It takes a village: Saving newborn lives in Pakistan

In a region with high newborn mortality rates, training all the local health workers in the community is saving lives.

By Fatima Shahryar
A mother holds her newborn baby, Pakistan
UNICEF Pakistan/2018/Saiyna Bashir
04 October 2018

BAHAWALNAGAR, Punjab, Pakistan, 4 October 2018 – “Two years ago, I lost my baby when he was only five days old,” says Mafia Bibi, a mother of three. “This was the second time that I lost a newborn within the first few days of birth.”

Losing her children one after another for unknown reasons was so heartbreaking to Mafia Bibi that she wanted to make sure she didn’t conceive again anytime soon. So she turned to her friend Razia, a community health worker – or 'Lady Health Worker' as she is called in Pakistan – for advice on birth spacing.

“I have known Razia for several years now, but never really sought her help. Every time I had to deliver, I would travel to my parents’ home, in another village,” she says. “This time when I asked her for advice, she was very kind and guided me patiently. Two years passed by until I was pregnant again.”

On Razia’s recommendation, Mafia Bibi delivered her next child at a health facility, under the supervision of a doctor. Her previous children were all delivered at home without skilled birth attendants. Razia also counselled her on how to make sure her baby is as healthy as possible.

“I am exclusively breastfeeding my newborn, Mohammad Ramzan, who is now one month old,” says Mafia Bibi.

A community health worker talks to a group of women and children, Pakistan
UNICEF Pakistan/2018/Saiyna Bashir
Razia Sardar, a 'Lady Health Worker' in the village of Fateh Kot, teaches women of her community during a support group meeting.

Facing high newborn mortality rates

Fateh Kot, the small village where Mafia Bibia lives, is located a few kilometres from the border with India. For their livelihoods, residents depend mainly on cattle farming and labour jobs. Many of the people in the community live in poverty, without access to education or knowledge of good health and hygiene practices. Based on age-old traditions, most women rely on advice from the elderly for childbirth practices, which can pose a threat to the mother and child’s health.

Pakistan has one of the highest newborn mortality rates in the world. In Bahawalnagar, around 106 babies out of 1,000 live births die during the first year of life, which is higher than average for the province and the country. This is in part because of a shortage of skilled birth attendants, as well as low rates of breastfeeding, immunization and antenatal care.

To improve the survival and health care of newborns, UNICEF and partners trained all of Bahawalnagar’s community health workers and their supervisors on how to improve newborn care at home. The health workers were given counselling cards with illustrations, to help them guide the mothers in their communities.

Through this project, UNICEF also procured thermometers, scales, portable projectors to show educational videos, and acute respiratory infection timers that help the early diagnosis of pneumonia for local health workers and health facilities.

A health worker weighs a baby as the mother looks on, Pakistan
UNICEF Pakistan/2018/Saiyna Bashir
Razia weighs a baby using a salter scale.

New advice for new mothers

Razia Sardar, the community health worker in Fateh Kot village, was one of  nearly 1,400 who were trained by UNICEF. Sharing her experience, Razia says, “I have been working here for the past 14 years. Every time there is a new intervention or improvement, I learn about it and inform the women of my community.”

Community health workers like Razia now regularly conduct support group meetings with mothers and pregnant women, where they advise them on maternal, newborn and child health.

“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,” says Razia. “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.”

With new equipment, and enhanced capacity, community health workers are now contributing towards higher rates of births with skilled attendants, and reduced rates of infant and child mortality.

“All children in my community are vaccinated, pregnant mothers are actively seeking health care advice and newborns are given the highest quality of care at home,” says Razia. “Not only this, but all mothers are breastfeeding their newborns, which makes me feel very proud.”

The project ‘Improved Health Outcomes for Newborns through Implementing Care of the Newborns at Home’ was made possible by funding from Johnson & Johnson, in close coordination with the Integrated Reproductive Maternal Newborn and Child Health (IRMNCH) programme in Punjab. UNICEF plans to scale up the programme to the remaining districts of Punjab province and other provinces throughout Pakistan.