Maternal mortality rates linked to conservative attitudes in FATA
“We were ready for supper when the walls of the nearby mosques suddenly began to reverberate with the sound of an assault by the Taliban,” recalls Rozina Bibi. She hails from Tirah, which lies between Kurram and Khyber Agencies. Tirah has been under the militants’ attacks for several months.
It was followed by the news of arson and gunfire from nearby villages. It was going to be their turn next. The threat was so frightening that, in a remote region, which is one of the most conservative parts of Pakistan, most women just fled without their veils and burqas. A number of them had babies in their arms. There was no supper, of course, and they had no time for taking any food along. “We fled into the woods. We travelled on foot for days on a terrain which was mostly rugged. It was extremely cold and we had few warm clothes.” Many children shivered to death, there were newborns that died immediately, and there were miscarriages and complications in deliveries. Many women died on the way.
Rozina Bibi broke down when she related how they had to abandon the old and weak individuals who could not complete the journey.
According to Dr Sumaira Rafi, who looks after all reproductive health facilities operating under Merlin, a UK-funded international health charity active in IDP camps across Khyber Pakhtunkhwa, premature labour and PVA leakage are common issues faced by women migrating from the troubled areas. As a result of their giving birth in completely unhygienic conditions, placenta complications and post-partum hemorrhage are other issues these women face. For those who survive, the ordeal leaves devastating psychological effects, she says, such as deep depression.
Maweez Bibi, who currently lives in the Tokh Sarai Camp in Hangu, had a similar experience when she fled from home. “When the Taliban attacked our village, most women ran into the woods.” For three months they endured intense hardships. Many of the fleeing women lost their lives after suffering prenatal and postnatal complications.
But these were special circumstances as opposed to the difficulties they faced every day. Even in ‘good’ times, women in the Federally Administered Tribal Areas (Fata) have had very little access to family health facilities. Basic healthcare units are unheard of. Maimoona Rehman, Nutritionist, Emergency Response Fund (ERF) reveals that home deliveries conducted by a midwife or an elderly woman in the house are the norm. “The concept of doctors and trained midwives handling childbirth cases is alien,” she says. The crisis situation in the region has completely dismantled whatever healthcare structure existed previously. Facilities like clinics have been shut down because of perceived militant threats. Besides, the few that continue to operate have no female doctors or attendants, so treatment of women patients is out. Shah Zaman, a journalist from South Waziristan Agency who lives in Dera Ismail Khan, says obtaining healthcare in a conflict zone is almost impossible even for men.
Women family members are just as conservative as men when it comes to following tradition. “Back home,” says Amina Bibi (real name withheld on request), “we were not allowed to go to hospitals even if we faced death; even the women members of the family objected since there was no female staff at the clinic or hospital.” Amina Bibi, who lives in Jalozai Camp, said no matter how severe the complications were during childbirth, there is no question of an ambulance or other vehicle being hired for the patient to be taken to a hospital in the settled areas. Tradition rules that out because, unless she is accompanied by male relatives, her use of a service provided by a na-mehram (a man she is unrelated to) would violate her purdah.
Dr Sumaira Rafi feels that most women she deals with are in the process of giving birth to their 10th or 11th child, because local culture celebrates large families. At the same time, a large number of male children in the household are considered a source of pride for the family. Take, for example, Shamim, a mother of 10. She cannot reconcile with the tragedy of her daughter-in-law, who was hit in the stomach by a stray mortar as she fled the war and cannot conceive anymore because of the injury. “She has only one daughter,” the mother-in-law wails.
Trained female midwives have been recruited at some healthcare units in South Waziristan, but they are reluctant to serve due to the security situation. Shah Zaman, the journalist from South Waziristan, said the alternative is transporting a woman in advanced labour to hospital in Dera Ismail Khan over a distance of 80-90 kilometres on bad roads, making it virtually impossible. Even vehicles with patients are held up for hours at military checkpoints. “For many would-be mothers who lose their lives on way to hospital, this is a never ending wait,” he says.
