Maternal lives matter

In the past six months, Pakistan lost close to over 6,000 precious lives due to the Covid-19 pandemic. Justifiably, there has been great concern in almost all quarters about the trajectory of the pandemic and its impact on the economy, family structures, and livelihoods. Ironically, during the same period, we lost nearly the same number of lives to totally preventable pregnancy-related causes. Sadly, the death of mothers and newborns is too common to make national headlines or flash as breaking news.

It is true that the number of maternal deaths in the country are gradually coming down. Only last month, we were given the good news that our maternal mortality ratio had fallen from 276 to 186 deaths per 100,000 live births in a period of 14 years. However, we are still losing a mother due to pregnancy-related causes nearly every hour.

There are several measures that can be implemented to reduce maternal deaths; one option is encouraging birth spacing of three years. Global evidence has unequivocally established that closely spaced pregnancies contribute to adverse maternal and child outcomes. When a pregnancy occurs six months after a live birth, it leads to an increased risk of a maternal death, stillbirth, miscarriage, and a new born death.

According to the Pakistan Demographic and Health Survey (PDHS) 2017-18, nearly 18% of women became pregnant six to 17 months after a live birth and 37% within 24 months. PDHS data shows that the highest proportion of closely spaced pregnancies occur in the adolescent age group of 15-19 years. Compared to older women, this group also has the highest unmet need for birth spacing —nearly one out of six women in this age bracket wants to space her pregnancies but is unable to do so.

Unmet need for family planning (FP) stems from the inability of women to access services. The Lady Health Worker (LHW) programme, launched in 1994, had the mandate to provide doorstep FP services to rural women, who have higher unmet needs and more unintended pregnancies than urban women. This highly acclaimed programme is currently plagued with many issues, the foremost of which is a perennial shortage of contraceptive supplies. Within public sector health facilities, service providers do not consider offering FP services and counselling as their responsibility.

The Council of Common Interest decided that FP services must be provided through all public and private health facilities. This decision now needs to be fully implemented. This has several advantages, including avoiding the hesitancy some women and men have in visiting the socially stigmatised discrete FP centres. General health facility visits offer several opportunities for discussing family planning, such as during antenatal care visits, immediately after delivery, and during postnatal checkups. On these occasions, couples can be encouraged to discuss their FP needs and individually focused options can be suggested to help meet their needs. This service delivery approach would also allow men to discuss FP with male healthcare providers.

The Population Council estimates that even without increasing the current coverage of skilled birth attendance, by simply meeting the 17% unmet need for FP and thus raising the current contraceptive use from 34 to 51%, we could lower maternal mortality by around 30% and save nearly 4,000 maternal lives every year.

Family planning has been acknowledged by our religious scholars as a means to save the lives of mothers and children. This message now needs to be widely disseminated along with enhanced access to services.

Thousands of women and families in Pakistan are paying the high cost of inaction. We must act now to save maternal lives. It is a moral, ethical, religious, and humanitarian imperative.

Published in The Express Tribune, September 30^th, 2020.

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