KARACHI, Jan 28: As Gul Jan’s relatives mourn her death and the death of her newborn child due to prolonged and obstructed labour, they are also very worried about the well-being of her three surviving children, all under the age of 15.

The head of the family, Nasrullah, died in a malaria epidemic last year and relatives, whose means are too meagre to even support their own families, are in a state of extreme distress.

“The loss of a mother is the loss of the entire family. It’s not just the financial aspect we are worried about. From now on, the children will be the mutual responsibility of the whole clan,” Karim Baksh, the children’s maternal uncle, said.

According to a recently released Unicef report on the state of maternal and newborn health around the world, Pakistan still has a long way to go in terms of improving its health-care system. The country is ranked 43rd in the world for its under-five infant mortality rate, according to the report.

The infant mortality rate currently stands at 90 per 1,000 births for children under five and 73 per 1,000 for children under one. Further, between 320 and 530 women die of pregnancy-related causes per 100,000 live births in the country.

Back at the small settlement of Hussani Goth, Gul Jan’s relatives continue to mourn, and wonder how they will now care for her children. Hussani Goth was among the 18 villages of Deh Allah Bano (located in Union Council Gabopat, Keamari Town) which was hit by a malaria epidemic last year. By the time government relief was provided – after weeks of delay – over 20 people had already died in the coastal villages of the area.

“It was the worst time of my life. I saw three deaths in my family. The surviving families are still suffering, because fishermen do not earn much, diseases are rampant and there are too many mouths to feed,” says Gul Jan’s brother, Karim Baksh.

Recollecting the events following the death of his brother-in-law, Baksh was all praise for his sister. “Though she was pregnant at that time, she managed well after the loss of her husband. She was earning a little money by doing cloth embroidery. The major comfort, however, was the feeling that she was there for her children. Now, without her, life will be tough,” he said.

No basic health facilities

The villagers regret that despite the large number of deaths, not much has changed as far as health-care in their area is concerned. “There is a desperate need for a health facility for cases of pregnancy, as well as for mother and newborn care,” said Surriya Talpur, a member of an NGO which works in the area. “Cases of maternal and newborn deaths due to a delay in medical intervention – as was the case with Gul Jan – are common here.”

Medical emergencies force people to go to private clinics and hospitals in Mauripur, but that costs a lot of money, she added.

Deh Allah Bano, with a population of around 5,000 people, has no basic facilities or civic infrastructure. The inhabitants live in small huts close to their cattle and their survival depends on fishing and a small amount of agricultural cultivation. The only government dispensary in the locality has been closed for decades. Conditions in the rest of UC Gabopat, which has a population of 250,000, are not much different.

“From its poor infrastructure, the deh looks like a remote location in the interior of Sindh, whereas it is actually a part of Karachi. The government should pay attention to the health status of coastal areas,” Talpur said.

‘Grim’ picture

The situation, however, is not limited to the coastal areas, as the Unicef report shows. In addition to the high pregnancy-related death rate, the country also ranks lowly in terms of the number of mothers who seek institutional delivery (just 34 per cent). Skilled attendants are present at births 39 per cent of the time, while contraceptive prevalence is 30 per cent. Antenatal coverage is 61 per cent for single visits, and 28 per cent for four visits. The lifetime risk of maternal death is one in 74.

Of the 4,446,000 births that take place every year, 400,000 children die before reaching the age of five.

Bangladesh, a country comparable to Pakistan in terms of its resources and basic infrastructure, presents a brighter picture in comparison with the country. The under-five mortality rate is 61 per 1,000 live births and infant mortality (under one) is 47 per 1,000 live births. Of the total 3,998,000 births that take place every year, 244,000 children die before reaching the age of five.

Commenting on the report, Dr Zulfiqar Bhutta, professor and chairman, Department of Paediatrics and Child Health, Aga Khan University, Karachi, said: “The report is a grim reminder that Pakistan ranks very high on the maternal and child mortality table. Progress has been very slow and the country needs revolutionary measures if a desire exists at any level to improve our standing in this crucial area of human development.”

He suggested that the government should make it mandatory for all medical graduates to serve for two years in rural areas to overcome staff shortages. “There are simply no doctors in rural areas. The government spends millions of rupees on their training and the students should be ready to pay back this money by serving the poor in remote areas, provided they are supported with relevant facilities,” he said.

“There are many projects launched in and outside the country that have proved time and again that community-based cost-effective solutions are available to reduce mortalities in mothers and newborns. The only thing we need is sincerity on the part of the government and consistent, concerted efforts by technical managers, no matter which government takes over the reins of the country, to save the lives of mothers and children.”