Lack of trained midwives root cause of high maternal mortality

[Naveed Yaseen]

Trained midwives capable of providing skilled care during delivery can significantly contribute towards achieving a decline in maternal deaths and disabilities. Every country that has successfully reduced its maternal mortality ratio has done so with the support of well-trained and licensed midwives supported by accessible emergency obstetric care services.

This realisation, which is as old as 250 years, echoed at the inaugural session of the First Midwifery Conference held at the College of Nursing, Pakistan Institute of Medical Sciences (PIMS), here Monday. Organised by the Midwifery Association of Pakistan (MAP) in collaboration with TACMIL (Technical Assistance for Capacity Building in Midwifery Information and Logistics) health project of the United States Agency for International Development, the conference had Minister of State for Health Mohammad Afzal Sindhu as the chief guest.

Terming midwives as the backbone of the healthcare system, Sindhu said the dignity of this centuries’ old profession is acknowledged around the globe. He said nurses and midwives play a very special role in the achievement of our national health targets. He attributed the country’s high maternal and infant mortality rates to the non-availability of skilled midwives. “Seventy-five per cent of the deliveries in Pakistan are conducted by untrained birth attendants,” he regretted.

Today, 80 per cent of the deliveries in Europe are conducted by midwives. The role of the obstetrician is primarily reserved for complications which are outside the scope of midwifery practice. “Pakistani midwives also want to play similar role,” Sindhu stated.

Referring to the measures taken in this direction, the state minister said the government has started training a new cadre of community midwifery (CM) in 12 districts of the country, along with other midwifery trainings to provide midwifery services at the doorsteps of the people. “Every CM will have to serve a population of 5,000 in the catchments area,” he said.

Sindhu said the government is committed to reformation of the nursing and midwifery sectors on priority. Pakistan has one of the highest MMRs, which stands at 268 per 100,000 live births.

He appreciated the contributions of all national and international stakeholders who are jointly working for the uplift of midwifery in Pakistan, and expressed confidence that the initiation of midwifery education would prove to be a step forward in overcoming the existing gaps impeding enhancement of midwifery and referral services in the country.

The conference was also addressed by PIMS Executive Director Dr Abdul Majid Rajput, who acknowledged the role of midwives in reducing the infant and maternal mortality rates. Prominent among others were Imtiaz Kamal, president of MAP, Dr Nabeela Ali, Chief of Party, PAIMAN, Dr Zafarullah Gill, Chief of Party TACMIL, and Professor Ghazala Mehmood, Head of the Department of Gynaecology, PIMS.

The speakers emphasised the need to create midwifery posts in all teaching and district hospitals of Pakistan. There was also a strong feeling that the MNCH programme would collapse unless supported and managed by trained professionals. One of the speakers quoted a WHO report stating that Pakistan will be the only country, which will not be able to meet the Millennium Development Goals.

The Midwifery Association of Pakistan, which was established in 2005 with the assistance of the National Committee for Maternal and Neonatal Health (NCMNH) and Mother and Child Welfare Association, Sindh, is itself facing numerous constraints such as lack of space and regular income. The NCMNH has provided one room in which four paid staff members have been accommodated. The president of the association does not have a desk or a chair in the office owing to lack of space.

In terms of resources, MAP is surviving on projects, donations and membership fees. It does not have a regular source of income to hire additional staff of rent decent office space. Although the association has developed an ambitious three-year plan, its implementation will remain shaky in the present circumstances.

http://www.thenews.com.pk/daily_detail.asp?id=152185