UMERKOT: Umerkot and Thar­parkar are two districts in Sindh where death and disease stalk children and mothers. Behind a facade of serene pastures and brightly dressed women, poverty and lack of awareness about health issues are visible in the form of anaemic women with at least eight to 10 unkempt and sickly children trailing behind them.

Thari intellectual and writer Abdul Haleem Soomro believes that besides abject poverty, which is the chief culprit behind nagging malnutrition, birth of underweight and stunted kids, anaemic mothers, high levels of mother and infant deaths, people’s complete lack of awareness about birth spacing and family planning are also contributing to aggravating the problems.

“This major issue does not seem to be on the list of priorities of government, and the society at large appears to be completely unaware of its consequences,” he said.

In Sindh, according to multiple indicator cluster survey of 2014, two out of five children under the age of five are underweight (42 per cent), of which 17pc are severely underweight. Almost half of the children (48pc) under the age of five are short (stunted) for their age, and about one-quarter of them (24pc) are severely stunted. About one in every six is too thin for their height (wasted). Stunting in 20pc of children occurs in the womb of women who are malnourished, adds Soomro.

In an area with a tradition of large families, Sameena Kalroo with just three kids comes as a surprise in Manthar Kalroo village. “My first two kids were born one after the other, but I spaced the third child using family planning methods,” she said.

After that she convinced her husband to give consent for sterilisation and never regretted her decision. Seeing the benefits of small family, many women of her village started turning to her for guidance in birth spacing and she was soon noticed by a local NGO, Thardeep, which trained and offered her a job as a community health worker.

The World Health Organisation (WHO) recommends women wait at least 24 months after giving birth before attempting to become pregnant again. In Sindh, more than one-third (33pc) of kids were born less than 24 months after a previous birth, Dr Kiran Hemji, a gynaecologist with the health department in Umerkot, told this writer.

Risks of having babies too close together (less than 18 months) included premature birth, stunting, low birth weight and infant death, she added.

Tradition & illiteracy

The deadly mix of tradition and illiteracy makes the work of Gul Jan Chhoro, a Thari woman and a community health worker, all the more arduous. Not only is it difficult to broach the subject of benefits of family planning with people, it is extremely difficult to persuade both men and women to adopt it.

Her own maternal uncle, Khair Mohammad, with no steady income, was bringing up his 18 kids in extreme poverty yet he was against using any form of family planning. However, Ms Chhoro took it up as a challenge and convinced her aunt to get herself sterilised.

In fact, her uncle’s family was among the more than 100 she convinced last year to space their pregnancies and the women who do not want more children to get themselves sterilised.

Many believe it is a sin to adopt any form of modern contraceptive methods. Abdul Haque, who works at a roadside hotel in Umerkot and earns merely Rs400 a day to feed his seven children, thinks it is against the teachings of his religion to stop the birth of a child.

Even Mohammad Hashim, a bank official, and father of three sons and six daughters, wants more sons and is not willing to allow his wife to space births.

According to district population officer Rab Dino Soomro, of the 55 sanctioned family welfare centres, only 30 were functional and at several there was acute shortage of staff with key posts remaining vacant, including that of deputy district population welfare officer, demographer, assistant district population welfare officer, and three positions of women medical officers.

Mr Soomro said the district needed three reproductive health service centres but had only one. While two mobile service units had been working, two more were needed. In addition, 41 positions of family welfare counsellor and family welfare worker remained vacant.

Of the 44 union councils (UCs), 30 were not covered by the population department, while the remaining 14 had mobility issues. Five UCs of the district were completely in the desert, while 10 fell partially within the desert for which four-wheel-drive vehicles were needed, but the department did not have them.

Fehmida Rattar, a social organiser at Thardeep, said only 48pc of entire Umerkot was covered by LHWs as per data collected from district health department.

“If it is not religion, then it is the various myths that come in the way like excessive bleeding, or that it can affect breast feeding, or that oral pills make them fat, or that the IUCD can cause cancer etc,” she said.

Published in Dawn, August 24th, 2017