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Steps needed for welfare of expectant mothers

ONE out of 89 women in Pakistan dies of maternal causes, while two – thirds still deliver at home.

A maternal death occurs – while a woman is pregnant or within 42 days of the end of her pregnancy – from any cause related to the pregnancy.

Among women aged 12 to 49, complications of pregnancy and childbirth are the leading cause of death, accounting for 20 per cent of all deaths for women of childbearing age.

Women aged 25 to 29 are specially at risk for maternal death – nearly two out of five maternal deaths for this age group are from pregnancy-related causes.

Balochistan and the Sindh coastal belt have by far the highest proportion of women dying from complications of pregnancy, child-birth and puerperium (the six weeks immediately after delivery).

Still, almost 65 per cent of women deliver at home, and less than half receive any kind of post-natal care. Women living in rural areas and those who are poorer are especially unlikely to receive any care during pregnancy and childbirth.

However, only 25 per cent of pregnant women learn about warning signs of pregnancy complications, and less than half(43 per cent) take iron tablets or syrup.

Most women (80 per cent) get their blood pressure checked but less than half are weighed or have a urine or blood sample taken.

Proper medical attention and sterile conditions during delivery greatly reduce the risk of serious illness or death to the mother and baby. Only one-third of Pakistan’s births occur in health facilities–11 per cent in the public sector and 23 per cent in private sector facilities.

By contrast, two-thirds of birth occur at home. Home births are considerably more common in rural areas (74 per cent) than urban areas (43 per cent), and far more common among women with little or no education than among women with secondary higher education.

Fewer than two in five births (39 per cent of births) are assisted by a skilled provider (doctor, nurse /midwife, or lady health visitor). Half are assisted by a traditional birth attendant (dai).

A safe delivery kit is used for about one-third of home births. In 79 per cent of home deliveries, however, an unboiled thread is used to tie the umbilical cord and in 28 per cent, scissors are used to cut the cord.

One in every 11 children dies before reaching his/her fifth birthday. More that half of these deaths occur during the first month of life.

Diarrhoea and pneumonia continue to be two of the leading causes of death in children younger than five years. Children living in rural areas are at greater risk of death than those living in urban areas. Mortality rate for the under-five is 28 per cent higher in rural than urban areas.

The average childbirth gap in Pakistan is below two years. Spacing children at least 36 months apart significantly reduces the risk of infant and child deaths. Being a woman legislator I would suggest that the existing health services should be improved, emergency obstetrical care should be available to all women round the clock.

Equipping the existing basic health units and rural health centres with basic obstetrics care, ensuring availability of health professionals trained and experienced in obstetric complications may significantly reduce maternal mortality in Pakistan.

Traditional birth attendants should be trained to recognise complications and refer such cases to the professionals. Maternity homes should exist at union council level.

Literacy rate should be improved so that awareness about reproductive health and use of available health resources could be optimised.

Gender discrimination should be discouraged to make women part of decision-making. Repeated and closely-spaced pregnancies should be discouraged and contraceptive prevalence needs to be increased in culturally conservative areas.

The role of men regarding knowledge and use of contraceptive measures should be encouraged. Antenatal care is the right of every pregnant woman.

Socio-economic status of the community needs to be improved to avoid hindrance of high cost of care and poverty. Healthcare should be free for all pregnant women. NGOs should expand their services with the support of government in rural areas to upgrade reproductive health status.
Source: Dawn