In Pakistan, one woman dies nearly every hour from complications during birth, and in Balochistan, the country’s largest and least-populated province, the rate is even higher. Here, one-third of women marry before the age of 15, and two-thirds are illiterate. Only three out of ten pregnant women deliver their babies with skilled attendants, meaning any complications can be fatal.
Here, Doctors Without Borders/Médecins Sans Frontières (MSF) medical coordinator Cecilio Tan discusses MSF’s work in the region.
How is the health system in Balochistan?
In the cities there are tertiary hospitals funded by the government and private hospitals and clinics are mushrooming. The private ones are a little bit expensive, and unaffordable for the average person. In the rural areas there may only be basic health care units. You will be lucky if you have one nurse or paramedic. There are actually chances of not having doctors and proper materials.
Why is the maternal mortality rate so high in this province?
Common factors are poverty and a poor literacy rate. Many people live in remote areas and women lack the decision-making power to be able to go into the clinics to have medical consultations. There is also conflict and political instability in the province, which is also prone to natural disasters such as floods, earthquakes, and other emergencies. Moreover, nutritional health is worse among women than it is in men. Some women are underweight and when they get pregnant their wellbeing decreases further.
What is the background of the women that visit MSF health care facilities?
We assist populations from areas inhabited by different ethnic groups, as well as Afghans who cross the border seeking health care. We see Afghan refugees, some of whom have settled in the area for the past 20 years, so they are in a sense mixed with the local residents. There are also nomads, who are in Quetta in the summer and migrate to other places during the winter.
The people that visit our facilities belong to a low economic stratum; it is often difficult for our staff to talk to them because they speak different dialects. On average, women have six to eight children and they very often have the first baby at the age of 16. At the age of 22 to 24 they have no less than four children already.
What are the main issues related to maternity in Balochistan?
We face a wide range of issues in our projects. Eight out of ten pregnant women come for the first and last time during their antenatal care check-up, so we are limited in being able to follow-up properly. Most of the women deliver at home attended by untrained relatives or neighbors. During emergency obstetric situations that may require further medical or surgical intervention, referrals to tertiary-level hospitals are sometimes hampered by the unavailability of male attendants to accompany the women.
In this context a female patient can’t travel by herself. And if men (husbands or relatives) are working to support the family, this means the woman will generally be at home. That’s why pregnant women often come to us too late, only when there is already a complication. We would like them to come several times during the pregnancy and afterwards but they have other responsibilities. To take them away from home means that nobody will look after the children, cook, fetch the water, et cetera.
What are some of the risks for women who give birth without proper care?
Crucial moments during birth such as severe bleeding or a compromise to the baby’s blood supply can really mean the difference between life and death for the mother and the child if there are no skilled staff present. Skilled staff can at least raise red flags and refer the patient to a hospital as soon as possible, so the chances of survival increase.
Additionally, as they want to go home as early as possible, women often choose to go to private clinics to hasten deliveries by injecting drugs (oxytocin) that can lead to severe complications to both the baby and the mother.
What kind of postnatal care does MSF offer in Balochistan?
We are trying to promote breastfeeding as soon as possible. In some cases babies are not given breast milk but rather honey, dark tea, or other liquids, which really affects their stomach. MSF is also concerned about immunization and tries to improve the vaccination coverage for the children.
MSF currently runs four projects in Balochistan (Chaman, Quetta, Kuchlak, and Dera Murad Jamali) where it provides maternal health care programs. Some services offered include ante- and postnatal consultations, deliveries, and referrals for any emergency complicated deliveries, as well as newborn resuscitation and care, breastfeeding promotion, nutritional support, and treatment for reproductive tract infections.
Between January and April of 2014, MSF assisted in 5,176 deliveries in the province and offered 9,802 first antenatal consultations. MSF has been working in Pakistan since 1986 and currently runs projects in the provinces of Khyber Pakhtunkhwa and Sind, and in the Federally Administered Tribal Areas, in addition to its operations in Balochistan.