Life changed for the worse when Haji Khan took a decision, unwillingly, just because of social complications and he cannot forget a healthy daughter that he lost soon after birth years ago.

The sexagenarian Haji Khan (a pseudonym as he requested anonymity) recalls how he had made a tough decision while fighting his own conscience and bowing to his mother’s demand when his wife was going to deliver a baby.

"Decades ago, I requested my mother to let me take my wife to a lady doctor as she was going to deliver the first baby," he recalls, but his mother said there was no issue at home and no need to take her to a health facility.

Haji Khan says he had to bow to his mother’s insistence, and called a midwife, an acquaintance, to his home.

"My wife gave birth to a baby girl who had sound weight and health; she was my first daughter. But she expired moments after birth because the lady doctor said she did not have all the required facilities necessary for delivery cases in the home," he says.

He says he faced more anxiety and mental agonies when his wife suffered a miscarriage years after losing their first baby, and this time lost twins, a son and daughter. After a long time, however, God bestowed the couple with a daughter and a son who are now of school going age.

The story is one of the thousands due to our society’s general attitude problem as a whole, because there have been instances in which a woman even hands money to her son-in-law to take her daughter for regular checkup by a gynaecologist but refuses the same facility to her own daughter-in-law in her home.

‘Saas-bahu’ bickering:

Ms Bint-e-Hawa (not real name for anonymity) gets married and starts living happily before she falls victim to the syndrome of daughter-in-law versus mother-in-law bickering, which has been a ‘custom’ in most of Pakistani families.

Bint-e-Hawa, an orphan, was quite healthy before wedding. After marriage, dark circles appeared under her eyes and she became more silent with the passage of time at her in-laws’ home.

She got pregnant after marriage, but she lost her first baby in miscarriage as she complained she was subjected to all domestic chores at home.

A sister of Bint-e-Hawa’s husband doesn’t work at all and she is supposed to do all the household chores at home. A strange thing is that mother-in-law of Bint-e-Hawa takes extreme care of her own daughter as she pays her son-in-law for proper treatment of her pregnant daughter.

Like Bint-e-Hawa, there are many others facing a similar situation inside homes, particularly in rural areas. There was a time when people had little facilities. Though the health facilities are increasing with the passage of time, changing the attitudes in society still remains a challenge, resulting in a high maternal and infant mortality rates.

Maternal and infant mortality in KP:

The District Health Information System has reported that 72 women have died during pregnancy or deliveries in the first quarter of the year 2016, with maternal mortality rate of 151 per 100,000 population. Majority of the maternal deaths have been reported from Mardan district, ie 12, during the period.

Among other districts of Khyber Pakhtunkhwa, 11 maternal deaths have been reported from Peshawar, five from Swabi, eight from Abbottabad, five from Haripur, six from Mansehra, two each from Bannu, Lakki Marwat and Kohat, four from Nowshera, nine from Swat, and one each from Shangla, Upper Dir, Buner, Chitral, Malakand and DI Khan.

Similarly, a total of 1,185 infants have died of various ailments across Khyber Pakhtunkhwa province during the same period. Of the total infant mortality reported during the first quarter of 2016, 129 kids have died in Swabi, 155 in Mansehra, 51 in Kohat, 143 in Abbottabad, 22 in Karak, 92 in Haripur, 47 in DI Khan, 31 in Chitral, 152 in Mardan, 39 in Malakand, 16 in Buner, 75 in Peshawar, 16 in Lower Dir, 49 in Nowshera, 107 in Swat, 10 in Tank, eight in Upper Dir, four in Battagram, five in Shangla, five in Lakki Marwat, 17 in Charsadda, 11 in Bannu and one in Hangu.

Cash incentive for mothers:

Maternal, Newborn and Child Health (MNCH) programme provincial coordinator Dr Sahib Gul says the authorities have been taking measures to bring down the maternal and child mortality rates in the province.

He said the Khyber Pakhtunkhwa government has made history by starting cash incentives for mothers delivering babies at health facilities. "In order to attract more people to use health facilities for deliveries and avoid deliveries at homes, now the provincial government pays Rs2,700 to a mother delivering baby at a health facility. This cash incentive for mothers is only provided in KP, not any other province of Pakistan," he added.

He also said the cash incentive is not provided at teaching hospitals, but the rule is applied in all other health facilities. He said they had conducted several media campaigns to encourage people to use health facilities for deliveries, and one such campaign would be launched in near future.

Dr Iqbal Begum, head of Gynae Department at the Hayatabad Medical Complex, said that a normal delivery can be handled by a trained health worker at home, but other cases need to be taken to health facilities.

"A woman should use health facilities for delivery cases in order to have timely information if they have any disease during pregnancy and childbearing period," she added.

The Journal of Pakistan Medical Association has also stated in a research that there are many families who still choose to deliver at homes and home deliveries pose a high risk of maternal mortality. The association says that family tradition and poor socioeconomic condition appear to be the main factor behind opting for deliveries at homes.

The study recommends that in order to make home deliveries safer, they should be conducted by trained midwives, who can conduct delivery in a clean and hygienic manner, prevent and recognise Postpartum Hemorrhage (PPH) and can refer the patient promptly to a hospital with emergency obstetric care facilities, in case of complications.

Haji Khan suffered the incident decades ago, but he still bears the scars. But the problem is that there is not one Haji Khan, there are thousands like him suffering. And Bint-e-Hawa has lost her first baby to society’s double-standards and cruelties. But the problem is that there is not one Bin e Hawa; there are thousands like her suffering. This is because changing attitudes in our society remains a challenge!