Advancing Maternal Health in Pakistan via Midwifery Programs

Pakistan faces a critical challenge with its high maternal mortality rate. A multi-faceted approach led by the government, in collaboration with international and national partners, aims to elevate the role of midwives through specialized education and regulatory reforms. The initiative seeks to tackle complex issues from rural healthcare access to gender empowerment.

Pakistan faces a severe maternal health crisis, underscored by its high maternal mortality rate of 154 deaths per 100,000 live births. This alarming figure is shaped by numerous complex factors, including socio-economic constraints, limited healthcare access in rural regions, and restricted decision-making authority for women. In response, the Government of Pakistan, in collaboration with various international and domestic partners, has been taking steps to elevate the role of midwives in healthcare through specialized education and regulatory frameworks.

According to an abundance of research, midwives serve as a pivotal force in reducing maternal and neonatal mortality rates. They are also instrumental in providing broader sexual and reproductive health services. To capitalize on the transformative role of midwives, there is a pressing need for comprehensive investments in their education, professional development, regulation, and work environments.

Photo by Abuzar Xheikh

As early as 2006, Pakistan began implementing community midwife programs, aiming to bolster maternal care in rural communities. However, the pathway to ameliorating skilled birth attendance is not straightforward, considering that Pakistan has a strikingly low ratio of 0.72 midwives per 10,000 individuals.

To tackle these challenges, the Health Services Academy under the Ministry of National Health Services Regulations and Coordination has pledged to initiate a four-year Bachelor of Science (BSc) program in Midwifery. The program is a part of the broader Generation Equality Action Coalition's commitments on Bodily Autonomy and Sexual and Reproductive Health and Rights. The curriculum incorporates both reproductive health and self-care interventions, marking a first in the field.

The initiative has gained support from multiple international organizations such as the United Nations Population Fund (UNFPA) and the World Health Organization (WHO), along with national entities like the Midwifery Association of Pakistan and the Pakistan Nursing and Midwifery Council. Together, they have developed the National Midwifery Strategic Framework as part of a larger campaign named “Midwives’ Voices, Midwives’ Demands,” aiming to articulate the needs and aspirations of midwives in the country. The goal is to add 1,500 midwifery professionals to the healthcare system in Pakistan, supported by a comprehensive faculty development plan in collaboration with the University of Burnet, Australia.

While advancements are promising, midwifery in Pakistan is still faced with cultural and professional hurdles. Historical examples like the introduction of BSc Nursing illustrate that the integration of new healthcare professions into Pakistan's medical landscape is often met with resistance. As Nousheen Nazir, a midwifery graduate, noted, there is still a lack of acceptance of midwives within hospital setups among healthcare professionals in Pakistan.

The initiative is not only crucial for maternal health but also aligns with Pakistan's commitments to the United Nations' Sustainable Development Goals, specifically Target 3.1, which aims to reduce the global maternal mortality ratio.

By tackling the complex variables that contribute to high maternal mortality rates, Pakistan is striving to redefine its healthcare landscape. This collaborative venture between the government and multiple stakeholders can serve as an illuminative model for other countries facing similar healthcare challenges.

Source: UN Women

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