Zofeen Ebrahim
KARACHI, Pakistan, Sep 14 2010 (IPS) – The floods that have submerged one-fifth of Pakistan have begun to recede, but the crisis has brought to light one of the country s hidden miseries: the plight of mothers, who are dying in tens of thousands each year.
Many babies are being born in camps for those displaced by Pakistan s floods. Credit: Fahim Siddiqi/IPS
Doctors and relief workers are scrambling to help save the lives of expectant mothers in the camps sheltering those displaced by the floods that hit the country s northwest more than a month ago. Yet the state they are finding the women in has reminded them of Pakistan s dismal maternal mortality rate even during normal times.
According to the United Nations Population Fund (UNFPA), 320 women die for every 100,000 live births in Pakistan. The country s Demographic and Health Survey (2006-07) meanwhile says that Pakistan has about 30,000 pregnancy-related deaths each year.
Among the reasons for the high number of maternal deaths is the women s often shabby health, with many suffering from malnutrition and anaemia. Skilled health professionals are also often absent during childbirth, which in far too many cases take place under unhygienic conditions.
In addition, limited access to modern family-planning methods has meant that many mothers are having children one after another. Pakistan s current birth rate is actually 3.43 births per woman, but in remote areas, women have as much as 10 to 15 children each.
Dr Nighat Shah, secretary-general of the Society of Obstetrics and Gynecologists, Pakistan (SOGP), recounts that in one of the relief camps she visited recently, one woman had been delighted to have just given birth to a boy, after having 14 daughters.
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Terming the flood a good omen, the boy was named Sailab ( flood in the Urdu language) Khan, says Shah. But she says, Before next year and before a Toofan (storm) Khan is born, some interventions have to be done to save the life of this mother.
For now, though, doctors and other medical professionals have their hands full trying to look after the pregnant women in the camps.
UNFPA says that of the 18 million displaced by the floods, 70 percent are women. It adds that nearly 500,000 of these women are now pregnant. According to the UNFPA, that translates to some 1,700 going into labour each day, of which more than 250 would experience complications that would need emergency medical procedures.
Dr. Azra Ahsan of the National Committee for Maternal Neonatal and Child Health (NCMNH) recalls seeing many pregnant but extremely anaemic women in the camps she visited in Sindh province, one of the most affected by the floods.
She also says many of the mothers each had 10 children. But having worked in remote villages for many years, Ahsan was not surprised, adding, The lives of these women were no better even before the floods. They are from a different time, a different planet.
Still, she fears that post-flood food insecurity, extreme stress, and the total lack of hygiene in the affected areas have only put the lives of these women at greater risk.
Providing skilled birth assistance to flood-affected women is critical, says William Ryan, UNFPA s spokesman for Asia and the Pacific. Childbirth is always potentially hazardous, and maternal mortality in Pakistan is high in the best of times. (But) the trauma women suffer when they are displaced greatly magnifies the risks.
To complement local efforts to help the flood victims, UNFPA has deployed medical professionals to 23 mobile units and 13 government health facilities in the affected areas.
Shah says that at the very least, with many of the camps now being visited by health professionals, women there are benefiting from reproductive-health information that they would have otherwise missed. This, says the doctor, may help the women break free from what she calls the death trap of frequent pregnancies.
Now, says Shah, We can provide them the much-needed family planning services .
Ahsan herself notes that with only 22 percent of married Pakistani women using a modern family-planning method, this may be an opportune time to introduce the intrauterine contraceptive device (IUCD) to the women in the camps.
She does not think pills would be a successful intervention, reasoning, They will either forget to take it, or when the dose finishes they may discontinue (taking it).
Shah favours tubal ligation for those who already have more than three or four children. She even suggests offering counseling to women who come to deliver their babies at hospitals, and encouraging them to opt for ligation after their family is complete .
When they return home, says Shah, their lives will hopefully be better off if such interventions are made.
One key intervention is NCMNH s distribution of the drug misoprostal among women who are eight and nine months pregnant. The move is aimed at reducing cases of post-partum haemorrhage, which Ahsan says is the number one cause of maternal mortality among Pakistani women .
Gynaecologist Shershah Syed says those most at risk of post-partum haemorrhage are anaemic and malnourished women who have gone through multiple pregnancies just like many of the women at the various relief camps.
We are telling women and traditional birth attendants to use (misoprostal) immediately after delivery, says Ahsan. It s easy and does not require injecting a drug to stop bleeding. It does not require a skilled attendant either as the mother can be given the drug orally. It is specially a lifesaver since deliveries are taking place under the open sky.
