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Trainee midwives bring expert care to rural women in Pakistan

© UNICEF Pakistan/2008/Paradela
Tabassum Naseem monitors the health of newborn babies as part of her training to become a community midwife.

By Fatima Raja

NANKANA SAHIB, Punjab Province, Pakistan, 12 March 2008 – A high mortality rate for newborns plagues Punjab Province in Pakistan. But steps are being taken to prevent these deaths by training skilled midwives who can attend births and can give much needed advice to new parents.

Tabassum Naseem is one such trainee. She walks through the dimly lit women’s ward at the Nankana District Hospital and pauses to gently examine a pair of twins only three days old. The mother is exhausted after a C-section, but smiles proudly. Tabassum smiles back and continues to the next bed.

Training to be a community midwife at the Nankana District Headquarters Hospital, Tabassum is one of 35 young women undergoing an exhaustive, 18-month residential course supported by UNICEF to learn how to attend childbirth, monitor women for complications and refer them to hospitals, if necessary.

Once fully trained, each woman will return to her village to establish a midwifery home with UNICEF support. The trainees have been selected from communities of at least 10,000 people that do not have health facilities nearby.

‘Difficult for single women’

In Punjab, Pakistan’s most heavily populated province, only 33 per cent of births take place in the presence of a skilled birth attendant. In rural Punjab, this rate falls to 26 per cent – contributing to Punjab’s high maternal mortality rate of 300 deaths per 100,000 live births.

© UNICEF Pakistan/2008/Paradela
To become a community midwife, Tabassum (right) has to undergo 18 months of intense training.

Nankana is one of three districts in the province where UNICEF is supporting a midwife training programme targeting remote rural communities.

Tabassum comes from Meli Burji, a village 90 minutes away from Nankana Sahib, the district capital. She has had a harder journey than many of her colleagues. Married four years ago at the age of 21, she is separated from her abusive husband and has returned to her parents’ home with her daughter Irfa, 3.

“I used to feel a mental tension all the time,” she said. “It’s very difficult for single women. Often, families don’t let women do anything outside the house.”

Familiarity with women’s difficulties

Luckily, Tabassum had a supportive family, and when her father heard about the midwifery training programme, he suggested that she apply. Now, she lives at the hospital and visits Irfa every Sunday.

Growing up in a remote village, Tabassum was familiar with the difficulties women faced when giving birth. Traditional birth attendants often did not practice basic hygiene and were reluctant to send women who were facing difficult deliveries to hospital.

“They tell you all children can be born at home,” she said. “They say, we’ll give you an injection and you’ll be just fine!”

Working independently in rural areas

During her training, Tabassum is learning to conduct normal deliveries and to determine when a woman ought to be referred to a hospital.

Azra Parveen, the head nurse in charge of the training programme in Nankana, stresses the importance of counselling. “These young women must know how to talk to their patient, to her husband, to her mother-in-law,” she said. “We play-act how to deal with each of them for the good of the mother and the child.”

Practical experience and skill acquisition are stressed during the training. Tabassum and her colleagues recently returned from a three-month stay at a major tertiary hospital in Lahore, where they received hands-on training under the supervision of experienced obstetricians.

“We saw everything there,” Tabassum recalled. “There were times when we’d be delivering one baby and another woman would go into labour. I’d strip off my gloves, clean up, put on a new pair and start again.”

‘I’ve vowed to stand on my feet’

Since 2004, with UNICEF support, 69 health facilities have been upgraded to provide emergency obstetric and newborn care services in 11 districts and in the capital, Islamabad. Sixty-seven of these facilities provide 24-hour services.

More than 60 per cent of all deliveries are conducted by skilled birth attendants in 9 out of 11 focus districts. Seventy-four community midwives in three districts have completed their 18-month training and are now providing their services to pregnant women.

There is still a year to go before Tabassum and her colleagues return to their villages, but they are determined to serve their communities.

“I came here with the motivation to do something for myself and my village,” Tabassum said. “It’s difficult, but I’ve vowed to stand on my feet and I’ll carry my burdens myself.”



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