ISLAMABAD: A baby born in Pakistan is 50 times more likely to die in its first month than a baby born in Iceland, Japan or Singapore, highlighted by a Global assessment published by UNISEF in February.
One newborn out of every 22 in Pakistan dies within the first month, meaning 46 out of 1,000 newborn babies die within the first month of their life.
According to a report, Pakistan’s survival rate of newborns is ostensibly worse than many countries having compromised economies as well as weaker health infrastructure.
The biggest responsible factor for the high newborn deaths is the poor state of maternal health and nutrition, especially during pregnancy. Pakistan’s stunting rate (ie children shorter than normal for that age) which is an indicator of chronic under nutrition, is one of the highest in the world. Girls who are malnourished as children grow up and become pregnant, not having received any dietary rehabilitation to correct this deficit.
Limited resources due to widespread poverty, combined with a lack of understanding that pregnant women need nutritious diets along with micronutrients leads to poor weight gain of pregnant women. Thus, malnourished women give birth to babies who are small and weak — increasing their likelihood of dying in the face of otherwise minor illnesses.
Another key factor responsible for the high neonatal deaths is the poor provision of available obstetric care. Delivering in a health facility is generally considered safer as compared to delivering at home. However, according to the Pakistan Demographic and Health Survey (PDHS) of 2012-13, at least half of the births in our country are at home. Only 52pc of our births are assisted births, with the help of a skilled birth attendant, while the rest are not supervised by any trained person. The ability to care for the newborn is very limited in the home settings, with no access to immediate life-saving obstetrical procedures, otherwise provided at good health facilities. Examples of such critical services include obstetrical surgical interventions to safeguard both maternal and foetal lives as well as provision for subsequent neonatal resuscitation.
Most of the private-sector obstetric facilities are concentrated in urban areas, and operate on a business model that prefers high volume of low-complexity cases. They do not invest adequately in the infrastructure and personnel to deal with labour complications and advanced neonatal care. In case of any last-minute complications related to the mother or the baby, they bank on referring the case to public-sector facilities. However, very few public-sector facilities are capable of dealing with these complicated cases, and those able to are overburdened by the magnitude and complexity of urgent cases coming their way, both from the private sector and failed attempts at assisted or otherwise unsupervised home-based deliveries.
While these two factors are critically important, they still do not explain why Pakistan’s newborn mortality rate would be higher than any of the other countries listed in the top 10 of Unicef’s list. Especially puzzling is the fact that this report comes at a time when other indicators like rates of institutional delivery, skilled birth attendance and Caesarean section have progressively improved, particularly in Punjab and KP as shown by recent provincial health surveys. Unicef estimates seem to be based largely on the findings and trends of both the 2006 and 2012-13 PDHS, and there are some fundamental differences in these two surveys with how a baby’s death has been defined and classified. We clearly need more robust data to make better-informed estimates of the number and causes of newborn deaths, ideally with district-level specificity.
It seems that other than conducting research regularly, interventions most likely to reduce newborn deaths in Pakistan include those focusing both on the general and nutritional health of girls and women. This can be done by ensuring that during her infancy a female child is not malnourished, during adolescence every girl is provided adequate nutritional resources for herself as well as to cope with the added requirements of pregnancy so that she gets adequate diet for two, and after childbirth so she is able to provide adequate nutrition and immunity to the newborn via breast milk. All deliveries should be in the presence of a skilled birth attendant. The health facilities need to be upgraded, with networks and services being brought closer to the people.
Although the government bears the primary responsibility for public health, the developmental sector, the academic institutions and civil society also need to priorities this issue of women and girls health. Ignoring girl and women’s health any further literally threatens the future of our very nation.