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Site Last Updated: 1st September 2008 |
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| Under PPAF Sindh Coastal Area Development (SCAD) Program three Community Physical Infrastructure (CPI) schemes are under process. However seven CPI schemes have been approved by PPAF in Tehsil Jati, District Thatta, and Sindh |
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| SRSP recently signed Memorandum of Understand (MoU) with Agribusiness Support Fund (ASF) for a project in Nawabshah and Umerkot Districts of Sindh. |
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| Latest Reports |
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| TBAs Refresher TGH |
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| Traditional birth attendants can curb maternal and infant mortality |
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| A trained TBA shows off her new delivery kit including a head scarf, plastic apron and plastic gloves |
KARACHI,
31 August 2008 (IRIN) - Until recently, 55-year-old Sabhai Bibi, a
traditional birth attendant (TBA), known as a 'dai', used an age-old
method of cleaning the vagina after birth.
"I'd shape gur
[clarified sugar cane] and some herbs into a ball and put it inside the
vagina. After two days I'd replace it with a ball of misri [sugar
crystals] and remove it after five days," she said.
Bibi, from
the village of Sonu Khan Almani, some 300km from Karachi in Sindh
province, is not the only one using such potentially unsafe methods.
There are thousands of TBAs across Pakistan who handle most births in
rural areas with minimal training and basic equipment.
Fatima
Bibi, another TBA based in the nearby village of Qasimabad, told IRIN
that after cutting the umbilical cord with a kitchen knife, she would
use ordinary thread to tie it. She also advised women to push with
"full force" during uterine contractions, often not realizing the
cervix had not dilated. "I didn’t know this could lead to the tearing
of the cervix and cause post-partum haemorrhage," Fatima said.
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| In many areas of rural Pakistan it is believed that a girl should be married off as soon as she gets her first period |
Most
TBAs put kohl, oil and even cow-dung on the child's umbilical cord to
make it heal faster. The colostrum, the first milk after birth, is
wasted, and instead the child is given honey mixed with some herbal
concoction, even butter or 'kheer' (milk cooked with rice and sugar).
"Not
any more," said Bibi, who has delivered over 100 babies since she
started eight years ago. She picked up the trade from her
mother-in-law.
"We were not educated and followed whatever was
passed on to us," she said. Now, after 15 days of midwifery training,
she is horrified by the risk she had put women and infants through.
TBA training programme
Bibi
is among 104 TBAs trained under a programme by the Sindh Rural Support
Programme (SRSP), a local non-governmental organisation (NGO).
"Since
we started four years ago, I have found a sea change in these birth
attendants," said Fizza Qureshi, coordinator of the training project,
adding that TBAs play a crucial role in rural areas, where they carry
out over 80 percent of deliveries.
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| Just a child herself but Perveen will be marreid off at the end of the year as she has reached puberty |
The
training includes understanding the anatomy of the reproductive organs,
giving post-natal follow up counselling and educating women on
breast-feeding, safe delivery methods, sexually transmitted diseases
(STDs), family planning and child spacing. The TBAs are also provided
with disposable safe delivery kits with sterilised birthing supplies
that include gloves, a plastic apron, a plastic sheet, soap, clamps, a
new razor, string and cotton balls.
"These cost only Rs 40
[about US$0.50]," said Qureshi. "If these kits are made cheaper still
and made easily available in the market, this would further help ensure
adherence to hygienic practices."
The training has also helped the TBAs to identify birthing complications in time and refer cases to the nearest hospital.
Since
Saran Bibi received training a year ago, she has referred seven cases
to hospitals. "In the past I would never allow my client's family to
take her to doctors. I would consider difficult cases a challenge to my
expertise. I never realised that some infant deaths could have been
prevented," she said.
Questioning cultural norms
The
training has also encouraged women to question certain cultural norms.
"We had been brought up to believe that as soon as a girl got her first
period she should be married off," said Khadija Bibi, 35, who has four
children and has had two miscarriages. She recently had an intrauterine
device (IUD) - birth control device - placed in her uterus after her
fourth child.
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| A
makeshift cradle tied under a charpai (rope bed). Pakistan's infant
mortality rate is 83 deaths per 1,000 live births, the highest in South
Asia |
"My husband refuses to use a condom," she said shyly.
"It's
their husbands who do not want to adopt any family planning methods,"
said Pathani Bibi, another 'dai'. "They get married young, have too
many children and thus many die of bleeding." The major cause of
maternal mortality in these villages is by haemorrhage.
"We
need to understand the important role of the TBAs," said Dr Ghulam
Hyder Akhund, programme director of the government's Provincial Health
Development Centre. He said these "life savers" are "virtually
ignored”.
Pakistan's maternal mortality rate is 350 to 500
deaths per 100,000 live births and infant mortality rate is 83 deaths
per 1,000 live births, the highest in South Asia. At present, the
country is at risk of not reaching Millennium Development Goals
(MDGs) 4 and 5 of reducing under-five mortality by two thirds and maternal mortality by three quarters.
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