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Networks of care for mothers and children in Pakistan

© UNICEF Pakistan/2008/ Moore
Dr Aisha Iram examines three-month-old Omair. Omair's mother, Humera Afzal, had regular antenatal care during her pregnancy.

By Fatima Raja

KHANPUR, Pakistan, 28 January 2009 – A row of women sit in a brightly decorated waiting room at the Khanpur Basic Health Unit. The women have either come for their monthly antenatal checkups or postnatal visits, healthy babies in tow.

Inside the facility, Dr. Aisha Iram, the Medical Officer at BHU Khanpur, smiles down at Mahvish. Only seven-months-old, Mahvish squirms at the cold touch of the stethoscope as her mother holds her close.

"Mahvish was born by C-section at the Headquarter Hospital in Sheikhupura City," said Dr. Aisha. "We knew her mother's case history – she had had a prior C-section as well – and told her to go straight there for her delivery."

Dr. Aisha is one of only four women doctors who run a Basic Health Unit (BHU), a rural primary care facility in Sheikhupura District – a critical shortfall in a society where women regularly go without antenatal or postnatal care.  Rather than see a male doctor, many women consult traditional birth attendants known as ‘dais’.

Rural communities face roadblocks

Despite apparent need, most doctors prefer to work in cities or overseas where salaries are higher. Lack of security and mobility are other major deterrents.

Born and raised in nearby Sheikhupura Town, Dr. Aisha entered a residency programme at Lady Willingdon Hospital in nearby Lahore after studying medicine in Moscow.  It was at this specialised obstetrics facility that Dr. Aisha discovered the Punjab Safe Motherhood Initiative, a pilot project supported by the government of the Punjab Province.

The initiative seeks to reduce maternal and infant mortality in Sheikhupura District by rotating ten female postgraduate doctors to the district's hospitals.  Equipped with a mobile ultrasound unit, they visit 12 rural BHUs every month to provide on-site antenatal care.

Dr. Aisha made it her mission to initiate improvements in Sheikhupura.  She set up a labour room, conducted discussion groups with community-based Lady Health Workers to better assess the needs of pregnant women, and created a network of emergency help-lines, ready to request ambulances and alert doctors in higher level facilities to her patients' critical needs.

'The difference between life and death'

The intrepid doctor’s efforts yielded tangible results.  In 2007, the year in which Dr. Aisha joined the BHU team, the number of antenatal visits jumped to over 3,700 – up from about 800 in the previous year.  Many women now come for eight or more antenatal visits, and continue for postnatal care.

"These linkages can make the difference between life and death," says Dr. Tahir Manzoor, the Health Specialist at UNICEF's provincial office in Lahore. “We can train people in the communities, we can even have doctors working there, but in an emergency, the only thing that may save a woman's life is prompt and appropriate referral." 

The success of the Safe Motherhood Initiative has engendered similar projects in two other districts with the support of the Punjabi government, UNICEF and the United Nations Population Fund (UNFPA).

Dr. Aisha is among several Safe Motherhood Initiative alums who now intend to practice in their home communities.  Armed with a deep understanding of their own districts’ specific needs, the doctors bring an unprecedented level of care to rural areas.

The Safe Motherhood Initiative provides a system in which local doctors are part of a holistic network that links homes with tertiary care hospitals, ensuring that the appropriate level of care is available to rural mothers. 



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