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Community midwives provide inexpensive, local obstetric care in rural Pakistan

© UNICEF Pakistan/2010/Paradela
In Punjab province, Pakistan, Mussarat Pervaiz receives an antenatal checkup from a community midwife trained with UNICEF support.

By Shazia Hassan and Fatima Raja

KASUR, Pakistan, 19 May 2010 – When Mussarat Pervaiz gave birth to her first child eight years ago, she travelled to a private health facility where she paid more than $60 for the delivery. For the wife of a steel factory worker in a village in north-western Pakistan, this sum – which was repeated for four more births – was considerable.

Now in her sixth pregnancy, Ms. Pervaiz visits a brand new midwifery centre in her village, Dholan, where she receives ante-natal care and will deliver for under $12.

Established by a graduate of a UNICEF-supported community midwife programme, the centre brings safe conditions and financial relief to mothers like Ms. Pervaiz. This time, she said, she will give birth in the presence of a trained community midwife in a fully equipped delivery room, and only a few moments from her front door.

Midwives save lives

Across Pakistan, about two-thirds of women deliver children outside of a hospital or clinic. Only 39 per cent of women are attended by a skilled birth attendant of any kind. And in Punjab province, where Ms. Pervaiz lives, an estimated 226 women die per 100,000 live births. Trained birth attendants can potentially save thousands of lives each year in these conditions.

© UNICEF Pakistan/2010/Paradela
Aziza Ishrat, 25, one of the first women to graduate from a community midwife training programme, established a midwifery centre a year ago in Dholan village, in Pakistan's Punjab province.

The midwifery home in Dholan village is one new community centre hoping to do just that. It was established a year ago by Aziza Ishrat, an energetic 25-year-old who was among the first women to graduate from a community midwife – or CMW – programme supported by UNICEF and the government of Punjab province.

Ms. Ishrat is one of 281 CMWs trained in three Pakistaini districts as part of a pilot maternal health programme. With support from her husband – who supported her ambitions despite the traditional stigma around working women – she undertook a rigorous 18-month training programme in the provincial capital, Lahore. She returned home to Dholan as a midwife accredited with the Pakistan Nursing Council, ready to reach out to other women in her village. 

Building community trust

Despite her success, Ms. Ishrat said that opening her own community health centre was no easy task.

“Initially it was difficult to get the attention of the community women,” she said. “I went door-to-door and briefed them about the services they can get at my midwifery home.”

Over time, Ms. Ishrat worked to prove herself to women and families in her community. She has delivered 60 babies and referred 22 mothers to the district hospital in the past year. When mothers can’t afford transport to the hospital in Kasur, 30 minutes away, her husband gives them a lift on his motorcycle.

Today, Ms. Ishrat sees up to 10 women – many of whom would not otherwise have a health support system – for ante-natal checkups each month.

A boon to village women

Besides providing ante-natal care and attending births, Ms. Ishrat also provides women in the village with advice on reproductive health and child care. As a mother with a young daughter herself, she can relate to her patients and support them through difficult times.

For Ms. Ishrat, the new job provides an independent income and a strong position in her community. In addition to her fees, she receives a small monthly stipend from the government; in return, she commits to providing on-call services and helping with other health initiatives aimed at children, such as immunization campaigns.

But most of all, Ms. Ishrat finds her work rewarding. “I feel a great sense of achievement when I help a woman giving birth,” she said.



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