The Pakistan Demographic and Health Survey (PDHS) 2006-2007 estimated that about 276 women die during pregnancy or after within 42 days due to complications among 100,000 women who give birth in a year. However, the last survey was completely silent about the matter, leaving us with no recent authentic data on maternal deaths in Pakistan.
According to recent UN agency for population (UNFPA) State of the World Population Report 2017, countries such as Bangladesh, Laos, East Timor and Indonesia are seen as being likely to bring their Maternal Mortality Ratios (MMRs) below 70 deaths per 100,000 by the 2030 deadline, in accordance with the UN Sustainable Goals (SDGs). But others like Pakistan join the list of those that would not able to meet this deadline including Afghanistan, India, Nepal, Papua New Guinea, Myanmar, Cambodia and the Philippines.
The PDHS 2012-2013 says that about 73% pregnant women in Pakistan receive prenatal care from a skilled healthcare provider (doctor, nurse, midwife, or lady health visitor), but only 52% of women give birth assisted by a skilled provider. And only 48% mothers deliver babies in health facilities. The situation in rural areas is the worst with only 40% of pregnant women giving birth in any health facility, while in urban areas 68% of women give birth in proper healthcare facilities.
One in four women had no prenatal care at all. Prenatal care varies by region as about 30% of women in Balochistan received prenatal care from a skilled provider compared to 94% in Islamabad.
Pregnant women should take iron tablets for at least 90 days during pregnancy to prevent anemia and other complications. According to a government survey only two in ten women took iron tablets for at least 90 days during their pregnancy.
The health of mothers is frail and there are many social, cultural and policy level reasons for that, said Reproductive Health Expert and Maternal Neonatal and Child Health Consultant Dr Samina Naeem Khalid.
Midwives and lady health visitors are not properly trained to refer expecting mothers to the hospitals at an appropriate time, she said, and mothers who after gathering a budget and transport reach basic and rural health centers do not get proper care due to a lack of facilities. The tertiary care hospitals are overworked even in the federal capital and not able to cater to women coming from far off areas with complications, she added.
Even if mothers survive by luck, their nutritional health is poor, she said, adding, “More than half of the women are anemic and giving birth to malnourished children. Marriage at a young age and frequent pregnancies aggravate the situation”.
The provincial governments establish maternal and child healthcare programmes but do not add enough to the budget to expand and equip health facilities to provide better and skilled maternal care. If we want to improve the health of the nation, we will have to give priority to mothers, she asserted.
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