Dais offer a helping hand where nurses and doctors can’t reach

Published: July 29, 2010
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Midwives must be trained to bring down the maternal death rate

Midwives must be trained to bring down the maternal death rate

KARACHI: Because of expensive and scarce heathcare and medical facilities in Pakistan, most of the public, especially those living in rural areas, is left with no choice but to resort to midwives or dais when it comes to delivering a baby, said the Midwifery Association of Pakistan.

The association (MAP) celebrated the International Day of Midwives on Wednesday at the Jinnah Postgraduate Medical Centre to stress the need for more trained midwives in the country.

“Today, Pakistan has the highest rate of maternal mortality in South Asia at 276 deaths per 100,000 women,” said Imtiaz Kamal, the president of the association. Research proves that Pakistan has one of the highest ratio of maternal deaths in the world. Every hour two women die while giving birth.

At 83, Kamal has been working to train midwives in Pakistan for the last 57 years. This, she feels, is the most urgent need of the country in terms of basic health facilities.

She said that despite the fact that 60 to 70 per cent of babies born in homes are delivered by illiterate and untrained women known as Traditional Birth Attendants or dais , no efforts are being made to train them.  If there are not enough doctors and resources, then the people who are available should be improved.

“These [untrained] dais are killing mothers,” she said, explaining that a licensed midwife is trained to function as a specialist in normal obstetrics.

Eighty-five per cent of babies are born naturally while 15 per cent require medical intervention, said the press release issued by MAP. It is neither necessary nor possible for every baby to be delivered by a doctor. For 15 to 20 per cent of the cases with complications a midwife needs the support of a well-equipped health facility with highly qualified obstetricians.

Rukhsana, who has five children now, became quite ill after she gave birth to her third daughter with the help of a dai. When she did not get better she decided to look for second opinions. She was found to have a uterine prolapse and was later operated on by a gynaecologist after which she was finally better.

Pakistan needs a midwife in each village, she explained. Currently community midwives are being trained. “They are our hope for the future. Some of those trained have established themselves as independent practitioners of midwifery in rural areas and are doing a fairly good job,” said Kamal.

“While the government is saying that it will train 12,000 midwives for every village in the country they appear to be making no serious efforts for the cause,” she said. Usually projects are started only when international donors send something for a particular cause and these projects are stopped just as quickly when the donations are withdrawn.

“There are about 45,000 villages in the country, will that 12,000 be enough for the whole country then?” she asked.

Published in The Express Tribune, July 29th, 2010.

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