Tharparakar District, Sindh Province, southern Pakistan, is one of the least developed districts in the country, but a new health initiative is providing a glimmer of hope to local people.
Poverty and lack of education here mean there are few health facilities and little awareness about women's health issues. Most babies are delivered at home by traditional birth attendants (TBAs), who also perform unsafe abortions when needed.
The district's government-run civil hospital, in Mithi, serves a population of over 900,000 people, and Abida Noreen is the first gynaecologist in the hospital trained to perform a Caesarian section.
Her job at the Mother and Child Health (MCH) centre is a result of a public-private partnership in which the government, the Thardeep Rural Development Programme (TRDP - a local NGO), and corporate donors hired her on a full-time basis in January 2008.
Also hired were a lady health visitor (LHV) and an anaesthesiologist. Some 15-20 Caesarians are performed in the hospital a month, and the surgery costs around Rs1,500 (US$19).
Low birth weights
Studies in the area suggest that in poor families 25-30 percent of babies are born under 2.5kg and usually die before their first birthday.
Government agencies have estimated that in rural areas of Tharparkar, the maternal mortality rate (MMR) is as high as 600 per 100,000 live births compared to a UNICEF estimate for the whole of Pakistan in 2006 of 320. The infant mortality rate for those aged under 12 months ranges from 80-100 per 1,000 live births, compared to the Pakistan-wide figure of 78. For related UNICEF statistics on Pakistan click here.
Photo: Sumaira Jajja/IRIN
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TRDP head Sonu Khangarni says: "Given the low pay at state-run hospitals, trained staff refuse to work in places like Mithi, but due to this public-private partnership, the good pay attracted the right people. For the first time in 60 years we have this medical service in this area. It is a small step in the right direction."
Malnutrition, poor hygiene
Talking to IRIN about the health issues faced by women in this remote region, Mohni Gotam, another gynaecologist at the hospital, said: "Malnutrition and poor hygiene are major health issues with women, as urinary tract infections are very common here, followed by anaemia. Many times all that is needed is good hygiene and folic acid, along with a healthy diet."
However, LHVs said birth spacing and contraception were what women here needed help with. Sumera Mohammad Siddique, a young LHV at the MCH centre said: "We have women with six or seven children approaching us wanting to know about contraceptive methods. Yet when we tell them about condoms, they refuse [to use them], saying their husbands will not approve."
Saba (not her real name), another LHV said: "People here prefer terminating a pregnancy rather than opting for oral contraceptives or condoms. Women feel their husbands would think of them as 'loose women' if they told them to use condoms."
"Will of the gods"
Sitting on a bench waiting for her turn to see a specialist is heavily pregnant Nandni. In her 30s, she is pregnant with her ninth baby but this is the first time she has visited a doctor. "I gave birth to all my children at home as I cannot afford medicines and travel. But over the past three years, I have lost three babies and this time I did not want this to happen," she said. In tow is her 13-year-old daughter who was recently engaged and who will be married in a year's time.
When asked by IRIN if she knew that an early marriage might prove to be harmful to her daughter, she simply smiled, saying: "That's the will of the gods. If they want, she will go on and give birth to 10 healthy children and be there to look after them."
This article was produced by IRIN News while it was part of the United Nations Office for the Coordination of Humanitarian Affairs. Please send queries on copyright or liability to the UN. For more information: https://shop.un.org/rights-permissions
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