A hard place for newborns

November 17 marked the World Prematurity Day, held every year to raise awareness regarding the challenges posed by premature births. A premature or preterm birth is when a baby is born before 37 weeks of gestation. Pakistan, unfortunately, is among the top five countries that have the highest proportion of premature births. It is estimated that out of nearly six million births in Pakistan, a million babies are born prematurely. Due to the lack of adequate facilities 600 babies die every day in Pakistan due to prematurity, asphyxia and infections. Even those preterm babies who survive, without proper care are likely to suffer from vision and hearing problems and respiratory disorders.

Pakistan also has the dubious distinction of being among the top five countries having the highest number of neonatal deaths i.e. deaths of babies below one month of age. We are only second to Lesotho while the other four are the Central African Republic, South Sudan and Somalia. The major cause of neonatal deaths in Pakistan is due to preterm births.

Maternal and child health indicators are a good measure to gauge a country’s level of development. Our statistics reflect the sorry state of our healthcare system and the government’s priorities.

There is no easy and quick fix that can overhaul the problems afflicting our health system. We do not have the resources to meet the ever-increasing health needs of a growing population. We cannot keep expanding healthcare at the same rate as our population is increasing. Systemic issues that have plagued the health system cannot be fixed overnight. But what the government can do, is introduce cost-effective preventive interventions that can reverse the negative trajectory of our health indicators.

Premature births are related to both maternal and fetal conditions. Mothers suffering from high blood pressure, diabetes, obesity, younger age and interpregnancy interval of less than 24 months are more likely to have preterm births. Preterm birth management requires specialised neonatal intensive care units with trained neonatologists and auxiliary staff with adequate equipment such as functioning incubators, ideally available in at least all district and tehsil headquarter hospitals. This may be difficult to implement considering our meagre healthcare budgets. Simple community-based interventions such as maintaining skin-to-skin contact of the baby and mother soon after birth to prevent heat loss, delayed bathing, cord care, clearing of airways and correct use of antibiotics by Lady Health Workers and Community Midwives can save precious lives.

But most importantly a key intervention that can help both the mother and newborn is birth spacing. Research evidence shows that mothers who conceive less than six months after giving birth have a 70% higher risk of preterm birth than women with an optimal pregnancy birth interval of 18-23 months. While the risk for those with an interval of six to 11 months was 20% higher. Nearly 37% of pregnancies in Pakistan occur within 24 months of the preceding birth. Couples need to be informed that after a live birth they need to wait for 24 months before attempting the next pregnancy. Provision of family planning services and counselling can help couples freely decide upon the number and spacing of their children based on their fertility preferences.

Pakistan is undoubtedly an unsafe place for newborns, neonates and mothers. This situation cannot be allowed to prevail as even resource constrained countries such as Afghanistan and Nepal have done much better in improving child survival. We have no option but to focus on greater inclusivity in healthcare provision with a greater focus on investing in preventive care.

 

Published in The Express Tribune, December 14^th, 2020.

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