Pakistan's high maternal mortality rate

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Pakistan's high maternal mortality rate

EDITORIAL (July 04 2010): A high maternal mortality rate can leave a long-lasting ripple effect on the whole society, creating unfathomable problems for families left without the protective, guiding and nurturing hand of a mother. According to experts at a seminar held in Peshawar, Pakistan has the highest maternal mortality rate in South Asia, where, in most cases, the deaths are preventable. Its causes are multiple, inter-related and complex.

However, studies have identified four major medical causes of maternal mortality in Pakistan: haemorrhage, hypertensive diseases, sepsis and abortion. The ratio of maternal mortality is wide-ranging, from 286/100,000 in Karachi's urban areas to 756 in rural Balochistan. Another relevant statistic is that over 89 percent of deliveries are conducted by traditional birth attendants at home, who are unable to manage the complications that may arise.

It is said that Pakistan, India and Bangladesh account for 46 percent of the world's total maternal deaths. In Pakistan, one of the major factors contributing to the high female mortality rate is a relatively poor educational and low socio-economic status that women enjoy in the country.

Out of the eight Millennium Development Goals, set by the United Nations, MDG No 3, 4 and 5 relate to women and children. Under MDG No 3, the member states are committed to promoting gender equality, empowering women and eliminating gender disparity, while MDG No 5 binds all countries to improve maternal healthcare and reduce, by three quarters, the maternal mortality rate - a target Pakistan is highly unlikely to achieve by 2015.

Meanwhile, raging inflation, essentially fuelled by mounting fuel prices, has pushed more people below the poverty line (based on $2-a-day criterion). Food inflation has gone up, with the worst affected by the cut in per capita calory intake being mostly women, which has left them vulnerable to diseases due to low body resistance.

Women, being the main victims of rising household poverty in the country, particularly in the face of absence of equitable and institutionalised social safety nets, have had to bear the brunt. Gross neglect of the agriculture sector - the main poverty alleviator and food provider - coupled with large-scale grain exports and hoarding - has created shortages, which the middlemen exploit to maximise their profits.

Further, the power crisis has contributed towards fuelling inflation, making deep inroads into household budgets. The rising budgetary deficit, and an extremely low tax-to-GDP ratio, that has stayed static at around nine percent (it ought to be 15-18 percent), coupled with exemptions and the rising cost of debt servicing has further reduced the budgetary share for health and education sectors - the two pillars of a knowledge-based economy.

According to the State of the World Children Report, 2009, the per capita healthcare spending in Pakistan stands at 18 dollars per annum, out of which only four dollars are spent in the public sector. (It should be at least 45 dollars). Meagre allocation to public sector healthcare and reduction in per capita calorie intake, thanks to the rising food prices, has indirectly contributed towards higher maternal mortality rate. The trend needs to be reversed by implementing an equitable policy framework.

Pakistan's inefficient public health delivery system, with grossly ill-equipped and under-funded BHUs serving as the focal points of healthcare in the vast rural hinterland, has played a role in rising maternal mortality. Delay in reaching hospitals, after the haemorrhage has started, due to poor availability of transport, particularly in the rural areas, has also been recognised as a big risk factor.

Teenage pregnancies, due to early marriage are yet another cause of rising maternal mortality. Birth spacing gives women time to recover from nutritional deficiencies caused by pregnancies. (Studies have shown that birth intervals of less than 24 months increase the risk of neonatal mortality.) Only a holistic and sincere approach by the government to this issue of great national importance can help address it.

Business Recorder [Pakistan's First Financial Daily]