New programme helps women and newborns survive and thrive in Pakistan’s North Eastern province

Peshawar, Pakistan - 15 December 2020: Life has not always been easy on Gulsanga, a 27-year-old mother of two who lives in Khairabad, a village of Khyber district in Pakistan’s northeastern Khyber Pakhtunkhwa province.

Together with her husband Kashif, a daily-wage laborer who believes that a woman’s place is ‘either in the house or in a grave’, Gulsanga is raising two young boys in a community where conservatism in the norm. Families living in the area are amongst the most marginalized segments of the population, with limited access to healthcare and education services.

Girls are the first on whom poverty takes a toll.

“Child marriage is a common practice in our community. Girls become pregnant at an early age,” Gulsanga tells. “Women are usually confined within the four walls of their homes. During pregnancy and childbirth, they follow traditional practices passed on by mothers and grandmothers. Many pregnant women and newborns die of complications related to the pregnancy and the birth.”

Women and girls are further disadvantaged as local customs do not support sending them to school or to health facilities for routine examinations.

Across Pakistan, many communities continue to suffer from poor maternal, newborn and child health outcomes. Neonatal mortality rate reaches 42 per 1000 live births in the South Asian nation, where one in every 14 children born in the country does not survive past their fifth birthday. Neonatal mortality in Khyber Pakhtunkhwa’s newly merged districts (KPMD) where Gulsanga lives is even higher, reaching 55 per 1000 live births.

Previously known as the Federally Administrated Tribal Area (FATA), the KPMD are seven tribal districts laid in a north-to-south strip along the border with Afghanistan. In 2018, they were merged into the neighbouring province of Khyber Pakhtunkhwa. Local communities are both very vulnerable and conservative, with mothers traditionally pressured to give birth to boys. The latter are usually welcomed and well looked after, while girls are more likely to be seen as bad news and neglected.

Gulsanga was one of many women whose child did not survive the harsh living conditions. She lost her first-born within a month of his birth. The child was delivered at home by an unskilled traditional birth attendant as her in-laws did not allow her to deliver in a hospital. The baby’s leg was fractured during the delivery and he died of an infection. Her second child, who she also delivered at home, suffered for months due to medical complications. The young mother says that her pregnancies were ‘an ordeal’ and childbirth, ‘a nightmare’. 

To help improve newborn survival as well as women’s and girls’ lives, Khyber Pakhtunkhwa’s Health Department has launched a new initiative with technical support from UNICEF and generous funding from the United Kingdom’s Foreign, Commonwealth & Development Office (FCDO).

The ‘Naway Wraz’ programme (‘A new day’) promotes positive changes in behaviours and attitudes towards mother and child health care in KPMD, while supporting the provision of safe and essential healthcare for pregnant and lactating women to help mothers and children survive.

For Gulsanga, the programme has been life-changing.

As she became pregnant with her third child, a mobile health outreach team operating under the programme arrived in her village. They started registering and screening women and children who required assistance in terms of health and nutrition. When they reached Gulsanga’s home, her husband did not allow them to enter the house. It took a lot of persuasion and reasoning on the part of the female team members before he agreed to let them check his wife’s health. 

“At first, I was skeptical about women from outside the community examining my wife and telling her about new practices which we traditionally do not follow,” Kashif says. “Gulsanga did not have any complication during her pregnancy and was given newborn and clean delivery kits. I now realise how important this was for my wife and children. These women were godsend.”

Upon learning about the death of Gulsanga’s first child and the medical problems her second child faced, and after noticing that she was weak, the team registered her as one of the pregnant women who needed medical assistance in the village. They also referred her to the nearest Hospital for a more detailed checkup. The medical team provided her with folic acid and other multi-micronutrient supplements in order to improve her nutritional status and that of her unborn child.  Gulsanga says that for the first time in her life, she felt ‘pampered’.

A Lady Health Visitor – a female health care provider in vulnerable communities - started visiting her at home regularly. She advised Gulsanga on Infant and Young Child Feeding (IYCF) practices, including the need to exclusively breastfeed her child from birth and up to six months, and how to maintain hygienic practices. The Lady Health Worker also advised Gulsanga’s relatives that they needed make sure that she stayed healthy and had to prepare for the birth. She also highlighted the need to register the baby at birth.

“I breastfed my second child for only three months, after which I started feeding him boiled potatoes,” Gulsanga tells.  “After listening to the Lady Health Worker, I felt embarrassed about how ignorant I was, I did not even had him vaccinated as per the schedule, but no one had taught me these things.”

This summer, Gulsanga gave birth to a healthy baby boy, Zalmay, with the help of a trained birth attendant at the Hospital. The child received all required post-birth vaccinations and care.

“Becoming the mother of a healthy child has made me a different person,” Gulsanga says, adding that the little boy has brought immense happiness to the family.

Gulsanga now advises other women in the village to open their doors to outreach teams and go for medical checkup at the Hospital when they become pregnant. Mentalities are slowly changing in her community. More and more men now agree to let medical mobile teams visit their pregnant wives at home, and to bring them to the hospital for a checkup.

Between April 2019 and August 2020, Naway Wraz mobile outreach teams provided half a million people with access to essential basic health services such as antenatal and postnatal care and immunization, including more than 20,000 pregnant women who received antenatal care through door-to-door outreach services. While only 44 per cent of pregnant women delivered babies at health facilities with the assistance of skilled birth attendants in 2018, they are now 65 per cent to do so in key areas where the programme was initiated in April 2019.