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Community midwives in Pakistan help mothers and babies survive

UNICEF Image: Pakistan, midwives
© UNICEF Pakistan/2007/Paradela
Community midwives like Afshan Keerio (right) assist mothers in rural Pakistan during pregnancy and childbirth.

By Antonia Paradela

Here is one in a series of stories on successful initiatives to promote healthy lives, provide quality education, combat HIV and AIDS, and protect children against abuse, exploitation and violence – all part of a special edition of ‘Progress for Children’, UNICEF’s flagship publication on advances towards the Millennium Development Goals. The report was launched on 10 December.

SHAHDADPUR, Pakistan, 24 December 2007 – Inside a small, mud-walled clinic, a group of expectant mothers converse while a community midwife performs her check-ups. She takes one of the young women’s blood pressure, notes the details and, with a smile, reassures the mother-to-be that everything will be fine.

The trained midwife, Afshan Keerio, assists women in 16 villages near her home in rural Sindh Province in southeastern Pakistan. She monitors the health of mothers and babies, assists during childbirth and is responsible for the prompt referral of complicated cases.

“I feel very happy to be able to assist mothers during childbirth, as there is no other midwife working in this area,” says the lively 29-year-old. Ms. Keerio is present at about 12 births each month and says that in at least two or three cases, complications arise. She refers these cases to nearby health facilities that are equipped with 24-hour obstetric services and skilled personnel.

Ms. Keerio performs an average of about 25 antenatal check-ups every month and also visits patients in their homes. One of her proudest moments, she remembers, was when she helped a mother deliver twins. She says she still recalls their exact birthweights.

© UNICEF Pakistan/2007/Paradela
Afshan Keerio checks the blood pressure of a pregnant woman in rural Pakistan.

Difficulty in rural areas

In Pakistan, a woman’s lifetime risk of maternal death is 1 in 74, compared with 1 in 8,000 in industrialized countries. Two-thirds of mothers in Pakistan do not have access to a skilled attendant when giving birth. The problem is exacerbated in rural areas, where the majority of births take place at home. In these areas, births are traditionally attended by local women known as dais, who have no formal training.

A skilled birth attendant can recognize early danger signs, provide first aid to both mother and newborn and, in case of serious complications, promptly stabilize the situation and refer the patient to a health facility.

There are seven community midwives working in the Sanghar District of Sindh Province. The women, including Ms. Keerio, have received training and support from UNICEF.

Learning valuable skills

Ms. Keerio has gained the trust of a local birth attendant, who now sends pregnant mothers to her for care. Through such a referral, she recently assisted a 35-year-old mother of six in the birth of her youngest child. On Ms. Keerio’s advice, the mother fed her baby only breast milk for the first six months.

“Talking to Afshan, I learned how to look after myself so that I can look after my children,” the mother says.

Community midwives like Ms. Keerio work closely with a team of female health workers who provide health messages and services to communities in rural and remote parts of Pakistan. Through this coordinated effort, the number of mothers with birth complications who received assistance at the nearest public hospital has increased in recent years, and lives of both mothers and newborns have been saved.



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