The war on mothers and children

Last week, I noticed newspaper headlines about the rate at which newborn children die in Pakistan. The figures being cited were astonishing even for me. Having worked for the Alif Ailaan campaign for education for five years now, no measure of evidence surprises me: Pakistan has been waging war on its children for decades. But the data released by Unicef last week was shocking. More shocking than Imran Khan’s latest marriage, more shocking than Ahad Cheema’s promotion to BPS 20, more shocking than the inanities of Nawaz Sharif or his low IQ tormentors across the institutional spectrum, and more shocking than the price Pakistan will pay for its love affair with Lashkar-e-Taiba.

The headlines last week were that Pakistan had the world’s highest neonatal mortality rate. To understand how bad things were, I turned to Saman Naz. Ms Naz is currently a PhD student, and having apprenticed at the Population Council with the brilliant Dr Zeba Sathar, is among the brightest young Pakistani demographers around (full disclosure: Ms Naz was also head of research at Alif Ailaan until 2016).

My natural instinct as a Pakistani nationalist is to be defensive whenever Pakistan tops a horrible global list. I asked Ms Naz if it was possible that the data being used by Unicef was faulty. My hope was that she would confirm what many already know: that Pakistan’s maternal and child mortality rates are really bad – but that things were not so bad as to land Pakistan on the top of any list of shame. When I received her response, I knew immediately that I would not like the answer. True to her nature as a thorough researcher, Ms Naz’s email was long and had many tables and graphs.

In her own words, “Pakistan has been constantly performing poorly for neonatal mortality (deaths within first month of birth). Most of child mortality stats usually report infant mortality (deaths within first year of birth) but the recent Unicef rankings are based on neonatal mortality (again, this for deaths of children within the first month of their life) that is why it is a little shocking. It has been widely reported in child health surveys that although Pakistan has been making some progress in infant and under-five mortality, the neonatal mortality rates have been almost stagnant for over twenty years”.

How has Pakistan performed in comparison to its neighbours with whom it shares so much history, culture and conflict?

In 1990, Sri Lanka‘s neonatal mortality rate was 13 per 1,000. In 2016, this had fallen to 5 deaths per 1,000 live births. This 55 percent improvement was the third lowest in the region. India reduced neonatal mortality from 57 to 25 per 1,000 live births. And Afghanistan, the country that so many Pakistani strategists sneer in derision at, reduced neonatal mortality from 75 per 1,000 live births to 40.

In 1990, Pakistan ranked better than India, Nepal, Bangladesh and Afghanistan with 51 deaths per 1,000 live births. Today, Pakistan ranks lower than all of them with 46 deaths per 1,000 live births. Bangladesh has only 20 deaths per 1,000 live births today. A child in Pakistan is more than twice as likely to die before her or his first birthday than a child in Bangladesh. Not only is Pakistan the worst in South Asia and the world, at only 11 percent, the improvement over almost three decades represents the lowest rate of improvement of any country in South Asia by a long way.

How could a nuclear weapons state, a country with such a massive diaspora, a country that is unique in having beaten back multiple insurgencies in the last decade, a country with so much geostrategic potential and so many talented women and men, and so much compassion – how could this country allow this to happen?

For this, I return to demographer Saman Naz. She points to the most recent Pakistan Demographic and Health Survey from 2013. In it, tables 8.2 and 8.3 help map out a profile of these child deaths.

As we already know, infant and child mortality in Pakistan has improved over the last two to three decades – but shockingly, neonatal mortality has increased in three of four provinces since the 1990s – with Khyber Pakhtunkhwa alone having lowered neonatal mortality as of 2012-2013.

The disparity in neonatal mortality rates between urban and rural Pakistan is vast. It is 47 per 1,000 in urban areas and 62 in rural areas. Just for comparison again: Islamabad is 26 and Bangladesh is, nationwide, 20.

How is neonatal mortality different for mothers who are educated versus mothers who are not? This is where a lot clearer picture begins to emerge.

Mothers with no education suffer a neonatal mortality rate of 65. It lowers dramatically for mothers with a middle school education down to 48. And then lowers dramatically again for mothers they have completed higher secondary schooling down to 27. Imagine: every city and village in Pakistan (including Dera Bugti, and Dadu, and Kohistan, and Rajanpur) could have the neonatal mortality rate of Islamabad if every single girl was able to complete her FSc or FA or other kind of high school education.

Almost the exact same trends are obvious in terms of wealth quintiles, with the poorest 20 percent of Pakistanis enduring a neonatal mortality rate of 62, the second poorest 67, the third poorest 63, but the richest 20 percent only 34 deaths per 1,000 live births of children one month or younger.

‘Poor and illiterate’ describes the vast majority of women in Pakistan. The neonatal mortality crisis is a moral crisis. It is a crisis not so much of babies dying as it is of a nation having abandoned mothers to try to extract the foetuses that they bear from the burden of poverty, an inability to read, to write, to think creatively, and to dream in technicolour, what to say of dreaming in full 4K.

Learning outcomes for the slightly over half of all children that do attend school are so poor that some advocates question whether out-of-school children are a problem worth tackling at all. The recent horrors of child sexual abuse and exploitation that came to the fore after Zainab Ansari’s eight-year-old body was found on top of a heap of garbage in Kasur have already been forgotten. The debate on child protection has been buried along with Zainab by a media, judiciary, executive and society that have fooled themselves into believing that dispensing quick and dirty justice to monsters like Zainab’s rapist and murderer is an adequate response to a larger disease that afflicts the country: a criminal disregard for children other than our own.

For a nation that prides itself in its Islamic heritage as the children of the Ummahat-ul-Momineen, we have a strange hatred for mothers. Pakistani Muslims have failed to infuse the discourse with anything remotely resembling the kinds of values that Ummatees of the Prophet (pbuh) should aspire to.

Between now and 2030 (the deadline to meet the Sustainable Development Goals (SDGs), elected and unelected government officials will not tire of the repeated foreign trips to discuss SDGs. SDG 3 has one target for neonatal mortality, under indicator 3.2. It is that by 2030 Pakistan will reduce neonatal mortality to “at least as low as 12 per 1000 live births”. It is 46 right now. We have twelve years to make it one fourth of what it is right now. It is unlikely to happen. But this doesn’t make it okay to ignore. It is a matter of utmost shame shared by all Pakistanis, myself included.

The writer is an analyst and commentator.