Enhancing mothers' capacity for better care of newborns at home

Educating and training mothers to ensure health and survival of newborns in South Punjab

Fatima Shahryar
Mafia Bibi holding her one month old baby boy

15 July 2018

Bahawalnagar, Punjab - July 2018: “Two years ago, I lost my baby when he was only five days old,” says Mafia Bibi, a mother of three, living in village Fateh Kot of Bahawalnagar District, Punjab. “This was the second time, that I lost a newborn within first few days of birth.  So, to seek advice on birth spacing, I contacted Razia, the Lady Health Worker (LHW) in our village.”

“I have known Razia for several years now, but never really sought her help. As every time, I had to deliver, I would travel to my parental home, located in another village. This time when I sought her advice, she was very kind and guided me patiently. Two years passed by until I was pregnant again. On her advice, I delivered my child at a health facility under the supervision of a doctor, unlike earlier deliveries, which were at home with the assistance of an unskilled traditional birth attendant. I am exclusively breastfeeding my newborn, Mohammad Ramzan, who is now one month old and much healthier compared to my other children.”

"Losing my children, one after another, for unknown reasons, was so disheartening that I did not want to conceive anytime soon."

Mafia Bibi, resident of Fateh Kot and a mother of three
The image shows a woman breastfeeding her baby
Mafia Bibi, breastfeeds her one-month-old son, Mohammad Ramzan. Bahawalnagar District, Punjab

Fateh Kot is a small village located a few kilometers from the international border in Bahawalnagar district of Southern Punjab. For their livelihood, residents of the village depend mainly on cattle farming and labour jobs on daily wages. Poverty, lack of education and access to basic services, adds to their poor knowledge about health and hygiene. Sticking to age-old traditions, most women rely on advice from the elderly and conventional practices, which can pose threat to mother and child’s health and life.

In Bahawalnagar, around 106 babies out of 1,000 live births die during first year of their lives while the number of deaths during the first month is proportionately higher. This reflects on the poor state of newborn mortality in the country, which stands at 55 per 1,000 live births, making Pakistan one of the countries with highest newborn mortality rate.

To improve the survival and healthcare of newborns, UNICEF, with funding from Johnson & Johnson, initiated the project: ‘Improved Health Outcomes for Newborns Through Implementing Care of the Newborns at Home’, in January 2017. The project is being implemented in Bahawalnagar District in close coordination with the Integrated Reproductive Maternal Newborn and Child Health (IRMNCH) Program Punjab.

Lady health worker Razia Sardar speaks during a support group meeting
Razia Sardar, Lady Health Worker in village Fateh Kot, Bahawalnagar District, educates women of her community during a support group meeting at her Health House

Under this project, all LHWs of Bahawalnagar district and their supervisors were trained for improved care of newborns at home and were provided counseling cards with illustrations, to help them educate the communities. LHWs regularly conduct support group meetings with mothers and pregnant women, where they counsel them and advise on maternal, newborn and child health.

A baseline survey to assess the prevailing state of newborn care and survival in Bahawalnagar was also conducted as part of the project. Speaking of the survey findings and interventions for newborn care at home, Dr. Khalid Hussain, District Coordinator, IRMNCH Bahawalnagar says, “I read the baseline survey and found the situation to be really alarming. The support being provided by UNICEF to reduce newborn mortality, and efforts around it, is commendable. Provision of portable projectors to conduct awareness sessions in field has specifically proven to be extremely useful. We hope and aim that each Lady Health Supervisor is provided an individual portable project so more LHWs can be reached to promote and enable improved newborn care at home.”

Razia Sardar, the LHW in Fateh Kot village, was one of the 1389 LHWs trained by UNICEF. Sharing her experience, Razia says, “I have been working here for past fourteen years. Every time, there is a new intervention or improvement in content, I learn about it and inform the women of my community. Earlier this year, along with other LHWs from neighbouring villages, I received the training on caring for the newborn at home. We were also trained on counseling skills, so we are able to communicate in a better way for improving mothers’ knowledge and health practices.”

Razia Sardar weighing a baby in her village
Razia Sardar, Lady Health Worker from village Fateh Kot, weighs a baby at her Health House, using newly provided salter scale. Bahawalnagar District, Punjab

“Initially, it was very difficult as some women were not allowed by their families to attend my sessions, while others would listen but not follow the instructions. It has been tough but a worthwhile journey as all people of my community, women and elderly alike, now trust me and come to me for advice and services. All children in my community are vaccinated, pregnant mothers are actively seeking health care advice and newborns are being provided best of care at home.  Not only this, but all mothers are breastfeeding their newborns, which makes me feel very proud.”

Under this project, UNICEF procured 1,700 thermometers, 1,500 Acute Respiratory Infection timers for early diagnoses of Pneumonia, 1,500 salter scales and 25 portable projectors that were provided to the LHWs, community midwives and Health Facility staff.

With new equipment, and enhanced capacity, LHWs are now contributing more towards improved skilled birth attendance and reduction in infant and child mortality rates.

“Simple cost effective interventions are well known and can help avert many deaths due to preventable causes. I am extremely delighted to witness a positive change in the district Bahawalnagar community due to this project focusing upon provision of care to the newborns at household level. The initiative must be scaled up to the remaining districts of Punjab province and other provinces for enhanced coverage of improved care of newborns”, says Dr. Samia Rizwan, Health Specialist at UNICEF, Pakistan Country Office, reiterating the scale-up vision of UNICEF Pakistan health programme.