Recently a woman in Raiwind gave birth outside the Tehsil Headquarters Hospital Raiwind early Monday morning after staff at the hospital refused to treat her. Pakistan was not a healthy state to begin with. Its sickness began even before its birth. It inherited a legacy of sickness and suffering, a burden of high mortality and morbidity coupled with a poorly developed infrastructure to address the health needs of the growing population. A year before Pakistan emerged as a newly independent state carved out of British India; an extraordinary document described the poor state of health in that country.
“Environmental sanitation in the country is at a low level in most parts. Malnutrition and under-nutrition reduce the power of resistance of an appreciable section of the population and the existence of health services are altogether inadequate to meet the needs of the people while lack of general education add materially to the difficulty of overcoming the indifference and apathy with which the people tolerate the unsanitary conditions around them and the large amount of sickness that prevails”.
Data on the basic social and health indicators complements the still-grim overall picture. The national averages do not show the wide disparities and significant differences that exist between the provinces, districts and urban and rural differences. Children and women are the disadvantaged sections of the society and consequently bear the brunt of the heavy burden of disease and deformity. Diarrheal disease and its ensuring complications, such as dehydration, continues to be the major killer of children in Pakistan, accounting for nearly 48 per cent of the total deaths of children under 5 years of age in the country. It is followed closely by Acute Respiratory Diseases. Pakistan has the third largest number of reported cases of Neonatal Tetanus in the world, proportionately higher than the more populous India. Till recently, Pakistan was responsible for nearly 75 per cent cases of polio in the EMRO region of WHO. These diseases leave behind a residue of suffering and disability but are largely preventable. The vaccine which could have prevented these disease, costs no more than a few paisa but this is no consolation to the child or the family who were denied the right to immunization.
The 1996 Progress of Nations, published by UNICEF, highlighted the fact that half of the world’s malnourished children are in Pakistan, India and Bangladesh, where malnutrition rates are typically twice as high as Sub-Saharan Africa. Quoting statistics from Pakistan, the report noted that in spite of improvements, 40 per cent of Pakistani children are malnourished. More girls than boys are afflicted with malnutrition and of those who survive to puberty significantly large numbers become “at risk” mothers.
The number of women in Pakistan who die while giving birth is difficult to determine. The maternal mortality in Pakistan is estimated to be somewhere in the range of 190 to 1,700 deaths per 100,000 live births, while a 1990 estimate gives the national maternal mortality rate as 340. The continuing tragedy of maternal deaths in Pakistan is brought home in the analysis by Prof. S. Jafarey and Kotejo’s study of the women who were “brought dead” to one of the premier health institutions in the country. The major reasons cited by the study were delay in seeking care due to socio-cultural factors and inadequate medical services at the first-care level. These women did not come from some hard to reach corner of Balochistan, but these women lost their lives right in Karachi, literally within a stone’s throw from some of the most sophisticated tertiary care hospitals in the country.
The problem of maternal mortality in Pakistan is a reflection of the generally poor health status of women’s health. An overwhelming majority of women suffer from anaemia and malnutrition, both of which are worsened during pregnancy. Many women never realize their full growth potential, putting them at high risk of obstetrics difficulties. Higher fertility rates, child birth at early ages and high parity and negligent care of high risk pregnancies multiply their risks of sickness and death. (S. Mahmud and A. Aslam, Maternal Mortality in Pakistan: Policy Strategy). Death is the final outcome, but not in all cases. One quarter of all adult worn en in developing countries are affected by injuries and disabilities during pregnancy and childbirth. “Many of these injuries go unspoken and untreated, but they are painful, humiliating and permanent,” according to the same report which thus identifies another major public health problem being faced by countries such as Pakistan. “This issue, fast in its conspiracy of silence is the most neglected tragedy of our times.”