Saving Lives Through Behavioural Change in Childbirth Practices
By: Fatima Shahryar
BAHAWALPUR DISTRICT, PAKISTAN, February 2014 – “I delivered five of my children at home in the hands of a dai (Traditional Birth Attendant/TBA)”, says Kaniz Safdar (35) resident of Jhangiwala village, Bahawalpur District. “There were complications during every delivery and I suffered for months. During my sixth pregnancy, the dai told me that there could be a threat to my life and it is advisable that I see a doctor. I had myself checked at this hospital and a few days later delivered my sixth child here. Now, I can tell the difference between delivering at home and in a hospital under the care of a skilled birth attendant.”
The Basic Health Unit (BHU), Jhangiwala is located in a rural vicinity of Bahawalpur City. Women from different villages in the area come to this government supported facility, established to cater the basic health needs of people living in the area. In the past few years UNICEF has supported the Punjab Health Department to upgrade and equip BHUs to provide round the clock maternal and neonatal services including Tetanus vaccination for pregnant and lactating women.
“I am pregnant for the seventh time and visit this hospital regularly for check-ups and vaccination. Doctor guides me on how to keep myself and my child healthy. The dai never told me these things. I will deliver my child here. It is clean and safe.”
After receiving an anti-tetanus injection, Kaniz says, “I am pregnant for the seventh time and visit this hospital (BHU Jhangiwala) regularly for check-ups and vaccination. Doctor guides me on how to keep myself and my child healthy. The dai never told me these things. I will deliver my child here. It is clean and safe.”
Despite the presence of the health facilities, lack of awareness about health and hygiene, prevent women from seeking medical advice and services of Skilled Birth Attendants (SBA). Traditional practices and illiteracy are other factors that keep women from availing health care facilities during and after pregnancy.
“TBAs are unequipped and have no professional training,” says Dr. Muhammad Mushtaq Rana, Immunization Officer, UNICEF. “They use rusted knives and even sickles to cut the umbilical cord at the time of delivery. This can cause tetanus and lead to the death of the newborn and even mothers in some cases. To prevent this, it is important that massive awareness campaigns are carried out to give knowledge to the marginalized and unaware communities. We have achieved great success, but still have a long way.”
Unsafe deliveries are the leading cause of Maternal and Neonatal Tetanus (MNT) and thus the maternal and neonatal mortality. To address the issue and eliminate MNT, extensive measures have been taken by the Government with support from UNICEF. Addressing it at the basic level, Lady Health Workers (LHWs) ensure that every woman in their community is well aware of the risk of tetanus infection and seeks the services of an SBA. Similarly, once the woman consults an SBA, which includes a Lady Health Visitor (LHV), Community Midwife and a doctor, they prescribe and give her the required Tetanus Toxoid (TT) vaccination. This vaccination is also a mandatory part of the antenatal check-up and is thus recorded by the SBA.
“It is heartening to see that women are becoming more aware about maternal and newborn health,” says Rehana Kausar, the LHV at the BHU, Jhangiwala. The awareness level is increasing with time. I examine many women who come here for TT vaccination. We take this opportunity to guide them about antenatal check-up and other important health issues”.
"The awareness level is increasing with time. I examine many women who come here for TT vaccination. We take this opportunity to guide them about antenatal check-up and other important health issues”.
There are many women like Kaniz, who earlier delivered their children through unsafe practices and lost their new-borns to reasons unknown to them. With raised awareness, more and more women are now keen to seek the services of an SBA and get their vaccinations regularly.
In the neighbouring village called Lal Sohanra, medical staff at the local BHU has also experienced an increase in number of women visiting the health centre as a result of UNICEF-supported awareness campaigns. More women come in everyday for their antenatal and postnatal check-ups. Amongst them are unmarried women of child bearing age who are conscious about their health and want to go through a course of preventive vaccination before they get married.
“The word of mouth has a strong influence among rural communities. Since women have become conscious about their health issues, it is not just pregnant women or those who have recently given birth to a child that come for tetanus vaccination, unmarried women of child bearing age also get vaccinated,” says Afshan Malik, Lady Health Visitor and vaccinator at the Lal Sohanra Basic Health Unit.
Every day, women come to the BHU Lal Sohanra in numbers and wait patiently for their turn to be vaccinated. Due to UNICEF-supported community mobilization activities, rural women are now able to relate TT vaccination to their health in general and pregnancy and safe childbirth in particular. This is a positive behavioural change which has resulted in an increased demand for health services in rural communities.