Health care facilities for women and children in Balochistan are dismal. The provincial government has declared a nutritional emergency in the province. You! takes a look....
In Pakistan, thousands of women and infants die each year from medical conditions that are easily preventable. In the south-west province of Balochistan, which has some of the worst health statistics in the world, the situation is particularly dire. Access to health care and health education in the province, particularly for women and children, is extremely limited, and the province’s maternal mortality rates are the highest in the country. According to Pakistan Demographic and Health Survey 2018, only 56 per cent of the women in Balochistan receive antenatal care from a skilled provider and only 38 per cent of the births in Balochistan are assisted by a skilled care provider. Almost every second child (over 47 per cent) in Balochistan is stunted and less than one-third of children in the province are likely to receive all basic vaccinations. The Balochistan authorities declared a nutritional emergency in the province in late 2018. Earlier in the year, a National Demographic and Health Survey found that 47 per cent of children in Balochistan showed evidence of stunting, a condition resulting from impaired growth and development that children experience as a result of poor nutrition, repeated infection, and inadequate psychosocial stimulation.
Medecins Sans Frontieres / Doctors Without Borders (MSF) is one of the largest international healthcare providers in the province. It has been working in Balochistan since 2001, currently operating medical projects in four districts - Naseerabad, Jafferabad, Killa Abdullah and Quetta. Focusing on mother and child healthcare, MSF provides obstetric and gynaecological services to mothers, runs paediatric and new-born wards and offers treatment to malnourished children. The organisation assisted over 10,000 births and treated more than 11,000 malnourished children during 2018 in Balochistan.
MSF’s health promotion and counselling teams work with the medical teams to educate people on the importance of seeking timely healthcare for women and children, and to discourage harmful practices that are medically unsafe. Since 2008, MSF has been working in the eastern districts of Jaffarabad and Naseerabad supporting nutrition programmes for children under five years old in the District Headquarter Hospital in Dera Murad Jamali. MSF also has a network of mobile clinics and outreach sites across the two districts. MSF teams support inpatient therapeutic feeding for malnourished children with complications, a general paediatric ward, and a neonatal ward. MSF also supports mother and child health activities in the District Headquarter Hospital and basic emergency obstetric care is provided through the birthing unit, which is open 24-hours a day. Through health education sessions, MSF teams share knowledge on preventing medical conditions and seeking timely healthcare when needed, especially during pregnancy.
“Malnutrition is a serious issue that is aggravated by poor health-seeking behaviour, lack of social protection, extreme poverty, conflict and displacement. It must be addressed in a holistic manner that extends beyond MSF’s mandate,” said Pylypenko Tetyana, medical coordinator for MSF in Pakistan.
There is a large number of women in Balochistan who live in extreme poverty and cannot afford to feed their children properly. You! got an opportunity to talk to a few women who share their heart-wrenching stories with us. Their sheer state of helplessness clearly shows the callous attitude of the authorities towards the habitants. Hats off to organisations like MSF who are doing their part by creating awareness among women and also by providing medical aid to the sufferers.
Green tea, black tea and other herbs can be very harmful to new-born babies as their fragile digestive systems cannot handle the acidity. However, it is common practice in Naseerabad and Jaffarabad districts to feed new-borns with herbal teas.
Arish was born in October 2018 at the MSF birthing unit in Chaman district headquarter hospital, Balochistan. He was discharged in good health. Just four days after his birth, however, he was back at the hospital in severe condition. His mother, Malaika, was unable to produce enough milk to feed him. “When my son Arish was born, I couldn’t feed him, I gave him green tea instead. My mother-in-law said it was the best thing to do and that’s also what I had done with my other eight children,” says Malaika, a poor mother. According to Malaika, in the past her new-born children would fall ill after she gave them green tea and some of them developed pneumonia, but they recovered, sadly in case of Arish things got out of hands. When Malaika realised there was something wrong with Arish, she took him to a private clinic before bringing him to MSF. On day six, Dr. Farman, a paediatric consultant with MSF, advised that Arish’s parents receive counselling to prepare them for the worst. However, a few hours later, Arish passed away.
“You would be surprised by how common such cases are,” says Dr. Zialullah, who works at MSF’s facility at DHQ Hospital. “It’s so sad that people still follow age old customs and have wrong perception about so many things. I actually don’t blame them as they are ignorant and need to be informed what’s good for their babies. They use black tea and green tea as go-to remedies for everything, from burns and cuts to feeding babies.
“When Arish came to us his condition was critical. Normally after a baby is born, they lose around 10 per cent of their body weight in the first week. In Arish’s case, he lost 50 per cent, unfortunately he couldn’t survive,” he laments.
Undernourished moms give birth to sick babies
130 kilometres north of Quetta on the border with Afghanistan, MSF supports medical services for women and children, including reproductive, neonatal and paediatric healthcare. MSF medical staff offers free, quality medical care to local residents, Afghan refugees and patients who cross the border seeking medical help.
Born in Afghanistan, 25-year-old Madeena moved with her family to Chaman, Pakistan, when she was 10 years old. One of 14 children, her parents couldn’t afford to send her to school. She was married off to her cousin when she was only 14 years old.
“I became pregnant as soon as I was married but due to a premature delivery, I lost my first baby in my seventh month,” tells Madeena.
Madeena soon fell pregnant again, delivering her first baby at a tender age of 16. Her next four children were born consecutively, with no gaps. At 22, Madeena delivered a premature baby who didn’t survive. Three years later, she came to the MSF facility to deliver twin daughters, Safa and Marwa, who were born with Down syndrome.
“I live in a house with 25 people. My husband is unemployed; my eldest child is only nine years old. What can she possibly do to help me at that age?” she says, adding that her family house has no access to running water. Safa and Marwa have been admitted to MSF’s facility with severe malnutrition. Having been fed milk mixed with dirty water for the first six months of their lives, the twins have developed a history of chronic diarrhoea.
“A good number of women do not know how to wean their child properly and that results in malnutrition. These women are extremely poor, shoulder the child caring responsibilities and have too much to do, which does not allow them to give adequate attention to their new-borns,” observes Dr Muhammad Iqbal, a medical officer in the paediatric and nursery ward at MSF.
No control over their bodies
Gulshan’s story is the story of nearly every woman in Balochistan. 40-year-old Gulshan from Dera Murad Jamali has recently given birth to her 10th child at the MSF facility. She is one of the hundreds and thousands of docile women who have no say in domestic affairs and cannot take a decision. Unlike urban women are pretty much aware of their rights, these women are ignorant of their basic rights and have no control over their bodies and nobody asks them whether they want children or not. In fact, they are conditioned to give birth to children as soon as they get married. Gulshan was married as soon as she reached puberty - the time when women in Balochistan are usually married off.
“I have been married for 25 years now and I started having children immediately,” tells Gulshan. “Two of my sons work and one daughter is married with two children of her own, but the rest are still quite young,” she adds.
“This is the first time in her 12 pregnancies that Gulshan has come to the hospital,” states Gulshan’s mother. “Last year she lost her baby in the eighth month of pregnancy. Five months later when she became pregnant again, we noticed she became very weak, which is why we thought it was better to bring her here for the delivery,” she informs.
“I lost my two babies because I was undernourished and fragile. My diet consists of potatoes and lentils. And I hardly get to eat meat. After serving my large family, I usually end up eating leftovers. Despite all that I am expected to give birth to healthy children. My family is least bothered about my health. They only care about how many more children I can give birth to. Sometimes I feel as if I am not a human but just a child-producing machine,” says Gulshan with teary eyes.
All men and women are entitled to have basic human rights including the right to decide whether they want children or not. But women in Balochistan are even deprived of their basic rights. In places like Dera Jamali people treat women as commodities and they are not viewed as humans. This is a sorry state of affair. Though we live in technological era, when we look at the pathetic health conditions of women in Balochistan, it seems as if we still live in Dark Ages.
Well, there are organisations like MSF who are doing their job in Balochistan by providing medical assistance to poor women and children; it is the government’s responsibility to ensure that women should live in a safe and healthy environment - and to provide them with all the health care facilities. It seems like a distant dream but not an impossible one!
Photography by Khaula Jamil