What We Are Doing

A growing need for midwives in Pakistan 1 Jul 2014

By Mina Sohail, Save the Children Pakistan

Faiza Mohammed Azam, 30, began work as a community midwife in Sindh in 2010. In a span of almost four years, she has assisted about 35 deliveries in the outskirts of Karachi. Many midwives in Pakistan, face hostility mostly by men in villages who are not accustomed to women counseling their wives on medical issues. Similarly, Faiza had to encounter her share of obstacles in an effort to approach women hoping to be mothers in the community.

“Men would have a problem with me entering their house to talk to their wives, but with time people have been more accepting,” says Faiza. “I have a clinic at my home now and visitors come here.” Faiza who sees about four to five patients a day, says most women come to her wanting to know about family planning, birth spacing and the number of children they should conceive.

Pakistan has the highest maternal mortality ratio in South Asia and is ranked among the countries with the highest stillbirth rates, largely due to delays in receiving appropriate care from a skilled health worker. Nearly 60% of all births in the country occur at home and are conducted by unskilled birth attendants. They are a major contributor to the high maternal mortality ratio (MMR) in the country.

Faiza says she talks to these women about essential care before, during and after child birth so the women make informed decisions for themselves and their babies. “I give these women medicines that I have stocked and write them prescriptions.” In all these years of interaction with so many women, Faiza has become part of many households and their stories. She mentioned a case where a woman became pregnant for the first time after 10 years. The woman endured immense stress as her husband and in-laws sent her to her parent’s house for he inability to conceive. The woman had a family history of late pregnancy and felt vulnerable. After almost two years, her husband brought her back home, she conceived and the couple now have two daughters. Her husband is now cooperative and “even though the children are daughters, he helps in looking after them.” Faiza says that as a midwife, she often has to play the role of a friend and a councilor. She believes that rural areas need a lot of CMWs so they can counsel people well and guide them about hygiene.  

The availability of frontline health workers such as community midwives and lady health workers in Pakistan is insufficient to meet the increasing population needs. Particularly in rural areas, there is an acute dearth of midwives and female nurses. According to the Pakistan Demographic and Health Survey (PDHS) 2012-13, one in every 14 Pakistani children dies before reaching the age of one. One in every 11 does not survive to his or her fifth birthday and Pakistan’s Millennium Development Goals (MDGs) Report 2013 reveals that the country is far from reaching MDG4 targets of under-five morality which is 89 against the target of 52 deaths per 1,000 live births.

Save the Children’s EVERY ONE Campaign has called on the federal and provincial governments to maximize the number of frontline health workers so that no child under the age of 5 dies from preventable causes. One of the objectives of EVERY ONE Campaign is to increase funding and improve policies to increase the number of health workers and enhance their impact – through funding, required equipment and training and to deliver basic maternal, newborn and child health care services. 

One of the major reasons for maternal deaths during pregnancy and childbirth is the use of unskilled birth attendants who often work in unhygienic conditions and are not equipped to handle complicated situations that may develop during childbirth. However, changing attitudes of people in accepting the services of midwives for the better health of mothers and babies is essential in a society where people often hold on to traditional and quaint beliefs that take precedence over medical solutions.