There are 40 government maternity homes in the sprawling metropolis of Karachi, which are supposed to cater to the needs of the poorest segments of the society. However, barring four or five, doctors are not available in these hospitals in the second half of the day, Dr Shershah Syed, a leading gynaecologist, told the News.
Dr Syed, former general secretary, Pakistan Medical Association (PMA), said that if a pregnant woman arrives at the hospital after 1 o’clock, the delivery is conducted by an “aya” and even sweepers.
“Seventy per cent of the children across the world are born during the night between 2a.m and 6a.m, therefore, all maternity homes should work round the clock,” he said.
Prior to partition in 1947, there was Lady Dufferin Hospital, Sobhraj Maternity Hospital, a maternity home in Soldier Bazaar, Aga Khan Maternity Home in Kharadar, a maternity home in Eidgah, and a maternity home in Lyari. Furthermore, Holy Family Hospital and Seventh Day Adventist Hospital also provided maternity services and they were sufficient to cater to the needs of the then thinly populated city of Karachi, Dr. Syed said.
After the creation of Pakistan, the load on maternity homes increased immensely because of the influx of immigrants from India.
According to the Government of Pakistan Census Reports, the population of Karachi in 1941 was 435,887. In 1951, it shot up to 1,137,667 indicating an increase of 161 per cent over a period of 10 years. In 1961 it was 2,044,044, and in 1998 it was 9,802,135. Today it has been estimated to be over 15 million.
“It must be noted that maternity homes are not run by doctors alone but they need midwives, paramedics, ‘ayas,’ sweepers and security staff besides having basic facilities such as water and electricity. But, gradually, we are witnessing a sharp deterioration in these areas,” Dr Syed pointed out.
“It’s the job of the City District Government Karachi to pay heed to these problems but sadly enough the budget is not being diverted to the health sector,” he said.
“A society that does not care for pregnant women cannot claim to be civilised,” he said.
He said that there should be at least 100 maternity hospitals of 100-beds each in the public sector, but our priority is to build a fountain worth 225 million rupees at Clifton. We have failed, miserably, to provide solace to the down trodden and the lower middle and middle classes.
The gravity of the situation in the realm of maternal health in Karachi, as elsewhere in the country, can be gauged from the fact that one woman dies every 20 minutes in Pakistan due to postnatal infections, according to Dr Nighat Shah, a gynaecologist associated with the Aga Khan Healthcare Centre, Kharadar.
Statistics indicate that the lifetime risk of maternal death for women in Pakistan is 1 in 31, while roughly 1 out of 10 children born in Pakistan die before the age of five. Among the factors contributing to maternal death and infant mortality, are high fertility rates, inadequate access to quality maternal and child care services, a low rate of skilled birth attendance, inadequate emergency obstetric and newborn care, low female literacy, poverty, and a heavy burden of communicable diseases, according to UNICEF.
Professor Sadiqua Jafaray, President National Commission on Maternal Health (NCMH) said: “We don’t know the exact maternal mortality ratio (MMR) but it’s true that it’s very high in Pakistan. For the first time the National Institute of Population Studies is conducting a survey in Pakistan and its findings are expected to reveal the MMR by the end of this year.”
She said the medical causes of maternal death in Pakistan include haemorrhage (bleeding), eclampsia (high blood pressure during pregnancy), obstructed labour, and abortion.
“There are social and cultural causes of maternal death as well. Poor women are generally illiterate; they don’t know about complications and are malnourished. Anaemia itself can kill. Too many pregnancies during young age can also cause death,” Dr Jafaray, who is a leading gynaecologist, said.
Ismailimail 