AN EVERLASTING BOND: A Reflection on Child Mortality in Pakistan

By Amber Kalhoro

Published on June 2009

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Life as we all know begins with a cell. A cell over the course of time changes its morphology and travels a long distance to burrow itself deep within its mother’s womb seeking refuge and nourishment for its long awaited entry into the world. The cell has now become an embryo it waits patiently in the dark. Its tiny heart races when the sound of its mother is heard and kicks when she gives a gentle touch this is the beginning of an everlasting bond. A sudden contraction occurs the embryo feels uneasy it kicks violently, it becomes difficult to breathe, the embryo clings to its mother for dear life but the force is too powerful, it hears the shriek of its mother and shudders, the embryo is soon veiled under eternal silence and darkness. A mother just experienced a miscarriage and witnesses her unborn child being taken in a plastic bag to be discarded of.

Child mortality has become an increasing alarming issue around the globe especially in underdeveloped countries. Pakistan is one of such countries which face this adversity. Pakistan ranks the 47^th country to have the highest under-five child mortality rate according to statistics provided by the World Health Organization. Child mortality is affected by a combination of factors which can be classified into two broad categories biological and socioeconomic both of which are pertinent in determining the underlying causes of child mortality. Socioeconomic factors reflect the social status of the family, breast feeding, religion, culture, poor hygiene and maternal health education. Biological factors include high fertility, birth spacing, birth weight, maternal age and health, multiple births and infectious diseases.

Pakistan, a culturally oriented country, places a great burden of its traditions and norms on women. From the time of birth and throughout their lives women are constantly being shaped and molded in ways that satisfy the "male dominated society". In the never ending race against technological advancement Pakistan seems to be trailing far behind leaving a greater impact on women from low socioeconomic regions as compared to those from high socioeconomic regions.

Pakistani women belonging to rural and village based areas have higher ratios of child mortality as compared to those of urban areas. This is largely based on the availability of adequate health facilities, access to clean food and water and the practice of personal health and hygiene during pregnancy, failure in family planning and the resurgence of infectious diseases. In October of 2004 USAID established a program Pakistan Initiative for Mothers and Newborns (PAIMAN) through which it funded Pakistan 56.2 million dollars for improving the countries health status primarily focusing on maternal and infant health. It currently works in 11 districts, two FATA agencies and two Frontier regions to reduce newborn mortality rate and improve the health of mothers by improving access to quality health care to pregnant women and their infants. PAIMAN also provides skill-based courses to local rural women to provide pregnancy care and safe conduction of deliveries¹.

One of the major reasons for Pakistan’s high child mortality rates is the lack of health education among women. Statistics have shown that families with educated mothers show less child mortality rates compared to non-educated mothers these numbers vary from regions from urban to rural. Women in rural regions believe it is taboo to question norms placing themselves at a greater risk of endangering both maternal and infant life. It is believed that when a girl starts her first menstrual cycle she is to be married off. Early marriages are tantamount to early childbearing because young women are under considerable pressure from family and society to prove their fertility. Frequent and prolonged childbearing are associated with higher risks of malnourishment for mothers which in turn become incapable of providing nourishment for their children. Breastfeeding provides the most suitable method for nutrition to infants; breastmilk constitutes essential vitamins, minerals, and carbohydrates necessary for the growth and development of a child. Only 37% of children fewer than 6 months are fed exclusively on breastmilk². Colostrum, a thin yellow milky fluid, secreted from the mammary gland just after giving birth provides the most nutritional value and is of great importance to the infant in receiving nutrition. The health of the mother is a key determinant in the survival of newborns.

Over the last few years Pakistan has faced two major natural disasters the earthquake of 2005 and the flood of 2007 leaving millions of families homeless. This inadvertently has created job deficits which have left millions incapable of affording quality healthcare during pregnancy and postpartum.

Aside from the socioeconomic perspective, child mortality based on biological factors takes a greater toll. Pakistan has an estimated child mortality rate of 101 per 1000 live births³, nearly 423,000 children die each year and 97 out of 1000 are under the age of five. In Pakistan some of the challenges to child survival include a high rate of preventable disease, exacerbated by poor health infrastructure and misconceptions regarding vaccinations². The leading causes of death among children under five are pneumonia and diarrhea followed by birth trauma, measles, malaria, congenital anomalies, hemolytic diseases, maternal infections, malnutrition, all of which can be prevented through proper hygiene, nutrition, and medical care. 38 percent of children under five are reported to be moderately or severely underweight. 59 percent of rural Pakistanis do not have access to adequate sanitation facilities which increases the chances of contracting infectious diseases. Pakistan is still one of four countries where Polio remains endemic². Many families of rural districts are unaware of the benefits of vaccinations; therefore do not give much prioritization towards it.

Over the last two and a half decades child mortality has been a crucial issue to health administrators of Pakistan. Although Pakistan has shown improvement in the decline of child mortality since the 1980’s from 153 to 101 per 1000 live births³, the rates still remain substantial. Child mortality indicates the background, social as well as the economical development of a community. Organizations like UNICEF, WHO, USAID, Save the Children, and Pakistan Relief have successfully implemented programs within Pakistan that have improved maternal education, have established immunization camps and have trained local women and traditional birth attendants (TBA), to deliver children for women at home through clean and safe measures. These are several initial barriers that have been improved, yet large scaled obstacles such as health infrastructures and trained medical professionals still show some gray areas.

With a combination of maternal education, nutritional state of the community, control of communicable diseases, proper sanitation, family planning and emergency measures to cope with obstetrical complications the standard of health in Pakistan can increase tremendously and thus decrease the occurrences of child mortality.

References:

² The State of the World’s Children Report 2008: Child survival, A Pakistani Perspective. Via UNICEF. http://www.unicef.org/pakistan/FINAL_SOWC_Factsheet_Jan08.pdf. Accessed on November on 9, 2008.

³ World Health Organization, “Mortality Country Fact Sheet” Pakistan (2006). Via World Health Organization. http://www.who.int/whosis/mort/profiles/mort_emro_pak_pakistan.pdf. Accessed on November 8, 2008.

Article downloaded from http://www.globalpulsejournal.com/2009_child_mortality_pakistan