Maternal health: A first–or a final–journey for some babies in Balochistan
Pregnant women forced aboard donkey carts to hasten labour.
Although studies say that pregnant women must consult gynecologists for at least five of the nine months of pregnancy, this practice is largely absent in the province. PHOTO: AFP/FILE
ISLAMABAD:
The journey goes one of two ways: if they are lucky, the babies have a bumpy ride into the world or, in some cases, they perish with their mothers. In the absence of healthcare facilities in some districts of Balochistan, some pregnant women are forced to deliver their babies on donkey carts, the jolts from the ride hastening their labour.
“Pregnant women are made to climb onto a donkey cart with the help of male members of the family, who push the animal to walk on rugged terrain as the initial labour begins. The process comes to an end within a few minutes when the child is born with the jolts of the cart,” explains Yasmeen Lehri, an MPA from the ruling National Party. Lehri says that as state-run hospitals remain out of bounds for those in districts such as Bolan or Turbat, the chances of reaching a basic gynecology department in order to give birth remain slim for most women.
While these births are, according to Lehri, “exceptional cases when normal delivery is impossible”, she adds that such practices cannot be tempered due to a lack of funds for the development of healthcare in the province.
According to the Pakistan Demographic Health Survey (PDHS 2012-2013), the proportion of mothers reporting that they received antenatal care from a skilled provider is markedly lower in Balochistan (31%) than in Punjab and Sindh (78% each). The maternal mortality rate, according to Lehri, is 800 of 100,000 women in parts of Balochistan. Additionally, a Unicef report this year revealed that for every 1,000 live births 111 children die before their fifth birthday in Balochistan; 97 of these children die within one year of their birth.
A senior gynecologist who has served in different areas of Balochistan, Dr Robina Zammarrud, said such methods of delivery can lead to various complications, such as heavy bleeding, which may seriously threaten the life of the mother and child. She adds that most families avoid taking their pregnant women to doctors for pre-delivery consultation as they believe it ‘disgraces’ the pregnant female and family.
Although studies say that pregnant women must consult gynecologists for at least five of the nine months of pregnancy, this practice is largely absent in the province. “It is unfair to the pregnant woman, who is not allowed to have access to doctors during her pregnancy,” said Dr Zammarrud.
“About 70% of pregnant women are not permitted by their husbands to see gynecologists due to the stigma that it is a disgrace,” she revealed. Most of these women are from rural parts of the province.
Lehri says that for those women who manage to arrive at health centres to receive treatment, the quality of care offered leaves much to be desired. “I have observed that even in areas with the health centres, female gynecologists remain absent from their jobs, leaving pregnant women at the mercy of male nurses,” she said.
While provincial Home Minister Mir Sarfraz Bugti says donkey carts have been used as ambulances for pregnant women in his native town of Dera Bugti for decades, Dr Zammarrud points out that the use of carts as ambulances can cause unnecessary delays, and increase the risk to pregnant women.
Sangeen Gichki, manager of the non-profit Strengthening Participatory Organisation in the districts of Kech and Turbat, reiterated that male or female gynecologists are available only in the provincial capital and female health workers are not available in the rural areas, while mother and child care facilities are only available in a few major cities. While more than a hundred midwives live in Turbat, only 15 of them have been given delivery kits and medicines by the health department.
Some women arrive at health care centres when their case has progressed beyond the ‘Dai or midwife’s control. Dr Zammarrud, who hails from Mastung, said that many pregnant women die here due to high blood pressure because Dais are unable to control it during delivery. In many cases, the family only brings the pregnant woman to the hospital for delivery when the woman is about to die. Most doctors refuse treatment in such cases. “According to the law, an untrained dai can be prosecuted for handling such delivery cases,” Dr Zammarrud said.
Published in The Express Tribune, May 3rd, 2014.
The journey goes one of two ways: if they are lucky, the babies have a bumpy ride into the world or, in some cases, they perish with their mothers. In the absence of healthcare facilities in some districts of Balochistan, some pregnant women are forced to deliver their babies on donkey carts, the jolts from the ride hastening their labour.
“Pregnant women are made to climb onto a donkey cart with the help of male members of the family, who push the animal to walk on rugged terrain as the initial labour begins. The process comes to an end within a few minutes when the child is born with the jolts of the cart,” explains Yasmeen Lehri, an MPA from the ruling National Party. Lehri says that as state-run hospitals remain out of bounds for those in districts such as Bolan or Turbat, the chances of reaching a basic gynecology department in order to give birth remain slim for most women.
While these births are, according to Lehri, “exceptional cases when normal delivery is impossible”, she adds that such practices cannot be tempered due to a lack of funds for the development of healthcare in the province.
According to the Pakistan Demographic Health Survey (PDHS 2012-2013), the proportion of mothers reporting that they received antenatal care from a skilled provider is markedly lower in Balochistan (31%) than in Punjab and Sindh (78% each). The maternal mortality rate, according to Lehri, is 800 of 100,000 women in parts of Balochistan. Additionally, a Unicef report this year revealed that for every 1,000 live births 111 children die before their fifth birthday in Balochistan; 97 of these children die within one year of their birth.
A senior gynecologist who has served in different areas of Balochistan, Dr Robina Zammarrud, said such methods of delivery can lead to various complications, such as heavy bleeding, which may seriously threaten the life of the mother and child. She adds that most families avoid taking their pregnant women to doctors for pre-delivery consultation as they believe it ‘disgraces’ the pregnant female and family.
Although studies say that pregnant women must consult gynecologists for at least five of the nine months of pregnancy, this practice is largely absent in the province. “It is unfair to the pregnant woman, who is not allowed to have access to doctors during her pregnancy,” said Dr Zammarrud.
“About 70% of pregnant women are not permitted by their husbands to see gynecologists due to the stigma that it is a disgrace,” she revealed. Most of these women are from rural parts of the province.
Lehri says that for those women who manage to arrive at health centres to receive treatment, the quality of care offered leaves much to be desired. “I have observed that even in areas with the health centres, female gynecologists remain absent from their jobs, leaving pregnant women at the mercy of male nurses,” she said.
While provincial Home Minister Mir Sarfraz Bugti says donkey carts have been used as ambulances for pregnant women in his native town of Dera Bugti for decades, Dr Zammarrud points out that the use of carts as ambulances can cause unnecessary delays, and increase the risk to pregnant women.
Sangeen Gichki, manager of the non-profit Strengthening Participatory Organisation in the districts of Kech and Turbat, reiterated that male or female gynecologists are available only in the provincial capital and female health workers are not available in the rural areas, while mother and child care facilities are only available in a few major cities. While more than a hundred midwives live in Turbat, only 15 of them have been given delivery kits and medicines by the health department.
Some women arrive at health care centres when their case has progressed beyond the ‘Dai or midwife’s control. Dr Zammarrud, who hails from Mastung, said that many pregnant women die here due to high blood pressure because Dais are unable to control it during delivery. In many cases, the family only brings the pregnant woman to the hospital for delivery when the woman is about to die. Most doctors refuse treatment in such cases. “According to the law, an untrained dai can be prosecuted for handling such delivery cases,” Dr Zammarrud said.
Published in The Express Tribune, May 3rd, 2014.