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PAKISTAN: MATERNAL MORTALITY &
CARE - CHILD HEALTH - GENDER
Direct Link to Document:
2006-07
Pakistan Demographic and Health Survey Final Report
July
25, 2008
Calverton,
MD - In Pakistan, 1 in 89 women will die of maternal causes, according to
the 2006-07 Pakistan Demographic and Health Survey (PDHS). Among women age 12
to 49, complications of pregnancy and childbirth are the leading cause of
death, accounting for 20 percent of all deaths for women of childbearing age.
The National Institute of Population Studies recently released the final report
of the 2006-07 PDHS at a ceremony in Islamabad.
The survey findings also show that under-five mortality has decreased by roughly 20 percent since 1990, while the infant mortality rate has declined by about 15 percent. Still, one in every eleven children in Pakistan dies before reaching his or her fifth birthday, and more than half of these deaths occur during the first month of life. The PDHS is one of the largest household-based health surveys ever conducted in Pakistan. Teams collected data from a nationally representative sample of more than 95,000 households
More key findings from the 2006-07 PDHS final report are highlighted below.
Maternal Mortality Measured
One of the goals of the 2006-07 PDHS was to obtain reliable information about maternal mortality. Results from the PDHS show that women age 25 to 29 are especially at risk for maternal death. Nearly two out of five deaths for this age group are from pregnancy-related causes. Postpartum haemorrhage is the leading direct cause of maternal deaths, followed by puerperal sepsis and eclampsia. Obstetric bleeding (postpartum and antepartum) is responsible for one-third of all maternal deaths.
Balochistan has by far the highest proportion of women dying from complications of pregnancy, childbirth, and puerperium (the time immediately after delivery). Rural women are more likely to die of pregnancy-related causes than urban women (23 percent compared to 14 percent).
Cancer, tuberculosis and other infectious diseases are the next most important causes of death among women of reproductive age. Younger women are more likely to die from infectious diseases (20 percent), not including tuberculosis, than older women.
Maternal Care Improves Slightly
The percentage of women making four prenatal visits, as recommended, increased from 16 percent in 1996 to 28 percent in 2006-07. Nearly two-thirds (61 percent) of women in Pakistan had at least one prenatal visit with a skilled provider, most often from a doctor (56 percent). Educated women are twice as likely as women with no education to get prenatal care from a skilled provider (96 percent compared to 50 percent).
However, one-third of pregnant women, do not get any prenatal care at all, according to the PDHS. Of these women, the majority (73 percent) do not think it is necessary, 30 percent think prenatal checkups cost too much money, and 8 percent say the health facility is too far away.
Only one-third of Pakistan's births occur in health facilities-11 percent in the public sector and 23 percent in private sector facilities. By contrast, two-thirds of births occur at home. Home births are considerably more common in rural areas (74 percent) than urban areas (43 percent).
Fertility Declines; Family Planning Use Steady
Fertility has decreased steadily since 1984, when the total fertility rate (TFR) or the average number of children per woman was 6.0. Today, a woman in Pakistan will have 4.1 children, on average. Urban women have 3.3 children, on average, compared to 4.5 children per rural woman. As in other countries, fertility also varies by the mother's level of education. Women with no education have 4.8 children compared to women with secondary education, who have 3.1 children.
The contraceptive prevalence rate is 30 percent, roughly the same as it was in 2003 (32 percent). While 96 percent of married women know about modern methods, only one in five (22 percent) currently married women uses a modern method, most often female sterilization (8 percent) and condoms (7 percent). Modern method use in Pakistan lags behind neighboring countries with 49 percent of married women in India and 47 percent in Bangladesh using modern methods.
Infant and Child Mortality Rates Decrease
Pakistan's infant mortality rate, 78 deaths per 1,000 live births, has declined since 1990-91 when the PDHS showed it was 91 deaths per 1,000 live births. Compared to other South Asian countries, however, children in Pakistan are more likely to die in the first year of life, according to the new PDHS. Pakistan's infant mortality rate is higher than the rates in Nepal (48), India (57), and Bangladesh (65).
The under-five mortality rate is 94 deaths per 1,000 live births, down from 117 deaths per 1,000 live births in the period 1986 to 1990. Children living in rural areas are at greater risk for death than those living in urban areas. The under-five mortality rate is 28 percent higher in rural than urban areas.
More than Half of Children Lack Immunizations
Nearly half (47 percent) of Pakistani children ages 12-23 months have all the recommended vaccines; 6 percent of children do not have any vaccinations. Children are least likely to get their third DPT vaccine, their Polio 0 vaccine (given at birth), and their measles vaccine. Compared to children in other South Asian countries, Pakistani children are less likely to be fully vaccinated. In Nepal, 83 percent of children have all their vaccinations and in Bangladesh 73 percent of children are fully vaccinated. In India, by contrast, 44 percent of children are full vaccinated.
Children whose mothers have no education are far less likely than children whose mothers have higher education to be fully immunized (38 percent versus 71 percent). The percentage of children who are fully vaccinated also varies by province, ranging from a high of 53 percent of children in Punjab to a low of only 35 percent of children in Balochistan.
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http://www.irinnews.org/Report.aspx?ReportId=80089
PAKISTAN:
Traditional Birth Attendants Can Curb Maternal and Infant Mortality
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A trained TBA shows off her new delivery kit including a
head scarf, plastic apron and plastic gloves |
KARACHI, 31 August 2008
(IRIN) - Until recently, 55-year-old Sabhai Bibi, a traditional birth attendant
(TBA), known as a 'dai', used an age-old method of cleaning the vagina after
birth.
"I'd shape gur [clarified sugar cane] and some
herbs into a ball and put it inside the vagina. After two days I'd replace it
with a ball of misri [sugar crystals] and remove it after five days," she
said.
Bibi, from the village of Sonu Khan Almani, some 300km
from Karachi in Sindh province, is not the only one using such potentially
unsafe methods. There are thousands of TBAs across Pakistan who handle most
births in rural areas with minimal training and basic equipment.
Fatima Bibi, another TBA based in the nearby village of
Qasimabad, told IRIN that after cutting the umbilical cord with a kitchen knife,
she would use ordinary thread to tie it. She also advised women to push with
"full force" during uterine contractions, often not realizing the
cervix had not dilated. "I didn’t know this could lead to the tearing of
the cervix and cause post-partum haemorrhage," Fatima said.
Most TBAs put kohl, oil and even cow-dung on the child's
umbilical cord to make it heal faster. The colostrum, the first milk after
birth, is wasted, and instead the child is given honey mixed with some herbal
concoction, even butter or 'kheer' (milk cooked with rice and sugar).
"Not any more," said Bibi, who has delivered
over 100 babies since she started eight years ago. She picked up the trade from
her mother-in-law.
"We were not educated and followed whatever was
passed on to us," she said. Now, after 15 days of midwifery training, she
is horrified by the risk she had put women and infants through.
TBA training programme
Bibi is among 104 TBAs trained under a programme by the
Sindh Rural Support Programme (SRSP), a local non-governmental organisation
(NGO).
"Since we started four years ago, I have found a
sea change in these birth attendants," said Fizza Qureshi, coordinator of
the training project, adding that TBAs play a crucial role in rural areas,
where they carry out over 80 percent of deliveries.
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Just
a child herself but Perveen will be marreid off at the end of the year as she
has reached puberty |
The training includes understanding the anatomy of
the reproductive organs, giving post-natal follow up counselling and educating
women on breast-feeding, safe delivery methods, sexually transmitted diseases
(STDs), family planning and child spacing. The TBAs are also provided with
disposable safe delivery kits with sterilised birthing supplies that include
gloves, a plastic apron, a plastic sheet, soap, clamps, a new razor, string and
cotton balls.
"These cost only Rs 40 [about US$0.50]," said
Qureshi. "If these kits are made cheaper still and made easily available
in the market, this would further help ensure adherence to hygienic
practices."
The training has also helped the TBAs to identify
birthing complications in time and refer cases to the nearest hospital.
Since Saran Bibi received training a year ago, she has
referred seven cases to hospitals. "In the past I would never allow my
client's family to take her to doctors. I would consider difficult cases a
challenge to my expertise. I never realised that some infant deaths could have
been prevented," she said.
Questioning cultural norms
The training has also encouraged women to question
certain cultural norms. "We had been brought up to believe that as soon as
a girl got her first period she should be married off," said Khadija Bibi,
35, who has four children and has had two miscarriages. She recently had an
intrauterine device (IUD) - birth control device - placed in her uterus after
her fourth child.
"My husband refuses to use a condom," she said
shyly.
"It's their husbands who do not want to adopt any
family planning methods," said Pathani Bibi, another 'dai'. "They get
married young, have too many children and thus many die of bleeding." The
major cause of maternal mortality in these villages is by haemorrhage.
"We need to understand the important role of the
TBAs," said Dr Ghulam Hyder Akhund, programme director of the government's
Provincial Health Development Centre. He said these "life savers" are
"virtually ignored”.
Pakistan's maternal mortality rate is 350 to 500 deaths
per 100,000 live births and infant mortality rate is 83 deaths per 1,000 live
births, the highest in South Asia. At present, the country is at risk of not
reaching Millennium Development Goals (MDGs) 4 and 5 of
reducing under-five mortality by two thirds and maternal mortality by three
quarters.
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