Promoting Maternal and Child Heath in Pakistan

Nurturing Tomorrow: Exploring the Impact of Healthcare Systems and National Policies on Maternal and Child Health

By Fizza Javed*

Infant mortality is one of the indicators by which we can tell about the condition of the people of any country. The infant mortality rate in Pakistan is 55 per thousand live births (1). Ensuring the health and well-being of a mother is the cornerstone of securing a healthy start for her infant. It's a critical link that profoundly impacts the growth, development, and even mortality of the baby. Several key aspects underscore this crucial relationship. Maternal nutrition plays a pivotal role. A mother's well-balanced diet during pregnancy and breastfeeding is more than just sustenance for herself—it's the primary source of vital nutrients that fuel the infant's growth and bolster their immunity. Equally significant are maternal health conditions. Pre-existing ailments or infections in the mother, such as gestational diabetes, hypertension, HIV, or sexually transmitted infections, can directly affect the baby's health, highlighting the interconnectedness of their well-being. Maternal mental health significantly influences the mother-child bond and shapes the baby's emotional well-being and cognitive development. Issues like depression or anxiety demand attention, recognizing their impact beyond the mother's immediate health.

Baby-Friendly Hospital Initiative (BFHI):

The Baby-friendly Hospital Initiative (BFHI) was launched in 1991 to promote breastfeeding in health facilities (2). It requires facilities to have a 75% exclusive breastfeeding rate, follow marketing regulations, and implement the Ten Steps to Successful Breastfeeding, including:

●      Have a written breastfeeding policy that is routinely communicated to all health care staff.

●      Train all health care staff in skills necessary to implement this policy.

●      Inform all pregnant women about the benefits and management of breastfeeding.

●      Help mothers initiate breastfeeding within a half-hour of birth. (Interpreted as: Place babies in skin-to-skin contact with their mothers immediately following birth for at least an hour. Encourage mothers to recognize when their babies are ready to breastfeed and offer help if needed).

●      Show mothers how to breastfeed, and how to maintain lactation even if they should be separated from their infants.

●      Give newborn infants no food or drink other than breast milk unless medically indicated.

●      Practice rooming in – allow mothers and infants to remain together – 24 hours a day.

●      Encourage breastfeeding on demand.

●      Give no artificial teats or pacifiers (also called dummies or soothers) to breastfeeding infants.

●      Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinics.

BFHI Evaluation:

An evaluation of BFHI was done in a Tertiary, privately run hospital in the capital of Pakistan, Islamabad. The hospital has good antenatal services. There are two unit(s) for infants needing special care; NICU-1 and NICU-2. There are healthcare professionals involved in supporting breastfeeding or managing alternative feeding options depending on the needs of the mother and child. There is no proper or separate staff or committee for providing counseling on HIV.

Findings:

There were 67% C-section and 33% SVDs. 53% of these mothers were informed about the risk of giving water and formula milk to the newborn. But only 27% were shown how to express milk by hand and only 33% were taught to identify the cues of breastfeeding and informed about how often they should feed their newborn. In 45% of the cases, the infants were given something else other than breastmilk. Some families had the tradition of giving “ghutti”(pre-lacteal). A few gave honey while others gave green tea. Upon inquiring about the reasons for this practice, the most common answer was “tradition” while in case of green tea it, they had a strong belief on the myth that it is used to clear the food pipe of any blockages.  

This table depicts the difference breastfeeding practices in different modes of deliveries.

 

Observations:

In this private hospital within an army setup, several concerning issues surfaced. The staff displayed indifference towards civilian patients, particularly those who were financially disadvantaged or less educated. Shockingly, routine HIV testing was often disregarded under the assumption that HIV cases are rare in Pakistan, leading to its omission.

Furthermore, despite a senior doctor's directive to utilize feeders for expressed mother's milk in the NICU, some nurses fed babies directly from bottles. Disturbingly, certain mothers lacked agency over their reproductive choices; despite their poor health and malnutrition, they had limited say in avoiding pregnancies due to uncooperative husbands (3). In many cases, decisions regarding timing and number of children were dictated by the husband's mother, essentially becoming the family planner.

This power dynamic, especially prevalent in impoverished families, poses significant risks. Financial strains, inadequate living conditions, and the inability to cater to the needs of newborns and existing children underscore the gravity of the situation. Often, families reside in cramped, single-room accommodations with limited resources, resulting in malnourishment, lack of education, and even contributing to domestic violence.

These interlinked issues, ranging from healthcare negligence to lack of agency in family planning decisions, perpetuates cycles of poverty and compromises the well-being of children and families (4) .

Recommendations:

Addressing these multifaceted challenges requires a comprehensive approach focusing on healthcare accessibility, education, reproductive rights, and poverty alleviation. Programs like the Baby-Friendly Hospital Initiative (BFHI) are incredibly beneficial in supporting parents with child-rearing. However, to enhance its impact, there's a crucial need for increased manpower, resources, and expansion of its outreach. Integrating Family Planning programs alongside BFHI can empower couples to consciously plan for their children's future, fostering a brighter outlook. Marital counseling should also be emphasized, addressing vital aspects like family planning, living conditions, and other essential matters. Implementing these within hospitals, collaborating with pediatric and gynecology wards, and establishing a dedicated mental health department can significantly enhance accessibility and support for families, despite the often overlooked barriers in seeking mental health assistance.

References:

1. https://data.worldbank.org/indicator/SP.DYN.IMRT.IN?locations=PK
2. https://www.who.int/tools/elena/bbc/implementation-bfhi#:~:text=The%20Baby%2Dfriendly%20Hospital%20Initiative%20(BFHI)%20was%20launched%20in,health%20facilities%20with%20a%20framework
3. Asif, M. et al. (2021) 'Role of husband’s attitude towards the usage of contraceptives for unmet need of family planning among married women of reproductive age in Pakistan,' BMC Women’s Health, 21(1). https://doi.org/10.1186/s12905-021-01314-4.
4. Nadeem, M.A. et al. (2021) 'Women decision making autonomy as a facilitating factor for contraceptive use for family planning in Pakistan,' Social Indicators Research, 156(1), pp. 71–89. https://doi.org/10.1007/s11205-021-02633-7.

*Fizza Javed is a graduate of the National University of Medical Sciences with a Bachelor`s degree in Public health and is a part of the Media Team for the NGO " We Make a Difference, (WMD)