Pakistan tops the list of stillbirths in the world
In an age of scientific and medical advancement, most of the causes of maternal mortality and morbidity should be avoidable.
For a Pakistani woman, the risk of dying from pregnancy-related causes is 1-in-80 compared to 1-in-4,085 in industrialised countries. Such high maternal mortality is indicative of neglect of women’s health, and especially alarming is the high rate of stillbirths in this country.
Poverty, high levels of population growth, rapid urbanisation, inadequate social support, poor quality of information and travel systems, lack of opportunities in rural areas, and infectious and deficiency diseases contribute to Pakistan’s high rate of stillbirths.
Upon closer inspection, the real reasons for such low survival rates are decidedly more substantive.
In Pakistan, 32 per cent of babies are born with low weight, 36 per cent do not have access to medical facilities, 58 per cent receive no antibiotic treatment if they contract pneumonia, and 62 per cent have no access to ORS for diarrhoea. Obesity and non-communicable diseases — notably diabetes and hypertension — are listed as reasons for at least 10 per cent of all stillbirths. Malaria is the cause of eight per cent, while 7.7 per cent are associated with syphilis.
In 2015, Pakistan’s Rs4.3 trillion annual budget, earmarked Rs781 billion for defence, Rs250 billion for road infrastructure, Rs112 billion for energy, Rs78 billion for railways and Rs30.4 billion for the atomic energy commission
While Rs50 billion has been allocated for a single metro bus project in Islamabad, only Rs20.8 billion has been earmarked for health issues. Of that number, Rs12.8 billion will get dumped into non-development expenditures and Rs8 billion were left for the human condition.
Worldwide, 24.7 babies were born dead in 2000, compared to 18.4 stillbirths per 1000 in 2015. Seemingly, stillbirth rates have decreased slightly. But at present rates of progress – two per cent per year – Pakistan tops the list of stillbirths in the world with a rate of 43 per 1000. All things being equal, it would take 130 more years before a pregnant woman in Pakistan has the same chance of her baby being born alive as does a woman in Denmark.
According to The Lancet, 2.6 million babies are stillborn every year. Of that number, 1.2 million begin labour alive only to die before birth. In the last three months of pregnancy, 7,300 women around the world suffer the loss of their babies every day. And 98 per cent of the stillbirths are in low-income countries. The medical journal concludes that two-thirds of these stillbirths are contributed by Pakistan, India, Nigeria, China, Ethiopia, Democratic Republic of the Congo, Bangladesh, Indonesia, Tanzania, and Niger.
In Pakistan, social taboos and stigmas are a major reason this problem is not part of national discourse. Stillborn babies often are connected with black magic, luck and adversity. In many cases such women are stigmatised, socially isolated and deemed less valuable by society. In some cases they are subjected to abuse and violence.
The issue of stillbirths has been neglected historically in our country because the parents’ grief is disenfranchised and not accepted by their family, health professionals and the society. A survey questioning 3,503 parents of stillborn infants reveals that half of them counselled that “our community wants parents to try to forget their stillborn baby and have another child.”
When in public, parents often smother their grief.
Parents also have to pay for out-of-the-ordinary care with their savings or by selling their possessions. They often find themselves caught in a poverty trap.
The emotional and economic cost of stillbirths on families and nations is quite high. The burden of stillbirth affects parents, families, communities, and societies. The loss a women bears may trigger a psychological breakdown. Another study of The Lancet reveals that about 4.2 million women around the globe are living with depression associated with stillbirth.
Delving into the figures reveals that in the entire country there are 1,142 hospitals, 5,499 dispensaries, 5,438 basic health units and671 maternity and child health centres. Medical professionals include175,223 doctors, 15,106 dentists, 90,276 nurses and 15,325 lady health visitors. The country has 118,041 hospital beds. Compared with the population, there is one doctor for every 1,073 people, one dentist for 12,447 individuals and just one hospital bed available for 1,593 persons.
These statistics are among the worst in the world.
With 1,593 persons already in the queue for a single hospital bed, what improvement can be expected in addressing Pakistan’s troubling rate of stillbirths? For the current year, a total outlay for health sector was budgeted at Rs114.2 billion, which included Rs31.9 billion for development and Rs82.3 billion for non-development expenditures. Alarmingly, this is equivalent to 0.42 of a per cent of the country’s GDP.
Because of the lack of health centres, 89 per cent of deliveries are assisted by birth attendants at home. They often are not prepared to meet the medical needs of the mother or child when complications arise.
Every year, 4.6 million babies are born in Pakistan. Of every thousand babies born, 82 die before reaching age five. The cost of these deaths — including indirect and intangible costs of stillbirth — is extensive and usually absorbed by the families alone. This issue is particularly onerous for those with few resources, and it also contributes to long-term mental-health concerns.
Some countries spend more on the human condition than anything else. Cuba, for instance, produces first world results on a third world budget which breaks the myth that to spend on health, you need to be a financial power of the world. According to Michael Moore’s latest film Sicko, Cuba’s medical care puts America’s to shame. This island nation has 67.23 doctors per 10,000 residents, the highest of any major country. Qatar has the lowest health spending in the world, just 1.8 per cent of GDP, which just below Myanmar and Pakistan at 2.2 per cent.
With health-system improvements most stillbirths are preventable. Solutions will depend upon the priorities of government, which holds the financial key.
The value of each baby’s life — as well as the associated costs for parents, families, care providers, communities, and society — should be considered as a reason to strive toward preventing stillbirths and reducing associated morbidity.
The time has come to shift our national spending behaviour from things to people.