It is a pleasure for me to be here today in Washington, and a wonderful opportunity to share with you some of our experiences from Pakistan.
Pakistan is a country of 140 million people in South Asia, as of this year the 6th most populous country in the world. During this year of 2001 alone, nearly 5 million new lives will be added to the population.
What does this mean for the women and children of Pakistan? Their vulnerability is striking when we look at the common practices related to pregnancy, birth and the postnatal period. Most Pakistani women are married very young. The average Pakistani woman is illiterate – as only 35 percent of women know how to read and write. She has little to no decision-making power in the family structure she lives in. Her husband and her mother-in-law make most of the decisions and hold most of the financial power in the household. They are not always receptive to the special needs of pregnant women. During research done by Save the Children US, we heard the following comments:
“There is nothing special about pregnancy and babies are born just like that” (Perception of men in the family)
“ We never went for any check-ups and yet gave birth to children. Young women these days are not doing anything extraordinary - why do they want to waste money and go to the doctors”
(Mother in law)
The average Pakistani woman is likely to have anemia (the prevalence in child-bearing age women is 40 percent). Neither she nor her husband are likely to use any contraception (the CPR is only 24 percent), and she is likely to bear at least five children in her lifetime.
During one of her pregnancies, she probably will not get any ante-natal care (30 percent), and she only has a 50 percent chance of getting herself tetanus toxoid shots. She will almost definitely deliver at home with an unskilled birth attendant (82 percent, 18 percent skilled), with unclean and unsafe conditions. Is it any surprise to us therefore that 340 out of 100,000 live births end in maternal death? In Pakistan, the likelihood of dying at pregnancy is 200 times more than in the developed world (US, Sweden).
Seventy percent of the population live in rural areas, where the health facilities are not adequately equipped to manage any complications. In case of emergency, there is delay in shifting the women to the hospital because of difficulty in arranging for transport and money. Even when a woman reaches the hospital the quality of care is poor, and essential obstetric care is not often available at the district level.
Women know there are big problems. One of the women said to us during our research:
“I went for a check-up and doctor told me that I have high blood pressure so delivery has to take place at hospital. But my mother-in-law said all deliveries take place at home. When labor pains started, my condition grew very bad and my mother in law arranged for a transport, but I was embarrassed to get in the car in my state. The baby died a few hours before birth. (a woman from Haripur district, to Save the Children staff)
In the words of one pregnant woman: “I think I am pregnant again. Let’s see who dies this time … me or my child” (a woman from Khuzdar, quoted to Dr. Farid Midhet BSMI)
What about the 5 million babies born in Pakistan this year? What kind of world are they entering? The first and foremost fact for these newborns is that their survival, much less their future, is not at all guaranteed.
Out of every 100 babies born, 9 or 10 will not live to see their first birthday;
5 or 6 won’t even live for a month;
3 or 4 are not likely to even make it through the first week.
They die of infections, tetanus, and from low-birth weight. That’s 200,000 precious newborn lives lost this year in Pakistan, with an additional equal number of stillbirths during the late stages of pregnancy. (The IMR is 91/1000 live births and Neonatal Mortality Rate is 48.9/1000 live births.). In Pakistan, a baby is not even given a name for the first 15 days because parents are not sure the baby will make it.
Is there any cause for hope in all of this? As a Pakistani woman, I would like to say that, yes; there is cause for hope. I am lucky. I have a family who supports me, and helped me through medical school. From childhood my ambition was to be a clinical doctor, but when I got my first posting in rural Punjab and I saw these conditions first hand, I had to do something. So I went into public health, a field I have been working in for the past 11 years. I went into public health because I did not want to stay working in big hospitals where you only saw the mother and baby at the end of their long journey of despair. I wanted to help them in their homes and their communities, because most of the problems they face can be solved in their own homes and are actually preventable.
So yes, I do have hope. Working with Save the Children focusing on these issues through a community-based approach, we have been able to make changes. Working with the government as partners Save the Children has been able to ensure that 5.2 million women of child-bearing age in Pakistan have got tetanus toxoid shots, saving both their and their newborn’s lives. Through working with partners at the community-level, we will be reaching men and mothers-in-law as well as women, to change their attitudes towards the need for good household behaviors and health-seeking practices – so that women breastfeed, deliver in hygienic conditions, and if they need care, seek it quickly. We are working towards improving the quality of health care through training the necessary health care providers, so that when the women and children get to the hospital, they don’t die there. Newborn lives can be saved by simple actions, which are not complicated and high tech.
The government of Pakistan is dedicated to improving the life of that average Pakistani woman who I have talked about. Policies have changed over the past ten years. But there is gap between the policies and actual implementation. As partners in this fight for saving women and newborn’s lives, we are hoping to bridge this gap, and take all the opportunities possible to make that change.
