Simple in her dressing and demeanour, with a gentle, reassuring smile and friendly conduct is the lady the world knows as Professor Sadiqua N Jafarey, one of the leading gynaecologists of the country and president of National Commission on Maternal and Neonatal Health. Having chaired the obstetrics and gynaecology department at Jinnah Postgraduate Medical Centre (JPMC) for several years she is now associated with Dr Ziauddin Hospital, Karachi.

The youngest of eight siblings, Prof Jafarey explains that she was the ladli of the household and got all the advantages of a favourite child. Unfortunately, she lost her father when she was hardly three or four years old. Having done her matric and Senior Cambridge from Jufel Hurst School (in those days people often did both) she joined the recently opened the Government College for Women, Frere Road, Karachi, for FSc and later joined Dow Medical college from where she graduated in 1956.

When asked why she opted to study medicine, she laughs and says, “It’s not the case of being interested in the field since childhood, but as my mother wanted that at least one of her daughters become a doctor and since all my three sisters left studies after Senior Cambridge, so I decided to fulfil her wish.”

Postgraduation was not possible in Pakistan at that time since the College of Physicians and Surgeons had not been established and she was reluctant to go abroad. She states, “As my mother was a heart patient and I was the only doctor in the family but on the reassurance of my mother’s cardiologist about her health I proceeded to the UK in 1960.” She did her DRCOG (Diploma of Royal College of Obstetrics and Gynaecology), came back for a while and then went back and did MRCOG (Member of Royal College of Obstetrics and Gynaecology) in 1964. Luckily she came back in her mother’s life who passed away in 1965.

Nowadays Prof Jafarey is incredibly busy with the ‘National Committee for Maternal and Neonatal Health (NCMH)’ that she is left with little time to pursue any hobby, except reading a little. Talking about her involvement with the NCMH, she elucidates, she  has been involved with it since the Committee was formed in 1994, soon after her retirement from the JPMC.

“Benazir Bhutto, the then prime minister, made this committee and entrusted us (myself, Dr Faridoon Sethna of Lady Dufferin Hospital and Imtiaz Kamal, a very senior and internationally known midwife) with a huge task of reducing high levels of maternal mortality in the country. Along with the medical causes, we had to address the social factors as well, for instance, poverty, malnourishment and lack of healthcare, because all these add to the risks of maternal mortality.”

After returning from England, Prof Jafarey spent some time at the Lady Dufferin Hospital and then joined the Jinnah Hospital. Here she was exposed to the harsh reality of the high rates of maternal mortality. “I had seen the practice in England and when I came back, I realised that many women were dying during childbirth. Several were brought dead to the hospital. What was more disturbing that they didn’t always live far away even then couldn’t reach the hospital in time. The most unfortunate fact was that many of them lived in Karachi and within six to eight kilometres from the JPMC.

“At that time I wrote a paper, Mothers brought dead which showed that things were not well even in cities, though they were worse in the rural areas,” she adds.

Prof Jafarey cites ‘three delays’ as the major factors that contribute to high rates of maternal mortality. “First, the women do not recognise the seriousness of the situation, then they are not empowered to make the decision or go to the hospital on their own—they have to wait for the husband’s permission, and thirdly, delay at the hospital—even at the hospital there are many issues that delay treatment.”

Other factors include malnutrition, lack of education, early marriages, close birth spacing, etc. She emphasises the concept of ‘healthy, timely spacing of pregnancy’, i.e., “You should not get pregnant before the age of 18 and after the age of 35 as then you are more likely to have complications, that is to say the best time to have children is between the age of 18 and 35. By spacing we mean the interval between two children should be about three years—this is important as it not only affects the mother’s health but the baby’s health as well.”

Lack of services is also a major factor. Mostly untrained midwives are delivering babies at home which often lead to complications. Late referral and the long distances women have to travel to reach the right health facility often prove fatal. Among the complications postpartum haemorrhage (bleeding after giving birth) is the most serious; if it is not controlled she can die in two hours. There are other complications like eclampsia (fits), fistula (due to obstructed labour a passage is formed between the urinary tract and the vagina and the woman leaks urine all the time), unsafe abortion, etc.

Talking about abortion, the gynaecologist says that it is a very controversial issue. “Not only our people but our healthcare providers are also not very clear about laws related to abortion. The law permits abortion to save the life of the woman or for necessary treatment, but the term ‘necessary treatment’ is vague and we have to figure it out ourselves—is it for the necessary treatment of the mother for physical reasons, for mental reasons, other conditions of pregnancy that could cause psychological problems.

“Then religious aspect also has to be considered, as according to Shariah, if needed, you can have an abortion up to 120 days. I think everybody should be aware of what the law and religion says and then, of course, it is up to you.” Aware of the law and religion she still does not want to do it. “I don’t want to do it. This is something personal,” she exclaims.

When asked what can be done to save all these mothers? Prof Jafarey’s spontaneously says, “Correct all these factors”. Then laughs and adds, “The problem is that there are so many factors. If there was one problem our committee would have put it right. We have to address factors that include increasing literacy, reducing poverty, etc. Women need not only formal education but also health education; they should know what they have to do to remain healthy. At the same time, services have to be made available to them.”

“Some time back, the Unicef had started to train midwives but that didn’t work out. Now the government has started the programme of community midwife—but many details remain to be sorted out, like whether they will deliver the baby at home or at a birthing station or a community health centre,” she explains.

Prof Jafarey is taken as a role model by the children in her family. She does not have any kids of her own but many girls from the family are following her footsteps.