Sakina, a resident of Gulshan-i-Hadid in Bin Qasim Town, is still grieving the loss of an aunt who died a few months back due to a traditional birth attendant’s (TBA) mishandling of her case.

Knowing the fate of her aunt, Sakina, 18, wondered if all the women in her family would have to face the same risk to their lives at the hands of untrained TBAs. She also knew some women, whose pregnancies were handled by the TBAs, who either died as a result of mishandling of their deliveries or developed complications at later stages.

Opportunity knocked at her door when she came across a lady doctor in her neighbourhood, who handled pregnancies in a professional manner. It was through her that she found out about there being an institute of nursing and midwifery in nearby Jamkanda where young girls were imparted professional training in midwifery.

That is how Sakina joined the institute herself in the hope of being able to serve the women in her area who could not really afford to visit private hospitals for delivery purposes.

Handling of pregnancies by TBAs is a common phenomenon in Pakistan, particularly in the rural areas inhabited by over 67 per cent of the population. Figures taken from Pakistan’s Ministry of Health show an estimated five million women here becoming pregnant every year, most of them being in the rural areas. Over 75 per cent of the deliveries in rural areas take place in homes with the help of TBAs, who charge a meagre amount ranging between Rs500 to Rs1,000. But they are all not properly trained and around 62 per cent of these deliveries are conducted by unqualified TBAs.

Reports from the ministry also conclude that there are three women succumbing to maternal problems every hour. Also an estimated 30 babies die in the first month of their lives every hour. So in order to reduce the deaths, health experts have recommended the promotion of midwifery education in every single village of the country. The introduction of training courses help produce trained birth attendees to replace the TBAs.

Health experts suggest that the government introduce such training programmes at the community level for those who want to make a career out of midwifery.

“There is a strong need to set up community midwifery training schools in the rural areas of the country in order to prepare women as competent community midwives with sound knowledge, skills, understanding and desirable attitudes to provide health services (antenatal, postnatal, safe home deliveries and neonatal care) to reduce maternal and infant deaths in their respective villages,” said general manager of the Health Promotion Programme Dr Khalid Pervez.

The Pakistan Poverty Alleviation Fund (PPAF) in collaboration with Health and Nutrition Development Society (Hands) have set up model community midwifery training schools in districts of Sanghar, Hyderabad, Matiari, Badin and Thatta and Bin Qasim Town. Hundreds of young girls have been trained free of cost at these schools, and they in turn are providing proper and safe health services to the women in their areas in exchange for nominal charges.

“We have appointed qualified lady doctors and trained paramedical staffs, who impart intensive training to young girls in midwifery. We have also learnt that these young midwives are being welcomed in their areas and have replaced TBAs. This is an encouraging and positive change for us,” said Ghulam Hussain Baloch, general secretary of Hands.

Providing details of the training process and materials adopted at these training schools, Baloch said that the modules for midwifery have been developed in consultation with prominent health educationists and experts. Being comprehensive they cover all facets of training for community midwives in theory and practice.

“Audio visual aids, charts, models, overhead projector (OHP) films, handouts, etc., are also used for training for antenatal checkups. Besides, additional knowledge is also provided by resource persons in different topics such as communication skills, social mobilisation, health education, referral system, MIS maintenance, essential medicine, neonatal care and record keeping,” he said.

Meanwhile, a public health department official in Bin Qasim Town provided the information that the intensity of deaths during pregnancies has significantly decreased in areas where these midwifery training schools have been established.

The writer is a development journalist and WaterAid Media fellow. saleemzeal@gmail.com