ISLAMABAD – The perinatal mortality rate continues to be high in Pakistan, partially because 80 percent of the total 4.5 million annual births occur at home, observed the Pakistan Population Assessment 2003, a report by United Nations Population Fund (UNFPA).
The report noted that the average total fertility rate in Pakistan was estimated at 4.8. The rate is higher in rural and underdeveloped areas. About 33 million women in Pakistan have reached the reproductive age and each year 5.4 million become pregnant or give birth. The report held that about two-thirds of them receive no prenatal care.
It said the maternal mortality ratio is considered one of the best indicators of women’s health and of the quality and accessibility to health services. “Unfortunately, there are no reliable figures on the national maternal mortality rate for Pakistan, with the exception of an indirect estimate of 533 deaths per 100,000 live births.” The report noted that community-based studies suggest that the MMR in the country ranges between 300 to 700 per 100,000 live births.
The report showed that districts Khuzdar with a rate of 690 and Loralai with a rate of 610, both in Balochistan province, have the highest maternal mortality rates.
Most hospital-based and community-based studies confirm that the major causes of maternal mortality are similar, despite the level of development. They include postpartum haemorrhage, toxaemia of pregnancy, obstructed labour and puerperal sepsis. A small but significant percentage of maternal mortality is attributed to unsafe induced abortions.
It observed that although amassing data about maternal mortality rates was a difficult task in a country like Pakistan, the available data shows that the prevalence of severe anaemia among pregnant women was about 10 percent in 1988, two-thirds of pregnant women did not receive any prenatal care, over 80 percent of all deliveries occurred at home and only 18 percent of deliveries were performed by skilled professionals.
“It is believed that one-sixth of all pregnancies in Pakistan are complicated and that 10 percent of all pregnant women develop obstetric complications requiring medical intervention,” said the report. “In a study at the Pakistan Institute of Medical Sciences in Islamabad, about 3.5 percent of all deliveries conducted at the hospital’s Obstetric Department were regarded as ‘near-miss’— defined as a life-threatening obstetric emergency,” it said.
The report said that a decline in the infant mortality rate is slow in Pakistan compared to other developing countries. It claimed Pakistan has an infant mortality rate of 82 infant deaths per 1,000 live births. Referring to the government’s initiatives to train mid-wives to reduced the maternal and infant mortality rates, specifically in rural areas, the UNFPA report said, “There is no evidence that the training programmes in Pakistan have worked to reduce maternal mortality, although many programmes have reportedly improved the knowledge, skills and performance of mid-wives.”
It said factors such as reliance on untrained traditional birth attendants, lack of awareness regarding pregnancy complications, lack of faith in the modern medical system and several physical, economic and social barriers also contribute to these mortality rates.
It added that high levels of maternal mortality and morbidity were the results of women’s low status in society, poor nutrition, a significant proportion of high-risk pregnancies, poor access to healthcare services, poverty and illiteracy. The UNFPA report observed that there was no organised system to provide health education or counselling to expectant mothers, except for the lady health workers programme, which only covers 48 percent of the country.
“The mechanism for monitoring the performance of government health facilities is weak. Government health personnel are not accountable to communities, who, in turn, have little interest or faith in the government health system,” the report said. The report also stated that the government has realised these shortcomings and there have recently been efforts to harmonise the field operations of the two ministries responsible for women’s reproductive health needs.
Source: Daily Times