Here, Doctors Without Borders/Médecins Sans Frontières (MSF) OBGYN Jeltje Danhof reflects on her time providing maternal health care and working to educate the public at Chaman local hospital in Pakistan.
In the streets of Chaman, in Pakistan’s southwestern state of Balochistan, women are not easy to find. When they are seen, it is accompanied by a male relative but protected from view by a full veil. More often than not they are at home, unable to leave easily for hospital check-ups and out of reach of messages to welcome them to visit the nearby MSF clinic for pregnancy examinations and to give birth.
How do you contact women with information about maternal health care services in a place like Chaman?
Last year doctors and nurses from MSF saw almost 14,000 pregnant women for at least one consultation before they gave birth, and assisted almost 9,000 women to deliver their babies in three separate projects in Balochistan. Over 4,000 of those deliveries were in Chaman alone. Still, almost three-quarters of pregnant women in the district were estimated in 2014 to receive no medical check-up before giving birth.
MSF provides maternal health services in the Chaman local hospital. It functions alongside the emergency room that treats primarily individuals caught up in violent clashes stemming predominately from local tribal rivalries. As women pass through the door of the mother-and-child clinic they remove their burkas and invariably reveal a perfectly made-up face and hands covered in intricate henna designs. They come once they know the hospital is here, so how can we make sure more women hear about it?
March 8 was International Women’s Day. It was an opportunity for us to promote our maternal health services and meet people. It was also an opportunity for us to misread local sensitivities and stick our foot in our mouth. What is the best way to approach the need for regular check-ups during pregnancy? Which is the most appropriate way to promote breast-feeding, something that is so important when MSF’s three projects in Balochistan have treated approximately 40,000 children under five for malnutrition since 2010? In discussion with the women I work with, and with some male community leaders, we drew up, adapted, and re-adapted our agenda until we were satisfied with our balance. First suggestion: keep the focus local and drop “international.” So on March 8, 2015, we celebrated “Women’s Day” in Chaman.
That Sunday we invited the wives of prominent community leaders, as well as all local female teachers and female health staff from both MSF and the local Ministry of Health. All of them were in a position to pass on our messages to other women in the community. Sixty women came to take seats we decorated with informational posters, and listened as MSF and community spokespeople presented. Many said they had no idea before that MSF was offering such health care. They toured the delivery room, the operating room, the pediatric wards, and the blood bank. We talked openly about our capacities, our limitations, and the challenges we face. They asked questions on our hygiene and disinfection practices. Over lunch, they had an informal opportunity to ask more.
In a parallel session in another part of the hospital, we invited the all-male press so that they could write about our hospital; however, it is unlikely many women will be able to read their reports. Literacy tracks so very closely with gender in this part of Pakistan.
It was a small opportunity seized, but such a meeting here is indeed unique and I am proud of the team for making it happen. I hope it means that many more women in Chaman hear about us and can visit during their pregnancy.
 Pakistan Poverty Alleviation Fund, 2013, Development Profile of Killa Abdullah District, available at http://ppaf.org.pk/Italian/Reports/District%20Profile%20Report%20Kila%20Abdullah.docx.