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In Pakistan, a skilled birth attendant delivers health and safety for mothers and children

“It makes me happy when the mother and child are both healthy,” says Shagufta Shahzadi, a community midwife in Pakistan.


By A. Sami Malik

Antenatal and postnatal care for women in rural Pakistan has improved dramatically, thanks in part to the work of women like Shagufta Shahzadi, a skilled birth attendant trained under a UNICEF-supported programme.

KASUR DISTRICT, Pakistan, 3 December 2014 – “My biggest pleasure is to see that the mother and child are both healthy after the delivery,” says Shagufta Shahzadi, 30, a skilled birth attendant (SBA) who lives and works in Nandanpura village, Kasur district, in Pakistan’s Punjab province. 

© UNICEF Pakistan/2014/Zaidi
Shagufta Shahzadi leaves her home in Pakistan's Punjabi province. A sign on the wall displays ‘Community Midwife’.

“There is a huge difference between services provided by a trained birth attendant and an untrained traditional midwife. A skilled person knows how to prevent and deal with complications during pregnancy, at the time of delivery and delivering postnatal care for mother and child.”

A day’s work for Shagufta could include delivering a baby, advising pregnant women on prenatal care, walking to the neighbouring village to provide postnatal care to a mother and the newborn. She takes a lot of pride in her work and feels a sense of achievement in the fact that due to her services, there hasn’t been a case of a pregnant mother or newborn death in her area over the last year.

Looking back at the struggle she had to make throughout her life, Shagufta recalls, “I was two months old when my father passed away. My mother raised me and my sister with the little money she earned by stitching cloths. Her resources were meagre, yet she made sure that we both completed our matriculation. Thereafter, we completed our respective trainings. My sister became a lady health worker, and I became a skilled birth attendant.”

© UNICEF Pakistan/2014/Zaidi
Shagufta takes notes while talking with a patient, to keep a record of the periodic check-ups she conducts.

In 2012, Shagufta graduated from an 18-month community midwife training course organized by UNICEF at the District Headquarters Hospital in Kasur.

It wasn’t easy, as the younger of her two daughters was only a few months old. Support from her husband and the rest of the family helped her complete the training, and their support continues while she works as an SBA.

“Things have changed”

Comparing the prenatal, delivery and postnatal care exercised by untrained birth attendants 25 to 30 years ago to the modern day services offered by SBAs, Shagufta sees a big difference.

“My mother tells me that when I was born, a traditional midwife came to our house to manage the delivery," she says. "She had no concept of hygiene and did not even wash her hands before checking my mother. She placed some ash from the stove on the floor and delivered me there. Things have changed now. Lives lost due to unskilled practices can now be saved.” 

© UNICEF Pakistan/2014/Zaidi
Shagufta checks a pregnant woman who has come to the maternity care centre she operates in her home.

Shagufta provides antenatal and postnatal services to women and children in 10 villages within Kasur district.

As the only SBA in the area, and also because of her friendly disposition, Shagufta is a popular local figure, and women feel comfortable discussing issues with her.

“I conduct periodic check-ups of the pregnant women, keeping a record of their blood pressure, body temperature, pulse rate and oedema,” says Shagufta.

“It is important that I keep my contact with her right from early days of pregnancy till the delivery, and thereafter to provide postnatal care to the mother and the newborn.”

Positive results

Pakistan has a high rate of maternal and child mortality, and one of the reasons is the lack of SBAs, especially in remote rural areas. In collaboration with the Health Department of Punjab and development partners, UNICEF initiated a training program for SBAs in various district hospitals in 2005 to train young women belonging to rural communities so that they acquire the skill and start their own maternity practice within their communities.

Shagufta sits with a mother and her newborn child, delivered just a few days before.

“Due to the positive results of this programme, the Government of Pakistan has scaled up the initiative across the country,” says Dr, Tahir Manzoor, Health Specialist at UNICEF Pakistan. “In Punjab province, more than 5,000 women have been trained and are performing valuable services within their own communities. We can already see the positive impact of their services and are certain that it will improve the scenario of mortality and morbidity for mothers and new born children in Pakistan over the next few years.”

Shagufta believes that ensuring health and safety for mother and child is imperative.

“If mothers and children are healthy, the entire society will be healthy. The future generations will be healthy," she says. "We must try to save lives, as life is precious, and you only get it once.” 



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