Need for skilled birth attendants imperative - UNFPA

The need for skilled birth attendants (SBAs) in Pakistan, where about 60 women are reported to die daily because of pregnancy-related complications, is absolutely imperative and needs to be linked and backed up by emergency obstetrics care and services at health facilities, according to a United Nations Population Fund (UNFPA) official. "We are advocating SBAs because an SBA is very well trained to handle life-threatening situations and to provide first-aid then and there immediately, because in a short span of time, a small amount of first-aid can do a lot," Dr. Mubasher Malik, a UNFPA reproductive heath adviser, told IRIN in the Pakistani capital, Islamabad. "So, an SBA knows what to do, how to manage a patient, how to start the basic management of complications, stabilise the patient and then, refer the patient. She can also perform a few simple life-saving functions and that's why we are saying that SBAs are absolutely necessary in the chain of events to save a mother's life," he stressed. A three-day regional workshop, called "Skilled Birth Attendants in South and West Asia" and organised jointly by the Ministry of Health and UNFPA, was formally launched on Monday in Islamabad. On Sunday, Dr. Olivier Brasseur, the UNFPA country head for Pakistan, and the director-general health, Major-General (retd) Mohammed Aslam told a pre-launch press conference that UNFPA and the health ministry had signed an agreement last week according to which UNFPA would provide grant assistance worth US $2.4 million to the health sector in 2004, for the strengthening of reproductive health services in 10 districts countrywide. The agreement falls within the ambit of a US $30 million Country Action Programme (CAP) signed by the Pakistani government and UNFPA earlier this year. "The grant by UNFPA will include community outreach programmes in reproductive health and work towards improving emergency obstetrics care and upgrading health facilities in terms of quality of care," Malik explained. According to an earlier media release, the maternal mortality rate in Pakistan is estimated to be 340-400 per 100,000 live births - or, that one in every 31 women dies of pregnancy related problems. One of the main reasons for such a high ratio is thought to be the fact that only 24 percent of births are attended to by SBAs. "You have to have an SBA who should be able to deliver the woman safely. Not only that, she should be able to refer a woman, who develops any complications [to proper medical care]. Thirdly she should be able to recognise the danger signs immediately," Malik stressed. According to Malik, 15 percent of all pregnancies develop some kind of a life-threatening complication, no matter whether the woman has had four or five ante-natal checkups. "It's just absolutely unpredictable," he said. Among other factors that contribute to such a high ratio of women dying during child-birth were decision-making at home, with deliberations often focusing on whether to send a woman to a health facility or wait for local faith-healers, Malik explained. "Another factor is transportation. It has been observed that, even if a pregnant woman leaves her home, it takes time to reach a health facility. If the woman has started bleeding after the child's birth, she has only two hours [to live], if not less. The blood is gushing out and she will lose one to three litres in three hours. So, time is of the essence," he emphasised. In many cases, even if a pregnant woman reached a health facility in time, health care providers would be found missing, Malik said. "So, we cannot say that by putting in SBAs, the mother's life will be saved one hundred percent. No, we have to take care of all these factors - which is a complete chain: starting from the home up to the hospital," he pointed out.