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Community Midwives provide rural women with 24-hour trained obstetric care on their doorsteps

© UNICEF/Pak2010/Paradela
Mussarat Pervaiz gets an antenatal checkup from a community midwife trained with UNICEF support

By Shazia Hassan and Fatima Raja

KASUR, Punjab Province, 2010 –When Mussarat Pervaiz had her first child eight years ago, she travelled to a nearby village to a private health facility where she paid over Rs 5,000 (US$ 60) for the delivery. For the wife of a factory worker in the local steel cable industry in the village of Dholan, this was a considerable sum, but had to be repeated four more times.

Now, Ms Pervaiz is in the eighth month of her sixth pregnancy. Sitting in a brand new midwifery home, she looks relaxed and at ease during her antenatal check-up. This time, she says, she will give birth in the presence of a trained Community Midwife in a fully equipped delivery room bare moments from her front door. The cost: US$ 6–12.

“Initially it was difficult to get the attention of the community women,” Aziza recalls. “I went door to door and briefed them about the services they can get at my midwifery home.” At first, few responded. “How we can trust a new person until you prove yourself?” they said.

Aziza Ishrat is an energetic 25-year-old who established her midwifery home a year ago. She is amongst the first women to graduate from the Community Midwife (CMW) programme supported by UNICEF and the Government of Punjab to ensure that every woman, especially in rural areas, has a trained attendant at birth. In a province where 226 women die per 100,000 live births – an unacceptably high figure – trained birth attendants with practical knowledge of basic obstetric care and hygiene, and who can recognise when a woman needs emergency medical help, can potentially save thousands of lives. Aziza is one of 281 CMWs trained in three districts, as part of a pilot programme to recruit and train women to practice in their own villages.

After her marriage, Aziza says, it was her husband, a civil servant who broke from the traditional reluctance to allow women to work, and urged her to apply to the CMW programme. Leaving her one-year-old daughter with her mother in Dholan, Aziza went to the district hospital in Kasur, and later in the provincial capital Lahore, to embark upon an exhaustive 18-month training programme. After completing it, Aziza returned home an accredited midwife with the Pakistan Nursing Council to establish her own practice at a fully-equipped midwifery home in Dholan.

“Initially it was difficult to get the attention of the community women,” Aziza recalls. “I went door to door and briefed them about the services they can get at my midwifery home.” At first, few responded. “How we can trust a new person until you prove yourself?” they said.

Over time, by providing quality antenatal care and inexpensive deliveries, Aziza has proved herself. In the past year, she has delivered 60 babies and referred 22 mothers to the district hospital. When some mothers could not afford transport to Kasur, thirty minutes away, she persuaded her husband to give them a lift on his motorcycle. Now, Aziza sees 8–10 women for antenatal checkups every month. Ms Pervaiz herself came to her after a sister-in-law’s good experience.

There is already a primary healthcare centre, BHU Dholan, in the village, but it closes at 2 pm every day. Since childbirth follows no timetable, Aziza’s midwifery home has been a blessing for the village women.

From here, she provided antenatal care to mothers, be available to conduct deliveries at any time of day or night, and use the contacts developed during her training to refer women in difficult deliveries to higher level hospitals. She also provided expert advice on reproductive health and childcare. She has persuaded Ms Pervaiz and her husband to limit their family, and has promised to personally escort the mother to the district hospital for a tubal ligation.

© UNICEF/Pak2010/Paradela
Rukhsana now plans to exclusively breastfeed baby Adeeba for six months following the advice of her local midwife

Later, Aziza goes to visit 22-year-old Rukhsana Qurban, the proud mother of a six-week-old girl, Adeeba. She is delighted with the convenience and expertise offered by Aziza’s midwifery home. Her first child, a two-year-old girl, had been delivered at a private hospital, and she and her husband had struggled to pay the US$ 60 bill. Aziza charged only US$ 6 and, knowing her neighbour’s circumstances, will wait till Ms Qurban can afford the payment. “This time I had three antenatal visits, and Aziza came to my home and counselled me about healthcare,” she says. “I delivered safely, and [after Aziza’s counselling] will breastfeed till Adeeba is six months old.”

For Aziza herself, her new job gives her an independent income and a standing in the village. In addition to her fees, she receives a small monthly stipend, about US$ 24, from the government, and in return commits to providing on-call facilities and helping with other health initiatives aimed at children, such as immunisation campaigns. But most of all, she finds her work perpetually rewarding. “I feel a great sense of achievement when I help a woman giving birth,” she says.



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