Maternal Mortality Rate in Pakistan

mother equal Mortality Rate in Pakistan motherly Mortality a Public health IssueShahida AbbasiIntroductionMaternal mortality refers to when a woman dies during motherhood or within six weeks after delivery. at that place ar many factors ofttimes(prenominal) as biological, socio-economic, cultural and availability of quality Reproductive Health Services (RHS) in the country which contribute to the alarming intent of Maternal Mortality Ratio (MMR). Pregnancy is a normal process in which women experience approximately physiological changes as it is essential for fetal growth and development. During motherhood women need wellnessy diet, antenatal checkup for pregnancy progress and identification of dangers signs and proper treatment. Unfortunately callable to certain reasons these needs argon not snug and resulted in death of the mother. This paper aims to in-depth analysis of the determinants of MM.Significant of the IssueEvery year much than 500,000 women die during mino rbirth or from pregnancy-related causes worldwide. 99% maternal deaths come in developing country (WHO, 2005) as RHS, and family planning services ar not easily introductionible and affordable. According to UNDPs report Roca (2013) Pakistan has nobleest mortality dimension 260/100,000 per live births in the region.Socio economic determinantsP everywheretyPoverty plays as a barrier to satisfy elemental human needs and to access reproductive health services which contribute to maternal mortality. Current global economic crises adversely affected specially marginalized poor women. Escalation in fuel prizes made the fare items so expensive that it is beyond the capacity of the poor to buy. Due to inadequate quantity and quality of food intake, the large(predicate) women suffer with nutritional deficiency anemia. A canvass conducted by Khan, Fatima, Imran and Khan (2010) in Rawalpindi, to assess the risk factors associated with the nutritional deficiency anaemia revealed that ma jority of the pregnant women were anaemic due to iron deficiency fol pitiableed by folate and cobalamin and all these be tenacioused to low socio-economic group. Moreover, these nutritional deficit anemic women are at greater risk of having postpartum eject and sepsis. Furthermore, cost of RHS such as formal fee, screening, purchasing of medicine and travelling acts as barrier for women to obtain pull off. In case of urgency obstetric complications the cost of treatment goes much high and causes the delay in treatment. A qualitative study by Ronis, Mehboob, Masood, Amjad, Nishtar (2012) revealed that seventy percent of the patients sold their belonging or borrowed m wizy in edict to pay for delivery charges.Poverty is a great barrier for pregnant women in approaching family planning and counseling services. National contribute of Population employment (NIPS) Pakistan and ICF International. 2013. depicts that in pastoral areas twenty percent of married women have an unmet con traception needs that increase the chances of unwanted pregnancies leading to abortion. A study conducted by Fawad, Naz, Islam, Zaffar, Abbasi (2011) over the period of 5 years in Abbottabad calculated the MMR 1,057/100,000 live births. both the 78 patients who died belonged to low socioeconomic status and majority of them were illite number.Female literacyPoverty do female education as they cannot afford even primary education. These women are not aware of their reproductive health rights and utilization of RHS. According to Lynd, (2007) the literacy rate of jejuneness between the age 15 to 24 years of Pakistans female is (53%) comparatively lower than the boys literacy rate (77%) in the same age group. In-fact educated women are more autonomous in decision making and utilization of quality ante natal and perinatal services. It is also illustrated in National Institute of Population Studies (NIPS) Pakistan and ICF International. 2013National Institute of Population Study (NIPS) Pakistan and ICF International. 2013. that the antenatal sustentation is widely received by women with secondary or higher education. Moreover, an international cross sectional study was conducted by Karlsen, et al. (2011) revealed that lower levels of maternal education were associated with higher maternal mortality. This depicts RHS are not being utilize by illiterate women.CulturalCultural values are deeply rooted specially among poor and illiterate and it has significant impact on womens health. It is cultural heritage that boys are nourished with rich food as compared to girls beside the fact girls that requirement good quality and quantity of food in order to carry out reproductive responsibilities. Moreover, in conservative families, women mobility is strictly prohibited even to obtain emergency obstetric care. As women are not financially empowered they totally depend on husband regarding their treatment. All the important decisions related to ante natal care, place of de livery and post natal visit are made by the mother in truth or husband. Sometime the decisions related to reproductive health issue are made so late that pregnant womans condition gets worse. Moreover, women do not have the right to make independent decision for healthy timing and birth spacing which consequently lead to higher stinkiness one of the contributing factor to increase mortality. A qualitative study by Ronis et al., (2012) revealed that cultural norms in Pakistan restrict the women to opt RHS from female doctor only. Therefore their unavailability makes the services inaccessible.Gender InequalityGovernment has done much to decrease socio-economic gender inequalities on its part. As it is evident in the World Economic assemblages Global Gender Gap Report by Bekhouch, Hausmann, Tyson, and Zahidi (2013) Pakistan is on ranked 64 out of 136 countries in political empowerment of women. Pakistan had secured the second utmost ranking in the overall measure of gender-based biases. The cultural heritage and ethnic diversity have been playing role in mediating gender inequality. In-fact boys are provided with nutrient food and good quality of schooling as compared to girls. A report by Bekhouch et al. (2013)14 million girls and 18.3 million boys enrolled in basic education in 2006, this depicts the handiness and affordability of girls education. Moreover, gender inequality is also reflected by the accessibility, affordability and acceptability of RHS. According to UNDPs report Roca (2013) in Pakistan 260 per 100,000 live births, women die due to pregnancy related causes reflects the commitment of the government to provide the RHS to marginalized women.Early marriagesEarly marriage is one of the customs which is mostly practiced in rural areas. Due to low socio economical resources parents cannot afford required amount of food especially to their daughters therefore, too soon marriages is considered one of the way to get rid of this burden. Thus early marriage leads to early pregnancy that is one of the factors contribute to MMR. Early marriages consequently lead high parity. The National Institute of Population Study (NIPS) Pakistan and ICF International. 2013. report indicated total fertility rate in rural areas is high (4.2) and it is age specific fertility which is strong indication of early childbearing. It is estimated that 30 percent of all marriages fall into the category of child marriage which is more common in interior Sindh ( sink in 2012-01-19). It is well reflected in PDHS 2012-2013, that eight percent of teenage girls became mothers or expecting their first child. According to Roca (2013) Adolescent fertility rate is 28.1per 100,000 live birth which depicts the strong take the stand of early marriage tradition in Pakistan.High ParityEarly marriages consequently lead high parity. The National Institute of Population Study (NIPS) Pakistan and ICF International. 2013. indicates the total fertility rate in rural area s is high (4.2) and it is age specific fertility. Every time when a woman gets pregnant, the risk of dying increases. A study conducted by Rahim, Shafqat and Faiz (2011) also revealed that out of 268 deaths 47 percent were having more than five children thus supporting the evidence that maternal mortality is higher in grand multigravidas. These findings are consistent with the study of Fawad et al. (2011) out of 78 maternal deaths 49 patients were multigravida.Skilled Birth escortDue to paucity of skilled birth attendants (SBAs) in most of the rural areas deliveries are attended by unskilled traditional birth attendants (TBA) in Pakistan. These TBAs are not competently trained to detect dangers sign during pregnancy and delivery and to refer women for further treatment. The National Institute of Population Study (NIPS) Pakistan and ICF International. 2013. indicated that 67% of rural women received antenatal health care, while 41% women were assisted for deliver by SBAs. The reaso ns for less utilization of antenatal and delivery services are dearth of SBAs, geographical hindrance and long distance from health facility.Medical causesObstructed labor, antepartum postpartum hemorrhage, sepsis and eclampsia are obstetric emergencies which need timely intervention. Mortality due to these cases can be prevented by proper antenatal care and detections of life threatening signs and timely referral to comprehensive emergency maternal obstetric neonatal care (EmOC) services. A retrospective, analytic study to analyze direct causes of maternal mortality over a period of seven years was conducted by Rahim et al. (2011) identified hemorrhage a leading cause followed by pregnancy induced hypertension, ruptured uterus and septicemia. A study conducted by Fawad et al. (2011) revealed that eclampsia was the leading cause of maternal deaths followed by sepsis and hemorrhage. mayhap these precious lives could have been saved if the antenatal and natal services were provided or utilized. These studies calculated MMR 1311/100,000 and 1,057/100,000 live births live birth respectively a big figure as compared to UNDPs report by Roca (2013) reported MMR 260/100,000 live birth.AbortionAbortion is one of the most important direct medical causes of maternal mortality, accounts for 12-40 % of overall global maternal deaths (WHO, 1994 According to a study conducted by Sathar, Singh, and Fikree (2007) an estimated 890,000 induced abortions are performed annually in Pakistan and 6 to 13% deaths occurred due to complications of abortion like hemorrhage, sepsis and visceral injuries (Jafarey, 2002). A descriptive observational study conducted by Shaikh, Razia, Abbassi, Rizwan and Abbasi (2010) revealed that 230 women were admitted with complications of unsafe abortion over period of one year. These complications include bleeding, uterine perforation, and gastro intestinal flaw due to the procedure. Of these 12% women died as they developed septicemia. Deaths due to a bortion can be prevented if the safe abortion care services are available by the skilled birth attendants at the door step.Poor Reproductive Health Services It is quite encouraging that we have good health system that includes basic health unit (BHU), Rural Health Center (RHC) and Tertiary unit. Even though RHS services are available free of charges, BHU and RHC services are underutilized because of long distances to access. Moreover, poor referral system causes a delay in getting access and treatment. According Ali, Bhatti and Kuroiwa (2012) majority of the hospitals were lacking EmOC services and most referral hospitals equipped with EmOC were inaccessible. As in most of the rural areas broken roads and unavailability of proper ambulance services hinder the transfer of women in time. A cross-sectional survey on emergency obstetric care services facilities conducted by Ali et al. (2012) revealed that more than 50 percent of the public health facilities were lacking female doctor to provide Emoc services, thus creating a barrier for women to opt reproductive health services.Summary of analysisMaternal mortality is a public health issue that should be stem out. There are many factors which contribute to MM, and poverty is worse determinant that prevents female to receive education, have nutritious food and get access for reproductive health treatment. Reducing injustice and promoting female education is one of the key strategies to empower women and to bring their status equal to man. MM due to obstetric emergencies can be prevented by strengthening existing health facilities and increasing female skill birth attendantsRecommendationGovernment and NGOs should have one focused agenda to seat in female education as this is their fundamental right. Empowering women with education consequently will improve their socio economic status and will reduce the gender inequity as well.Incentive should be provided to poor women who attend antenatal services in order to el iminate costs issue.Food supplement and medicine for rectification of anemia should be free available to pregnant women.All the stake holders should collaborate in ensuring family planning and counseling services as to reduce unmotivated pregnancies which leads to induces abortions.Reproductive health services including Post Abortion Care (PAC) and family planning services should be made available, accessible and affordable within community settings. polished society, educationist and health professionals should raise the awareness regarding Child Marriage Restraint Act 1929 and its reinforcement, as child marriage is widely practiced in some parts of the country.It is imperative to strengthen existing health care facilities in order to provide emergency obstetric care.More skilled birth attendants should be trained and deployed who will provide twenty four hours services and make timely referral in case of emergency obstetric care.Health professionals should focus on research as suggested by Travis, et al., (2004) that identification of common national and international barriers in several studies will guide the policy makers and donors to pay attention.ReferencesAli, M., Bhatti, M. A., Kuroiwa, C. (2008). Challenges in access to and utilization of reproductive health care in Pakistan.Journal of Ayub Medical College Abbottabad,20(4), 3-7.Bekhouch, Y., Hausmann, R., Tyson, L. D., Zahidi, S. (2013, September). The global gender gap report 2013. Geneva Switzerland World Economic Forum 2013.Dawn (2012, January 19). Child marriage behind high mortality rate. Dawn. Punjab. Retrieved fromhttp//www.dawn.com/news/689119/childmarriage- behind-high-maternal-mortality-rate.Fawad, A., Naz, H., Islam, A., Zaffar, S., Abbasi, A. U. N. (2011). Maternal mortality in a tertiary care hospital. Journal of Ayub Medical College Abbottabad, 23(1), 92-5.Jafarey, S. N. (2002). Maternal mortality in Pakistancompilation of available data. J Pak Med Assoc, 52(12), 539-44.Karlsen, S ., Say, L., Souza, J. P., Hogue, C. J., Calles, D. L., Glmezoglu, A. M., Raine, R. (2011). The relationship between maternal education and mortality among women giving birth in health care institutions Analysis of the cross sectional WHO Global opinion on Maternal and Perinatal Health. BMC Public Health, 11(1), 606.Khan, D. A., Fatima, S., Imran, R., Khan, F. A. (2010). Iron, folate and cobalamin deficiency in anaemic pregnant females in tertiary care centre at Rawalpindi.J Ayub Med Coll Abbottabad,22(1), 17-21.Lynd, D. (2007). The Education System in Pakistan.Retrieved June,30, 2012.National Institute of Population Study (NIPS) Pakistan and ICF International. 2013. Pakistan Demographic and Health Survey (2012-13). Islamabad, Pakistan, and Cleverton, Maryland, ground forces NIPS and ICF InternationalNational Institute of Population Studies (NIPS) Pakistan and ICF International. 2013.National Institute of Population Studies (NIPS) Pakistan and ICF International. 2013. Pakistan De mographic and Health Survey 2012-13. Islamabad, Pakistan, and Calverton, Maryland, USA NIPS and ICF International.National Institute of Population Studies (NIPS) Pakistan and ICF International. 2013. Pakistan Demographic and Health Survey 2012-13. Islamabad, Pakistan, and Calverton, Maryland, USA NIPS and ICF International.Rahim, R., Shafqat, T., Faiz, N. R. (2011). An analysis of direct causes of maternal mortality.Journal of Postgraduate Medical Institute (Peshawar-Pakistan),20(1).Roca, T. (2013). Human development Report 2013. The Rise of the South, Human Progress in a divers(prenominal) World.Afrique contemporaine, (2), 164-166.Ronis, K. A., Mehboob, G., Masood, M., Amjad, S., Nishtar, S. The Voice of Women.Sathar, Z. A., Singh, S., Fikree, F. F. (2007). Estimating the incidence of abortion in Pakistan. Studies in Family Planning, 38(1), 11-22.Shaikh, Z., Abbassi, R. M., Rizwan, N., Abbasi, S. (2010). Morbidity and mortality due tounsafe abortion in Pakistan.International J ournal of Gynecology Obstetrics,110(1), 47-49.Travis, P., Bennett, S., Haines, A., Pang, T., Bhutta, Z., Hyder, A. A., Evans, T. (2004). Overcoming health-systems constraints to achieve the millennium Development Goals. The Lancet, 364(9437), 900-906.WHO. World Health Report2005. Make every mother and child count. Geneva WHO 2005.(2012, 19 January).National Institute of Population Studies (NIPS) Pakistan and ICF International. 2013. Pakistan Demographic and Health Survey 2012-13. Islamabad, Pakistan, and Calverton, Maryland, USA NIPS and ICF International.National Institute of Population Studies (NIPS) Pakistan and ICF International. 2013. Pakistan Demographic and Health Survey 2012-13. Islamabad, Pakistan, and Calverton, Maryland, USA NIPS and ICF International.