Each day, 500 new-borns, under one month old, die in Pakistan, according to a news report by UN Children's Fund (Unicef). This translates into a death at least once every four minutes, say experts according to a report by IRIN, the UN information unit on Monday.
Unicef's 'State of the World Children Report' (SOWC), launched in Islamabad on January 15, said that an estimated 216,000 Pakistani new-borns die each year before they are a month old. This group represents 58 percent of deaths among children under five.
According to Unicef, Pakistan has the eighth highest rate of death among children under one month in the world. The lack of services for mothers and babies, low awareness of health needs of pregnant women, and the poor status of women are contributory factors. So, too, is the maternal mortality rate (MMR), which stands at 320 deaths per 100,000 live births.
The MMR figure is higher in rural areas where women have even more limited access to healthcare. Unicef is convinced that better mother and child care, and improved hygiene and sanitation can remedy the situation. "If women have access to appropriate healthcare, know-how to access and utilise services and information, and are empowered to take decisions through education, then they will be in a position to make the best health choices for themselves and their children," said Martin Mogwanja, Unicef Country Representative for Pakistan.
For mothers like Mumtaz Bibi, 35, the neonatal mortality statistics translated into a personal tragedy. "My first-born child, Huma, a girl, died when she was just 10 days old. Even at birth, she was very weak.
"After the death of my daughter, I insisted on having a Lady Health Worker call on me during my second pregnancy. That really helped me to know about what things were good for me to eat, how to improve [my] health by careful hand-washing, and how to care for my baby," she said.
Lady Health Workers (LHWs), community-based teams of women trained to offer basic health advice to women, were also present when her second child, a healthy son, was born 10 years ago.
Unicef, with the government of Pakistan, is working to train community midwives and about 10,000 LHWs on the care of mothers and new-borns. Currently, support is being provided to 73 health facilities in the form of staff training and equipment.
There are also other initiatives. In Punjab, a pilot project, entitled 'Safe Motherhood Initiative' (SMI), seeks to reduce maternal and infant mortality in Sheikhupura District by rotating 10 female postgraduate doctors to the district's hospitals.
Traditionally, doctors prefer not to serve outside major urban centres. The 10 women doctors conduct deliveries at two hospitals and have a mobile ultrasound unit to assist in the process of monitoring pregnant women.
Aisha Iram is one of the doctors working with SMI. She heads a 'Basic Health Unit' in Sheikhupura District. "I conduct some normal deliveries here and arrange transport just in case," she said. "For women with complications, I tell them to go to Sheikhupura or Lahore. There have been times when I sat in the car and went with the woman because she was nervous."
Zulfiqar Bhutta, of Aga Khan University, Karachi, writes in Unicef's SOWC report that a pilot project in Sindh, which involved LHWs and community groups in improving health practices, significantly reduced new-born mortality. Providing basic preventative and curative healthcare can reduce maternal and newborn deaths by 20-40 percent. At present, only 39 percent of all deliveries take place in the presence of a skilled attendant.