Quetta: Baluchistan the militancy stuck province is having the highest maternal mortality rate owing to the absence of health services, tribal culture, lower socio-economic status of the masses and no security to medical officials and non-governmental organizations’ workers.
Bibi Razia, of Zhob district in northern Balochistan, was struggling to give birth to her 11th child when she breathed her last. Initially, an elderly village midwife treated her but owing to the complexity of her case, she was shifted to district hospital where no female health staff was present. Bibi Razia was eventually being taken to the Combined Military Hospital but she died on the way to the said hospital.
Muhammad Essa, Bibi Razia’s husband, told News Lens Pakistan that the poor have little chances to live and if he had enough money he would have dealt the delivery case of his wife in a sophisticated hospital.
“I can only earn enough to feed my children. The family’s health is left to God because I can’t bear the private health services that cast much money. That is why I couldn’t take Razia to a female doctor,” he said.
Mumtaza Bibi, a midwife, told News Lens Pakistan that every day a woman dies in the blood pool during childbirth.
“Our people are poor and government has not provided them enough health services. Secondly, keeping pregnancy a secret is the culture of our,” she said.
Mumtaza Bibi further said that a very few women visit female gynecologists because people are poor and they cannot afford the privately run clinics.
“When I am asked to deal with a delivery case, I don’t know if the pregnant woman is having a complex or a normal delivery. We are only called in the dark of night to attend the cases. Normal deliveries are easy to deal with as I have initial training but we are not trained to deal with most complex cases. In case of a complex case, we suggest the husband of patients to take the pregnant woman to a lady doctor as early as possible,” Mumtaza Bibi said.
In Balochistan tribal customs, abnormal security situation, existence of social taboos, presence of less or no health facilities and lack of widespread awareness about pregnancy care are some of the reasons that lead to the death of women each year.
According to the preliminary report of Pakistan Demographic and Health 2012-2013 survey the proportion of mothers reporting that they received antenatal care from a skilled provider is markedly lower in Balochistan as compared to Punjab and Sindh.
Save the Children, an international NGO, was initially working on Maternal Mortality Rate in the badly affected districts of Balochistan but Interior Ministry Of Pakistan banned the organization to remain active in Balochistan, Khyber Pakhtunkhwa, Federally Administered Tribal Areas and Gilgit Baltistan.
“Save The Children had planned a module for government run hospitals and basic health units to train the lady health workers and spread awareness about health issues particularly delivery and child birth,” a former employee of the organization told News Lens requesting not to be named.
Rehmat Tareen, a social activist, told News Lens Pakistan that Balochistan covers 43 percent of Pakistan’s area but has less population, fewer health facilities and face a high maternal mortality rate.
“In some of rural areas we have zero female literacy and a tough structure of tribal rules due to which female pregnancy is always neglected as people don’t understand the essential role of a doctor. Not a single doctor is available to the population of thousands of people,” he said.
Militancy is one factor that is standing in the way of medical facilities provision in disrupted areas of Balochistan.
Nadir Gul Barrech, Chief Executive Officer Balochistan Rural Support Program (BRSP), while talking to News Lens Pakistan said that pregnancies are always fragile and sometimes much complicated as excess bleeding can cause death of mothers on the way towards distant hospitals.
“I don’t think maternal mortality rate has decreased. It must have increased more than 785 per hundred thousand [referring an older survey by a government institution Demographic Health Survey 2006-7]. Lack of updated figures doesn’t mean the maternal mortality rate has decreased in the last seven years,” he said.
Barrech added that there is a dire need to educate mothers on the complexity of pregnancy and basic medical needs but that is impossible without a secure surrounding since many areas of the province are not easy to visit owing to poor security situation and fight between security forces and Baloch militants.
“The maternal maternity rate is controlled up to some extent. It is not that much higher now but it still needs much concentration. The masses across Balochistan need awareness to overcome strict tribal customs and have health education as these are the factors boosting up Maternal Mortality Rate,” said Balochistan Health Minister Rahmat Baloch while talking to News Lens Pakistan.
“The coalition government in Balochistan has provided a gynecologist, anesthesiologist and pediatrician to 14 districts headquarter hospitals across the province to control maternal mortality rate. Before, only seven districts were having such status. Moreover, three nursing colleges are opened in Khuzdar, Turbat and Loralai districts to graduate professional health workers who will be fulfilling the needs for maternal health as our province faces the scarcity of lady health workers,” Baloch added.
Balochistan government is working on a mechanism to make doctors work in their district and rural areas where maternal mortality rates are high and people are not having approach to health facilities.
Dr. Aftab Khan, Former Secretary General Pakistan Medical Association Baluchistan Chapter while talking to News Lens Pakistan said, “Doctors have no security here. Eighteen doctors were killed, 28 abducted for ransom and 3 of the doctors are still missing. 89 senior professors and specialized doctors have abandoned the province; most of them had been threatened. Poor security situation is one of the main factors that are keeping doctors from practicing in far-flung areas.”
According to Nighat Aaisha, a staff nurse at Kharan District Hospital, proper equipment, medicines, technical and well-trained staff is not available in labor rooms and even in some districts no building exists for labor room. Adding to this she said, on duty doctors live in cities and they rarely visit hospitals. Gynecologists are needed to be on duty for 24 hours a day because labor may happen any time.
