effective low-cost interventions even in low-income settings.
Pakistan’s MMR is 260 per 100,000 live births. Within Pakistan, Balochistan is the most dangerous area to give birth in – with an MMR of 758 per 100,000 live births.
It is essential to point out that most of this data is coming from government hospitals or the civil registry system, which is not the true representation of community-based population statistics. That data, when included, must be horrendous.
According to a Unicef report, the process of birth registration in Balochistan is the lowest at 7.7 percent, while Punjab is able to register 46.1 percent of its regions births. The dilemma with registering maternal deaths is also not different to that of registering births.
The commitment to the development of reliable civil registration statistics of vital events is essential for the existence of the demographic system. Maintaining a record of vital events is also necessary to establish the judicial status of an individual. Meanwhile, the registration of maternal mortality in a government hospital or in a community is a basic requirement for creating auditable resources, analysing the quality of services and forming a basis for research and future planning from past lessons.
One hopes our newly elected members of the national and provincial assemblies show some sympathy, motivation and dedication for proper funding for registration, data collection, and record-keeping of demographic statistics on an emergency basis. A review of the maternal mortality data is proven to be effective in providing solutions.
Data collection and policymaking are not impossible tasks – nor do they require a special task force. What is required is a sincere, dedicated and motivated approach. Countries like Africa which have a terrible economic status and horrific law and order crisis are still able to produce annual country-level reports on confidential inquiries into maternal deaths. Why do we lag behind?
The worsened health status of Balochistan can be highlighted by the number of health services available to our mothers. Balochistan is far behind in the doctor-patient ratio, with only 2,000 registered doctors to cure a population of 12.3 billion, excluding refugees. Due to no additional resources being added, the refugees – on whom data is sparsely available – also have to avail the existing funds for local communities.
There are only two registered medical universities in Balochistan, one of which is a private institution; the other is the only government medical institute producing doctors. This is in contrast to the 58 registered medical universities of Punjab which have produced 93,287 doctors to cure population on 110 million approximately.
Balochistan currently spends 7.7 percent – Rs18 billion – of its budget on health. That shows the government’s policy on health. By way of comparison, Punjab has dedicated Rs111 billion and Khyber Pakhtunkhwa Rs66 billion of its budget on the health sector.
Maternal mortality is not a problem without a solution. Countries are adopting strategies to improve outcomes and they have started their journey towards achieving the SDGs. Many developing countries have improved their MMRs by retraining and empowering the existing health cadre in pregnancy, labor and postpartum management. Improvement of quality and empowerment of the existing health system resources will produce better outcomes.
When it comes to the delivery of a woman by a skilled birth attendant, in Balochistan only 18 percent women get this chance. That is five times less than Islamabad which has the highest coverage of 88 percent.
More than 80 percent deliveries in Balochistan are done at home, unsupervised and conducted either by trained birth attendants or LHVs. Midwives, health workers, and traditional birth attendants are not suitable substitutes for obstetricians. However, their motivation for working in the rural areas can’t be ignored.
The WHO believes that training for professionalisation and broader use of midwifes can be helpful in reducing maternal mortality. Mid-wifery services are neglected in Pakistan but their registration, training and skill-building as well as proper networking with senior obstetricians is a good option for managing low-risk obstetric cases, referral of high-risk cases and ultimately improvement of maternal health in rural areas.
It is also worth mentioning that, no matter how skilled the birth attendant is, very little can be predicted or done when life-threatening complications give rise to an emergency. For this, Emergency Obstetric Care (EmoC) must be established in each district. EmoC centers must be fully functional, well-equipped with well-trained staff in obstetrical emergency management and should be in the vicinity of essential supporting units like blood banks, laboratories and surgical units. These units should be empowered enough for timely management of high-risk cases or facilitated enough for urgent referral to tertiary-care hospitals. These important steps will vastly improve maternal outcome.
Health in any progressive state is the centre of all policies, and is ultimately linked to the social and economic conditions we live in. Understanding basic problems and root causes, and the struggle and commitment to get solutions and improving the quality and life expectancy of citizens’ lives – as well as ensuring equal and equitable distribution of resources – is the responsibility of the state.
Improving job security and the literacy rate, prioritising the health status of citizens and ultimately adapting to a healthy environment in which we face early-life experiences, all play a fundamental role towards the betterment of society and health. Right interventions at the right time with the right policies can contribute to a healthy society.
The writer is a women’s rights activist and a doctor who works in Balochistan. Email: drsadiaali15gmail.com