Pakistan

In Pakistan, midwife training programme reaches the most vulnerable new mothers

© UNICEF/PAKA2010-00183/Ramoneda

Community midwives attend a UNICEF-supported midwife training class at the District Headquarters Hospital Sheikhupura in Punjab province.

This week’s UN Millennium Development Goals summit highlighted the importance of reaching the world’s most disadvantaged children in order to achieve the MDGs with equity by 2015. Here is a related story.

NEW YORK, USA, 24 September 2010 –The fifth United Nations Millennium Development Goal – one of a set of internationally recognized targets for reducing poverty worldwide – focuses on improving maternal health. To help achieve this goal and reduce the frequency of maternal death, UNICEF is encouraging women to have a skilled attendant at their delivery.

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In Pakistan, for every 100,000 babies born, some 260 women die during childbirth. The country is one of 11 countries that comprised 65 per cent of global maternal deaths in 2008. Yet most maternal deaths could be prevented if a skilled practitioner attended the birth.

Community midwives

Perveen Akhtar works as a midwife in the Kasur district of Pakistan’s Punjab province, providing obstetric care for women in her community. She has five children of her own under the age of 12 and received training from a UNICEF-supported community midwife programme while raising her young family.

© UNICEF/PAKA2010-00207/Ramoneda

A newborn baby lies on a bed at the nursery of the District Headquarters Hospital Sheikhupura in Punjab province, Pakistan.

Ms. Akhtar graduated from the 18-month intensive community midwife training programme with the practical skills to care for both mother and child. During the course, she was instructed on how to care for women for the entire pregnancy cycle, from conception to post-natal care.

The course also covers a mother’s emotional well-being – including ensuring that she and her family are prepared for childbirth and its potential complications.

Hospital referrals

In Pakistan, most women deliver their babies at home with the assistance of a local ‘dai,’ or traditional birth attendant. A key aspect of the community midwife training is teaching midwives when to seek additional or emergency medical care. This is an essential difference between her work and the work of the local dais, explains Ms. Akhtar.

“If there are any complications I refer them to a private hospital or a government hospital,” said Ms. Akhtar. “The minute I know there’s a complication I refer them and I usually know in advance if it’s going to be a complicated case.”

© UNICEF/PAKA2010-00209/Ramoneda

A community midwife examines a patient at her home in Ladeki-Gorhi village, Sheikhupura district, in Pakistan's Punjab province.

Ms. Akhtar recalls one particularly difficult case. She arrived at the home of the mother-to-be and found the woman bleeding. Ms. Akhtar suspected that the woman was suffering from placenta previa, a condition where the placenta sits very low in the cervix and can cause heavy bleeding during and after labour. She checked the woman several times, and with growing confidence in her diagnosis, sent her to a local hospital for care.

“I took her to the hospital and had an ultrasound done for her,” said Ms. Akhtar. “They confirmed that it was placenta previa. She had a C-section and God gave her a son, whereas her three previous children had died at childbirth.”

Equity in care

Only an estimated 39 per cent of women in Pakistan have a skilled attendant present at delivery, and that number decreases dramatically for the poorest 20 per cent of women in the country. Many of the country’s poorest people live in remote, rural areas, far from a basic healthcare centre.

“Some women die because they don’t have the proper facilities,” said Ms. Akhtar, adding that others die because they cannot find transportation even to hospitals that are accessible. It is in these remote locations where trained midwives can be most effective. Ms. Akhtar established a midwifery home in her community over two years ago. She also provides obstetric care to women who live in more rural areas – some 10,000 people in three adjoining villages.

Ms. Akhtar says she faced difficulties convincing some women to come to her for obstetric care. In other cases, women would see Ms. Akhtar only for their pre-natal care, but then deliver with the assistance of a dai.

“Initially, I had a lot of problems,” said Ms. Akhtar. “But now people come to me. Some go to the dais, but mostly they come to me.”