Preserving Health Rights of Female Sex Workers (FSWs): Are we doing Justice?

In Pakistani context where majority of the population are Muslims, prostitution is considered as stigma. Health providers often come across a challenge to provide optimal care to prostitutes when their own values and beliefs contradict with their professional obligations. This commentary article is based on a clinical case study in which a family planning counselor failed to respond to the contraceptive needs of a prostitute due to the non-supportive state policy for tubal ligation and provider\u27s own values for the stigmatized profession. This paper introduces a question for all health providers whether this act was justifiable on the basis of human rights paradigm, right for autonomy and principal of non-maleficence. This article is a commentary against the incomplete state policy of family planning and ethical principles violated in this case

Determinants of Inadequate Provision and Utilization of Post Abortion Care Services in Pakistan

Access to safe abortion services remain a challenge in many low and middle income countries like Pakistan. Evidence suggests that Pakistan shares a huge burden of abortion related morbidities and mortalities. Timely provision of Post Abortion Care (PAC) services could assist in preventing maternal deaths associated with unsafe abortions. However, there are certain socio-cultural, financial and political factors that restricts the provision and utilization of effective PAC services. This paper explores these determinants and suggest recommendations for policy and practice to promote PAC services in Pakistan

Adolescent Pregnancies: The case of Pakistan

Early motherhood not only causes poor health outcomes, but often also deprives adolescent girls of educational, social, and economic development opportunities for the rest of their lives. Evidence suggests that although the burden of adolescent pregnancies is less in Pakistan than in Bangladesh, Afghanistan and Nepal, the pregnancy outcomes continue to be devastating in this country. This paper discusses the social barriers in addressing this issue in Pakistan and proposes recommendations for targeted interventions to reduce the high birth rate amongst adolescents in the country. The role of midwives asfrontlinegatekeepers can be pivotal for prevention ofteenagedpregnancies in Pakistan. Unfortunately, the existing midwifery workforce is not very well prepared to deal with adolescents’ Sexual and Reproductive Health (SRH) issues

Exploring midwives\u27 challenges and strategies to provide care in maternity settings during harsh winter weather in northern areas, Pakistan: A qualitative study protocol

Background: Midwives play a vital role in enhancing the quality of care and achieving substantial reductions in maternal and newborn mortality rates. However, in the context of Gilgit Baltistan, the harsh winter weather, and frequent heavy snowfall present distinct challenges for midwives providing essential maternal care. These challenges can lead to an increased risk of maternal infections and newborn hypothermia. Consequently, the limited accessibility to healthcare facilities due to frequent harsh winter weather, and resulting scarcity of resources like heating, electricity, and water further exacerbates the situation.Objective: The objective of the study is to explore the challenges and barriers that midwives face in maternity settings and the strategies they use to overcome those challenges during winter weather in Northern Areas of Pakistan.Methodology: The qualitative exploratory design will be used in this study. Where approximately 11 midwives will be recruited using purposive sampling technique. Interviews will be conducted by using a semi-structured interview guide. Data will be analyzed by using Creswell content analysis approach

Promoting Positive Birth Experiences: Supporting Pregnant and Lactating Women During the COVID-19 Crisis

The World Health Organization (WHO) declared the COVID-19 outbreak a public health emergency of international concern, in January 2020. While international organizations and governments strive to strengthen the world’s emergency response mechanism to combat the pandemic, the public in general faces anxiety and fear. One of the most vulnerable groups is pregnant and lactating women. The pandemic has given rise to many apprehensions about the state of their health and well-being as well as that of their unborn or newly born child. A live Facebook session was conducted by a group of experts from a private university in Karachi, Pakistan, to proactively address the concerns of pregnant and lactating mothers during this challenging time. Worries raised by pregnant and lactating mothers during the live session helped in understanding the anxieties of this group amidst the COVID-19. This paper presents some recommendations in response to the apprehensions shared by pregnant and lactating mothers, that could help in promoting a positive birth experience. These recommendations include a) alternative methods of professional caregiving and support, b) engaging and strengthening midwifery services, c) safety of pregnant and lactating frontline health care workers, and d) supporting mental health and wellbeing. The proposed measures, if adopted by the government and the healthcare industry, could potentially, promote the safety and wellbeing of pregnant and lactating mothers during the pandemic

Enhancement of knowledge and skills of community midwives in Sindh, Pakistan

With a maternal mortality rate of 276 deaths per 100,000 live births, Pakistan is one of the countries with a large share in the percentage of world’s maternal mortality. As an intervention for the Millennium Development Goals (MDG) 4 and 5, the World Health Organization (WHO) strongly suggests that skilled care before, during, and after childbirth can save the lives of women and newborn babies. One of the interventions to ensure care to mothers and babies by skilled care providers is the capacity building training of Community Midwives (CMWs) aiming to improve their midwifery competency. One such training intervention was organized in Hyderabad, in the Sindh Province of Pakistan. Forty two CMWs who had graduated from ten districts across Sindh participated in the training; they were divided into 3 cohorts. The training aimed to review the midwifery knowledge and skills of CMWs; introduce them to evidence-based midwifery practices and the concept of respectful maternity care; strengthen their financial management skills, to enable them establish and sustain their birth centers independently; and, most importantly to provide hands on practice under the mentorship of clinicians. The training started with a pre-training assessment, to assess the participants’ previous knowledge and skills along with a learning needs assessment to facilitate self -directed learning. At the end of 5 weeks, a post training assessment was conducted to analyze the outcomes of this training. The post-assessment showed an increase in CMWs’ knowledge and skills, and they shared that the training had made them more competent and confident. This training was a significant effort to enhance CMWs’ development, as it was the first of its kind in the country. Through this training, the CMWs were able to review the important midwifery concepts and skills. Moreover, the CMWs recommended internship in the community with a mentor, after their graduation, and inclusion of management of birthing centers through coverage of entrepreneurial skills in the curriculum

Birth Centre Management and Business Skill Training for Community Midwives of Pakistan

The Community Midwifery program was introduced in 2007 across Pakistan with the idea that the trained Community Midwives (CMWs) will be deployed back to their ‘native’ rural communities. Hence, they are not employed by government rather they must earn their income by charging fees for their services. It is expected from them to attract clients, establish birth clinics and operate as a small business to support and sustain them financially. However, the CMW training program only teaches students about antenatal, intranatal, postnatal and newborn care, family planning services and awareness of community dynamics and does not include content about setting up a ‘birth station’ and how to market and sustain a small business. We encountered comments from CMWs in a variety of forums that many of them were unable to sustain a birthing station and financially support themselves. Hence a research intervention was designed for them known as ‘Business Skills Training (BST)’ with the objective of enhancing the business skills of CMWs to increase their likelihood of establishing financially sustainable birthing clinics. This article is the description of BST intervention and the process of this training

Implementation of a Bachelor’s in midwifery programme in Pakistan: Reflections of Midwifery Faculty

Introduction/Objective: There is an international consensus on the significant role of competent midwives in improving maternal and newborn health indicators. Midwives and midwifery education in the developing world including Pakistan have lagged behind in being part of higher education. To enhance the quality of maternal and newborn services through competency based higher education in midwifery, the first Bachelors of Science in Midwifery (BScM) programme was introduced in Pakistan. As part of a larger study about establishing this programme, this paper focuses on the reflective logs of midwifery faculty members who initiated this new programme in Pakistan. Method: The team of faculty members involved in the planning and execution of the programme were asked to record their reflections throughout the process of planning the programme to facilitating students in the first cohort. These reflections were collected at the time of the graduation of first cohort in 2014 and content analysis was applied to identify major themes emerging from the reflections. Findings: Major themes which emerged were: a) Scaling up of faculty competence, b) Utilizing student diversity as strength, c) Supporting students’ transition and adjustments in the programme d) Scaffolding students’ learning e) Helping students acquire clinical competencies. Overall, the team regarded the experience as unique and enriching for both students and faculty. The first Bachelors in Midwifery demanded a great deal of theoretical and clinical proficiency from faculty. Rigorous planning, networking with international midwifery experts, continuous faculty development, facilitating student learning through scaffolding, and incorporating periodic feedback from students were found to be the major strengths of the programme. Conclusion: The Bachelor of Midwifery programme in Pakistan has given new hope to the profession. The lessons learned and some of the practical recommendations may prove useful to other institutions and South Asian countries intending to initiate similar programmes