MOM MATTERS

This week, You! takes a look at the overall situation of mother-child mortality and morbidity rate in Pakistan. Read on...

every 30 minutes, somewhere in this world, a mother loses her life. An event of joy can quickly turn into a time to mourn. It is perhaps for this reason that in 2015 the United Nations listed maternal health as the 3rd Sustainable Development Goal (SDG). The aim is to reduce the global maternal mortality ratio to less than 70 per 100,000 live births till 2030. This will ensure universal access to reproductive healthcare services and the integration of reproductive health into national strategies and programmes.

While this is a global challenge, the risk women take when they choose to have children is particularly acute in Pakistan. According to Save the Children’s 2015 study, the country is rated as one of the most dangerous places in the world to give birth or raise children. Moreover, the research states that Pakistan ranks 149 out of 179 countries for mother and child mortality - with Pakistan’s Maternal Mortality Rate (MMR) being 276 per 100,000 births.

However, what’s more alarming is that not only has Pakistan performed poorly with respect to global rankings, when compared to neighbouring countries such as India, China, Afghanistan etc., sadly, the situation has remained the same.

Where we stand

Pakistan’s investment in its own healthcare system has been historically low. While the World Health Organization’s (WHO) benchmark for per capita spending in low-income countries is set at US$86, Pakistan expends just US$36.2. In the past decade, Pakistan spent about 0.5 to 0.86 per cent of its GDP on health. However, expenditures may be low but are rising.

In the same vein, the Government of Pakistan has also spearheaded pro-maternal and child healthcare initiatives to address the sometimes fatal gap in maternal care. In 2007, the government launched the national Maternal Neonatal and Child Health (MNCH) Programme to reduce the mother and child mortality rate by providing emergency obstetric and newborn care services, training healthcare providers, deploying community midwives, and strengthening institutions at the provincial and district levels. In addition to that, the Government of Pakistan has allocated approximately Rs. 1046.219 million to improve the health outcomes of mothers and their newborns, in the last two years.

Preventable complications

Some of the greatest challenges that Pakistan faces are preventable: low state investment on healthcare, a lack of access to family planning methods, and the limited amount of healthcare facilities in rural areas.

The most avoidable complication is the knowledge gap. Those living in rural areas do not have access to the information they need to ensure their wives are cared for and their newborns can grow into healthy, happy children.

Uniting to save mothers and their children

The international community has united to support the Government of Pakistan’s efforts to raise the standards of maternal and child healthcare in Pakistan. United Nations International Children’s Emergency Fund (UNICEF), WHO, Department for International Development (DFID) and United States Agency for International Development (USAID) have all consistently supported the government of Pakistan to improve healthcare accessibility and reduce the mother-child mortality.

DFID is supporting the Government of Pakistan’s MNCH Programme through a £90 million Maternal and Newborn Health (MNH) Programme. This initiative aims to improve access to services and promote healthy behaviour, especially for the poor and socially excluded.

In Pakistan, UNICEF promotes ‘Mother and Child Health Week’, which is a multi-pronged outreach campaign. The programme aims to prevent mothers and children from catching various diseases by informing them about basic hygiene principles and how to establish a healthy environment at home. UNICEF also distributes the Mother and Child Health booklet, popularly known as the ‘Green Book’. With easy to comprehend language and illustrations, the book is a reference and record keeping booklet which a mother can use not only for seeking guidance on health issues but also for maintaining record of her and her child’s health status, starting from pregnancy till the child turns five.

USAID has been saving the lives of mothers and their children for decades. It supports innovative approaches to strengthen the capacity of Pakistan’s public and private sectors to reduce maternal, newborn, and child mortality and morbidity rates. By engaging both the public and private sectors at the federal and provincial levels, it makes an appreciable impact. Since 2016, USAID has helped over 2 million women and children access maternal, child, and reproductive health care services and trained over 3,000 healthcare providers. Pakistan ranks second globally in newborn mortality rates, with 245,000 newborns dying each year, as UNICEF estimates.

With USAID’s support, the Ministry of National Health Services Regulations and Coordination (MoNHSRC) took steps to reduce the number of preventable deaths by promoting the use of chlorhexidine (a disinfectant and antiseptic) across the country. In Pakistan, this intervention is expected to prevent approximately 140,000 newborn deaths every year.

USAID specifically designs its outreach to also address the unique needs of rural communities and also utilises innovative communication strategies to increase awareness about maternal and child healthcare. In addition, it works directly with governments at the national and provincial levels to improve their technical and financing systems, which ultimately ensures that healthcare services are available and affordable at the community level.

An integral component of USAID’s work is ensuring that children have access to clean water and a nutritious diet. According to USAID’s 2012 Demographic and Health Survey, 45 per cent of the children in Pakistan suffer from stunting, delaying their development and impairing their ability to learn. Stunting may lead to a major deficit in human capital in the coming years. Through multiple projects, it is ensured that the food children eat contains the nutrients they need to grow and the water that they drink is clean.

Just getting there...

While the government and international donor agencies are collaborating to address such health challenges, the investment must be an enduring one. It is essential that they continue to enhance the reach and quality of primary healthcare in both urban and rural areas through various adaptable initiatives.

Small district hospitals need improved infrastructure, quality equipment and trained medical teams. Awareness of family planning methods must be increased and the role of individuals and civil society organisations, who continue to advocate the cause, should not be ignored.

Media can play a vital role by disseminating awareness regarding women’s reproductive health, family planning and childcare. Also, awareness regarding hygiene practices for women in urban areas of Pakistan is also crucial. Even the smallest steps can increase people’s understanding about the basics. We must be compassionate and accountable citizens. Women must support other women. Families must support their neighbours and this is how we can make a difference in each other’s lives.