Daily Times

Maternal Health is one of the major public health concerns nowadays. Poor maternal health eventually leads to maternal deaths and that exists in many developing and underdeveloped nations around the world. Globally, one pregnant woman dies every 2 minutes, either due to complications during pregnancy or childbirth. In 2020 alone, 303,000 women died of pregnancy or childbirth-related issues. Maternal mortality rate is particularly high in developing countries with the occurrence of almost 99% of all the cases reported in these areas.

South Asia is home to a large number of maternal mortalities. Afghanistan, Nepal and Pakistan are the countries where most of the maternal deaths are taking place. In terms of chiefly talking about Pakistan, the country has low socio-economic indicators. Besides, the social development index of Pakistan does not reveal a very positive picture. Currently, the country ranks 53 out of 184 countries globally in terms of maternal mortality and at third number in South Asia after Afghanistan and Nepal.

The country has been slow to bring advancement in gender equality, and education and change those socio-cultural practices that are hurdles in the way of seeking maternal health for women. Particularly talking of rural areas of Pakistan, the majority of rural areas of the country are deprived of necessities of life and rural people are supposed to live a difficult life. Despite the efforts of the government, health facilities in rural Pakistan are still scarce. Women and children in such a scenario have to suffer most from this neglect. The maternal healthcare system, despite different programs by the government, is not in the right direction. To deal with maternal mortality, identification of the causes is the first and foremost step. The maternal deaths that occur because of medical conditions are easily recognized. Several studies have contributed to maternal health research by identifying medical complications women face during and following pregnancy and childbirth like obstructed labour, sepsis, and post-partum haemorrhage. But researchers believe these problems could easily be managed and death can be prevented if other factors are considered like certain socio-cultural, radical and extremist behaviours that are especially predominant in rural households.

One pregnant woman dies every 2 minutes, either due to complications during pregnancy or childbirth.

It is evident in many researches that these factors are important to determine for pregnant mothers who will survive, and who will not. The poor status of families, lack of education, unemployment, traditional values, beliefs and practices, weak infrastructure in rural areas, the gender inequalities all contribute greatly to maternal mortalities. Unless the social structures of society are not strengthened, the political, educational and economic institutions cannot move towards the right direction. The religious card In particular is played. The radical and extremist thoughts in patriarchal societies where men declare family planning Haram in Islam, The rural women of Pakistan while having a life full of discrimination, will keep giving birth without listening to their body needs and requirements. Ultimately death will be their fate.

While deeply investigating maternal mortalities, particularly, certain cultural beliefs in rural Pakistan leave effects on the certain cultural displays of behaviours of people within a certain cultural context. For instance, the extremist thoughts of having suspicion of young girl characters, considering them a burden and marrying them off as early as possible is the common practice in most rural households. Hadith or verses from Quran are misinterpreted and quoted to favour marriages of girls at the very tender age of fifteen or sixteen years old. The scientific evidence is there that reveals high chances of obstetric complications among teenage girls. Similarly using the Purdah system for restricting women’s mobility truly damage women’s health while pregnant. The radical behaviours of general people that do not allow women to come out of the four walls of their houses even in an emergency, without being accompanied by men is a pivotal barrier for women seeking maternal care. Another significant element of women’s perception of feeling unsafe while going out alone is an additional cultural constraint that ultimately damages pregnant women’s health.

In addition to that, lack of education and poverty cycles keep these people in a state of ignorance and they keep following popular narratives that are old and backwards in every aspect of their lives. More than any medical treatment, a so-called spiritual healer (peer) has the status of a divine person in the villages. The “Jhar phoonk” and the use of water given by spiritual healers are usually the substitute for simple high blood pressure in many rural households that can cause death among pregnant women. Despite, people being concerned over supernatural involvement in pregnancy truly trust these spiritual healers to look after maternal care for women. Faith-based treatments have been described in such areas as equivalent or more reliable treatment as compared to available medical treatment.

Furthermore, Dai (traditional birth attendants) are culturally more accepted when it comes to posting or ante-natal care or even deliveries. The existence of radical and extremist thoughts has further strengthened the existence of Dai (traditional birth attendants) and spiritual healers in villages. D?? is still called and perceived as a “mother” in such rural households where maternal healthcare facilities are still either unaffordable, inaccessible, or they are ineffective because of people’s illiteracy or radical minds. Such extremist and radical practices do shape health-seeking behaviours. Many maternal deaths that take place in tehsil headquarter hospitals or district headquarter hospital in rural areas have reported the cases of pregnant women being mishandled by these “Dai”. With all such elements, the medical facilities, technology and ethno history are other components that contribute towards poor maternal health of women in a country like Pakistan.

Maternal mortality is a complex issue in Pakistan and is difficult to reduce in the presence of the indigenous laws, radical behaviours and extremist approaches due to which women are restricted in traditional societies from accessing the right maternal health care. Women are socially and economically not empowered in Pakistan. Their decisions about their own lives and their families are not considered important. As a consequence, the prevalence of maternal mortality is high in the country. There are very also few studies that have combined maternal mortality with the consequence of the death of a mother on the family and children. A family as a unit is ruined. Children who experience parental loss experience several devastating effects on their lives that include effects on mental health and nutrition, post-traumatic stress symptoms, education, and low self-esteem. Due to families torn apart after the departure of their mother, such children incline more towards extremism and display violent behaviours. The governments in Pakistan during different rules have made many policies related to maternal and child health care but most of these have not been able to achieve given targets mainly because of lack of resources and poor governance. The Ministry of Health sustained policies, allocation of the budget at the right place and right time, participation of real stakeholders and interest groups while making policies for maternal health, emphasis on girl’s education in rural areas, the role of the development sector and mass media in highlighting social and cultural factors are few of the ways forwards. Besides the capacity to warrant the delivery of quality health services remains the major test for Pakistan’s health sector.

The writer is Associate Professor in Department of Social Work, University of the Punjab, Lahore Pakistan. She can be contacted at soniaomer78@gmail.com.