Islamabad - Each year, nearly 8.6 million women become pregnant in the country and of these, 15 per cent (1.2 million) women are likely to face obstetric complications. Each year, there are nearly 14,000 pregnancy-related deaths (PRDs) as one maternal death occurs every 40 minutes and Pakistan has not been able to achieve its Millennium Development Goal (MDG) targets related to mother and child healthcare.
The Population Council recently conducted a study on “Using the Community Informant Based (Made-in And Made-for) Methodology for Estimating the Causes, Circumstances and Magnitude of Maternal Deaths in Punjab”.  This was shared in a Dissemination Seminar in Islamabad on Friday.
The innovative methodology employed community based key informants such as LHWs, Religious Leaders, CMWs, and Counsellors identifying deaths of women of reproductive age and pregnancy related deaths.
In her welcome remarks Sarah Hall, Programme Manager, (MNH) Research and Advocacy Fund (RAF) said that Planners in Pakistan require a method that can provide reliable sub-national estimates easily, cost-effectively and with greater regularity. In this regard, the Research and Advocacy Fund (RAF) offered support to the Government of Pakistan to assess the feasibility of testing a new community informant-based approach, “Made-In Made-For” (MIMF), for estimating the MMR at the community level.
In her opening remarks Dr Zeba Sathar, Country Director, Population Council outlined the background of the study and said that study has identified specific areas that need strong policy and programmatic interventions to improve maternal health outcomes. It confirms that maternal mortality persistently remains a major public health issue in Pakistan and this problem may be much larger than we assumed.
Attended by large number of provincial and federal government representatives, donor organizations, health professionals, academics, NGOs and civil society representatives, the report launch was an opportunity for subject experts to share their views on timely topics shaping the reproductive health and socioeconomic agenda in Pakistan and determine the best way forward for helping women and communities achieve optimal health outcomes. Speakers stressed on the role of research-based evidence to action beyond 2015 in order to build better policies and practices related to maternal and newborn health in Pakistan.
The Population Council study highlights maternal mortality remains a major public health issue. This study has successfully identified different networks that can be used at the community level to capture data on deaths in Pakistan, more so in communities that are close-knit. Lady Health Workers remain the best network; however, other networks can supplement data collection.
The study has estimated that 302 maternal deaths per 100,000 take place in the province of Punjab. It was also said that the study also raises important issues related to the quality of emergency obstetric care available at the facility level and the lack of a functional referral system in all districts.
The study found that a large proportion of women, realizing the importance of antenatal care, were more frequently getting antenatal check-ups. Husbands were seen to be more supportive and were the main decision-makers in deciding as to when and where to seek care.
The two major causes of deaths identified among PRDs were obstetric haemorrhage and pregnancy-induced hypertension. The study recommends that these conditions should be kept in mind when designing any future interventions as there are now simple strategies available to prevent the occurrence of both these conditions.
The findings show that women’s lives cannot be saved until or unless SBAs are integrated with a good referral system that is able to transport women in acute emergencies to facilities that can provide comprehensive obstetric care.
The study also raises important issues related to the quality of emergency obstetric care available at the facility level and the lack of a functional referral system in all districts. Sadly, it found that a large proportion of deaths in all 6 districts had occurred during transportation from one facility to other.
Another aspect highlighted by the study is the lack of advanced resuscitation facilities available at public sector tertiary care facilities to deal with severe complications. This is an aspect that needs the government’s urgent attention.
While no single approach can adequately meet all the requirements for estimating maternal mortality efficiently and with reliable precision, complementary measurement options and opportunities, such as the household census and periodic demographic and health surveys, must also be considered in order to validate results.
The study has highlighted the plight of women who, despite poverty, a stringent caste system, and restrictive socio-cultural norms still managed to reach a health facility but died because of a poorly functioning health system. If progress is to be made and health outcomes for women improved, the health system needs to be revamped.
The Policymakers highlighted the need for refocusing the Lady Health Workers on Primary Health Care and Family Planning. They said that all deaths should be recorded and LHWs should be given this responsibility and they can indeed pivotal in registration of deaths. This will help us reduce maternal mortality by introducing effective interventions and evidence based policies will be generated.  And, exclusive Ambulance Services should be made available for women at the time of delivery and referrals, the urged.