Pakistan can easily prevent around 10,000 maternal deaths due to unsafe abortions every year just by providing an enabling environment to the nationwide network of large self-sustaining healthcare service providers and general practitioners so that they could provide essential maternal health services.
Dr Syed Azizur Rab, the chief executive officer of Karachi-based non-profit organisation Greenstar, stated this in an interview with The News. He said the Greenstar has a network of 7,000 clinics across the country providing family planning and maternal health services in underprivileged areas for the past 30 years.
He stated that Pakistan had around 10 million pregnancies every year and approximately four million of them were unwanted while an estimated 2.6 million abortions annually took place in the country.
He said that these 2.6 million women opt for abortion owing to the lack of family planning services in the country. Every abortion is a testimonial that we have failed these women twice. First when we did not offer them the choice of birth spacing with one of the methods, and secondly by not providing them with a choice to manage this serious emergency at a trained service provider’s facility.
Dr Rab was of the view that the abortion-related deaths occured due to untrained birth attendants providing such emergency medical services in an unsafe environment by not following the infection prevention protocols and using unsterilised surgical instruments.
He said the Pakistani government had taken steps in the right direction by publicising guidelines at the federal level enabling any health care facility across the country to provide post-abortion care service (PAC). He said the guidelines had prescribed the bona fide medical and surgical methods to be carried out under the specified medical conditions ensuring safety of the mother.
The Greenstar CEO said the use of the manual vacuum aspirator (MVA) kits by trained service providers or doctors could easily prevent abortion-related deaths that occurred mainly due to the application of unsafe surgical methods for the purpose. He said that one of the main issues is that the MVA kit was not freely available these days due to its high cost after the levy of the exorbitant import duty.
He stated that earlier an MVA kit was available in the country for Rs3,000 but now its cost had increased up to Rs9,000 due to the rise in the import duty coupled with the devaluation of the Pakistani rupee.
“The three-time increase in the price of an MVA kit means that the service providers have been unable to dispense the post-abortion care services through a prescribed and approved method,” he commented, adding that the combination pill of misoprostol and mifepristone should be made available in the country as the safest medical method for the post-abortion care services in order to save life of mother and for necessary treatment as outlined in the approved national guidelines.
He was of the view that As Pakistan was facing a rise in the Covid-19 cases again, it could affect maternal health as experienced in the first wave early this year. He called on the public and private sector to work together and utilise their strengths for serving women in Pakistan. The private sector could bring in their quality of services, trained service providers and management skills while the public sector could support them by providing commodities, good governance and an enabling environment, he said.
Lastly, he highlighted that need for allowing the stocking of essential products for women care at the service providers’ clinic for quick access and support to women in need, especially in areas where no chemist shops were available.
He said that if these recommendations were implemented, a strong public-private partnership could go a long way in reducing mothers’ mortality.
He concluded by sharing that it took 70 years for maternal mortality and growth stunting to find a space in the opening address of a prime minister. With over 70 per cent of women going to the private sector and paying out of pocket, it was the time for our nation to take leverage from this opportunity and save these women’s life, he said.