Nature has shouldered the responsibility of the multiplication of mankind upon a woman and fulfilling this responsibility is an honor as well as a trial for her. If pregnancy and delivery remain normal, all steps remain unproblematic. But if any complication arises at any time from conception to delivery, then the life of the mother or the child is at risk. Ensuring the health and safety of the mother and the child during delivery is a social responsibility. However during the time starting from conception up to delivery, it is the responsibility of the midwife to take care of the mother and her child.
Pakistan is included among those countries where the highest percentage of maternal deaths occurs during pregnancy and delivery. The developed western countries have a maternal death rate of 14 occurring during childbirth, which is considered to be on the lesser side. In certain Asian countries like Malaysia and Indonesia, this rate is 41, whereas in Pakistan, this rate ranges from 350 to 400 and is considered to be the worst. (The Maternal Mortality Ratio is the ratio of the number of maternal deaths per 100,000 live births.)
Similar pattern could be observed in the neonatal mortality rate. More than 65 out of 1000 live births die during the process of delivery whereas more than 95 out of 1000 live births die before the age of 5. (Source: Pakistan Economic Survey 2009-10, UNDP Human Development Report 2010, World Health Organization 2010).
Inadequate facilities during pregnancy and delivery become the cause of maternal or neonatal deaths which is very distressing, especially in today’s advanced era when the provision of basic medical facilities are possible for the poorest of countries.
According to Pakistan Economic Survey 2009-10, only 0.54 percent of the country’s total GDP is allocated to the health sector while the proportion of medical expenditure is much higher in India, Indonesia and even in an underprivileged country like Bhutan.
Statistics for 2009 indicate there was 1 doctor for every 1128 people, 1 nurse for every 2452 people, 1 midwife for every 6480 people and 1 lady health worker for every 15, 836 people.
Countries providing trainings to qualified midwives are experiencing tremendous decline in maternal death and disability rates during pregnancy and delivery. In Pakistan, neither are such effective training programs organized nor are our community midwives qualified enough to deal with pregnancy and delivery complications. There are around 144 midwifery training schools in Pakistan but it is distressing to see that the available teachers are not well educated or trained. There is an absence of effective clinical trainings as well. A research study by UNICEF has stated that 90 percent of the certified midwives from these schools have never facilitated a single delivery.
Therefore neither are such qualified midwives playing any role in achieving the Millennium Development Goals (MDGs) nor can they bring down the maternal death rate during pregnancy and delivery. Training schools are not readily available for girls willing to be trained as midwives and those who are successful in getting trained are unable to gain respect and adequate compensation. This occupation requires continued education and training programs to make midwifery a prestigious profession and a career progression structure must be developed for the women choosing midwifery as their line of work. The health of the mother and the child and their life security during pregnancy and delivery requires adequate expenditures in the health sector and provision of basic health facilities on an urgent basis. Proper training of midwives and health workers should also be prioritized.
According to an estimate, there is a need of 100,000 trained midwives in Pakistan so that maternal and neonatal death rates could be brought down. We have examples of Malaysia, Indonesia and Sri Lanka where the governments have succeeded in doing so in a few years and their maternal death rate is now much lower from before at 41 percent.
There are around 144 midwifery training schools in Pakistan but to achieve a total of 100,000 midwives, there is a dire need to increase the number of schools. Not only that, Midwifery training also faces two other critical issues: The need for qualified and trained teachers and provision of text books and training material in Urdu as well as regional languages.
The Pakistan National Forum on Women’s Health, a non government organization, is working for the betterment of women’s health. The forum has published 11 books based on the subjects of women’s health, midwifery and training of health workers in the past 9 years, some of these books are being taught in various midwifery and nursing schools. In order to fulfill the need of midwifery teachers, a training program for midwifery and nursing tutors has also been commenced through which more than 100 female teachers have been trained in the last 3 years.
It is not possible for an NGO or a private organization to fulfill the nationwide requirements; it is the responsibility of the government to provide health and education facilities to the people. There is urgent need to strengthen the health sector by preparing skilled midwives who are capable of functioning as specialists in normal obstetrics. A few steps that could be taken are:
Preparation and employment of competent midwifery teachers.
Strengthening the examination boards to enable them to improve the midwifery examination system.
Finalization of a legal framework for midwifery practice to protect the midwife and the community she serves.
Sensitizing the community and the medical profession about the pivotal role of the midwife in lowering maternal mortality.
Improving midwifery education using available evidence of the existing weakness.
Strengthening the health facilities to provide backup support to the midwife.
Designing an educational system which provides opportunities for professional advancement to the midwife.
Acknowledging midwifery as a profession and developing a career structure for its members.
Designing a system to deploy and supervise the community midwife.
The government has the required resources and therefore has the capacity to make possible interventions to meet the nation’s requirements. We hope to see some affirmative action taken to aid in the cause of the midwife which in turn will help the country in the reduction of the maternal mortality rate.
No comments:
Post a Comment