“In the land of the blind, the one-eyed man is king.” For a stressed husband struggling to access urgent help for his laboring wife in a remote area with measly healthcare facilities, any elderly woman with experiential knowledge of childbirth is a welcome option regardless of whether or not she has even opened a biology textbook in her life.
One such husband was Samar Khan, a local farmer from a remote area in K-P, whose desperate decision to trust an unqualified midwife with the delivery of his wife brought devastating repercussions for his family. When his wife, Shandana, went into labour, Samar rushed her to the nearest healthcare facility, hoping to find the necessary medical care. However, upon arrival, they discovered that the clinic lacked both a doctor and a nurse.
With no other choice, Samar took his wife back home, where an elderly, untrained midwife attempted to handle the delivery. For hours, the couple waited anxiously, but things took a tragic turn when the unskilled midwife finally informed him that Shandana’s life was at risk and immediate medical attention was required. Samar rushed Shandana to Swat, but tragically, she passed away in the middle of the long journey, leaving behind her daughter.
With tears in his eyes, Samar shared the devastating story of losing his wife, lamenting the lack of proper healthcare services in his region. His wife’s death is not an isolated case but rather a heartbreaking reflection of the ongoing maternal health crisis in the remote areas of Khyber Pakhtunkhwa (KP), particularly in the merged districts where healthcare infrastructure remains weak and road access limited.
Each year, hundreds of mothers in Khyber Pakhtunkhwa, especially in its rural and conflict-affected regions, die during childbirth or due to prenatal complications. The Pakistan Maternal Mortality Survey (PMMS) 2019 revealed a shocking statistic: approximately 1 in every 143 women in Pakistan will die during their lifetime due to perinatal complications.
“Most maternal deaths occur in the far-flung regions of K-P, where healthcare services are limited. When complications arise during pregnancy or birth, many cases are referred to other cities, but due to poor road conditions, these women often arrive at the hospital in critical condition, and sadly, many die before they can be treated,” confirmed Dr Uzma Khan, a gynecologist at a private hospital in Peshawar.
According to the Pakistan Demographic and Health Survey, the K-P region struggles with some of the highest maternal and infant mortality rates in the world. In K-P, 62 infants per 1,000 live births die before reaching their first birthday, and approximately 11,000 maternal deaths occur annually. Although the maternal mortality figures might be alarmingly high in the northern-province, access to safe childbirth remains a challenge for low-income women across other provinces too.
Naila, a resident of Lahore, shared a heart-breaking account of her pregnant daughter, Kainat's ordeal at government hospitals. “We regularly visited the out-patient departments of government hospitals for check-ups. When Kainat's delivery time approached, an attendant at the hospital demanded money for a physical examination, claiming that it would expedite the process. She also advised us to visit the doctor privately. When we explained that we were struggling financially and could not afford to pay, the doctors refused to provide medical help despite my labouring daughter having a valid registration card,” lamented Naila.
Dr Tayyiba Wasim, Head of Gynaecology at the Services Hospital, confessed that the burden on public healthcare facilities forced low-income patients towards unskilled midwives. “If the midwives lack proper training, women could suffer from seizures and other complications. In such cases, patients might be taken to private clinics and ultimately to hospitals, where doctors do their best to save their lives—sometimes, however, it may be too late. Midwives should be licensed to practice; if they do not hold a license, their practice should be deemed illegal,” said Dr Wasim.
The plight of pregnant women suffering at the hands of untrained midwives is no less daunting in Sindh, where according to the Former Central Secretary General of the Pakistan Medical Association (PMA) Dr Qaiser Sajjad, 30,000 to 40,000 quack doctors and unauthenticated maternity homes are still established in its largest city, Karachi.
“These quack doctors and unqualified midwives administer unnecessary injections and drips to extort money from visiting female patients, while prescribing heavy antibiotics, which also creates resistance in the human body against these unnecessary drugs. Since the past 50 years, quack doctors and unauthenticated maternity homes have been doing illegal work and have now turned into a mafia,” implored Dr Sajjad.
According to Professor Dr Sher Shah Syed, a gynaecologist, currently, more than 0.6 million untrained midwives are delivering babies at home across the country, where annually nearly 0.6 million women suffer from, while more than 20,000 others lose their lives to various infections and complications arising during home births.
“Infections during home deliveries are not controlled due to which women suffer from various diseases throughout their lives. There are 85,000 villages in Pakistan, which are home to millions of marginalized women. Unfortunately, most of these villages do not have qualified midwives to save the lives of women and infants. Home deliveries are not the work of quack doulas, but it is the work of qualified community midwives,” stressed Dr Syed.
Dr Syed further revealed that since untrained midwives usually used a blade to cut the umbilical cord of the baby, this often caused severe infections and complications. “Furthermore, these midwives use small obstetric instruments, which are not sterilized. There have been many home deliveries during which the mothers have been rushed to the Rural Health Center due to excessive bleeding but could not survive. So far, there is no compiled data on the rate of infant mortality during home deliveries in the country,” said Dr Syed.
According to Former Project Director of Maternal, Neonatal and Child Health (MNCH) Dr Sahib Jan Badar, the Health Department had started a 2-year midwife course in 2008 to eliminate traditional midwives from interior Sindh and replace them with trained community midwives. Under this program, more than 12,000 midwives were trained.
“Almost 22 per cent of women are fertile, out of which 4.5 are pregnant, and are under the care of the community midwife. It is true that women and infants still face complications from untrained midwife-assisted deliveries. Even today, 40 children out of every 1,000 die before reaching the age of one. These deaths mostly occur due to infections acquired during an unsanitary delivery,” noted Dr Badar.
On the other hand, Dr Khizar Hayat, Director of the Maternal, Neonatal, and Child Health Program (MNCH) in K-P, spoke to The Express Tribune about the efforts underway to tackle the maternal and child health crisis. He shared that over 19,000 Lady Health Workers were currently serving in Khyber Pakhtunkhwa, and the government planned to recruit more to help prevent maternal deaths.
“The MNCH program aims to provide every woman with access to the healthcare she needs, ensuring the safety of both the mother and child. We are working to develop and update health facilities across the province, particularly in areas that have been historically underserved," claimed Dr Hayat.
Commenting on the operations conducted against unauthorized doctors and midwives working in quack maternity homes, Chairman of the Sindh Health Care Commission, Dr Khalid Sheikh, confirmed that the Commission had so far conducted raids against 20,000 quacks in Sindh including Karachi, of which more than 10,000 clinics have been sealed.
“A crack down campaign is also conducted from time to time. If any homeopathic doctor is using allopathy treatment methods in his clinic, then we reserve the right to take action against them and we have also sealed many such clinics. Similarly, if a caesarean section is performed on a pregnant woman in an unapproved maternity home in Sindh, we will take immediate action,” assured Dr Sheikh.