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 entry into the world. If all goes well, the cell develops into an embryo and waits patiently in the dark. Its tiny heart races when mother speaks, and its feet kick when mother strokes a gentle touch. However, the pregnancy may not always go to full term.

Child mortality has become an increasingly alarming issue around the globe, especially in underdeveloped countries. Pakistan is one of these countries that face child mortality. Pakistan ranks the 47th 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 that can be classified into two broad categories—biological and socioeconomic—both of which are pertinent to 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.

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, 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 gave Pakistan 56.2 million dollars for improving the patient health status, primarily focusing on maternal and infant health. PAIMAN 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. Women in rural regions believe it is taboo to question norms, and are therefore 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; breast milk contains essential vitamins, minerals, and carbohydrates that are 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 essential nutritional value to the infant.

Over the last few years Pakistan has faced two major natural disasters: the earthquake of 2005 and the flood of 2007. These disasters have left millions of families homeless, jobless and incapable of affording quality healthcare during pregnancy and the postpartum period.

Aside from the socioeconomic metric, a significant chunk of child mortality is defined by biological risk factors. 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. Thirty-eight percent of children under five are reported to be moderately or severely underweight. Fifty-nine 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 and therefore do not give much prioritization towards receiving preventive treatment.
Over the last two and a half decades, child mortality has been a crucial issue to health administrators in 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 is a thermometer of the social and economic 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. Several initial barriers have been improved, yet large-scale obstacles such as health infrastructures and trained medical professionals still show much room for improvement.

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 thereby decrease the occurrence of child mortality.

Amber Kalhoro is currently a third year medical student at Isra University in Pakistan. She has a bachelor's degree in Neuroscience from the University of California, Riverside, and plans to specialize on obstetrics and gynecology. She can be contacted for questions or comments at amberkalhoro@yahoo.com

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_kalhoro_amber_child_mortality_pakistan.html