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

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

Exploring maternal perspectives on human milk banks in Pakistan and identifying barriers and enablers for establishment

Background: Low-and middle-income countries including Pakistan still have low breastfeeding rates and infant feeding remains a concern. Human milk banks (HMBs) play a crucial role in neonatal and infant health by providing safe, pasteurized donor human milk to infants who do not have access to their mother\u27s own milk, particularly preterm and low-birth-weight infants. The perception regarding the concept and use of HMBs has yet to be explored in several contexts, especially in the low-and middle-income countries including Pakistan.Aim: To explore the perceptions of mothers regarding human milk banks in Pakistan, focusing on the barriers and enablers to their establishment, and the strategies to overcome these challenges.Methodology: This study will employ a qualitative descriptive exploratory approach. A purposive sampling technique will be used to select 10 to 14 mothers for participation, with the final number determined by data saturation. In-depth interviews will be conducted using a semi-structured interview guide, which will be validated by experts to ensure its relevance and comprehensiveness. The collected data will be analyzed following Creswell\u27s thematic analysis guide, ensuring a comprehensive identification of barriers and enablers to the establishment of human milk banks in Pakistan.Significance/Implications: Understanding these factors is crucial for midwives, as they play a key role in advocating for and educating about human milk banking. The findings can inform policy development and the implementation of support systems, ultimately enhancing maternal and infant health outcomes. By addressing the identified barriers and leveraging enablers, midwives can contribute to the successful integration of human milk banks into the healthcare system, promoting optimal breastfeeding practices

JAM – Summer 2022: One crisis after another…..

Editorial for latest Summer 2022 issue of Journal of Asian Midwive

Can CMWs sustain quality services and high coverage as private providers in Chitral? A three-year prospective qualitative study

Background: The maternal and neonatal mortality ratesof Chitral district of Pakistan are among the highest in the country. One of the factors that found to havepositive impact on maternal and newborn health indicators is the availability ofquality skill birth attendance because the majority of the poor women cannot access facility-based maternity care. Therefore, in 2006, the Government of Pakistan (GOP) has initiated a program to train and deploy Community Midwives (CMWs) to support safe pregnancies and births. The Aga Khan Health Service’ Pakistan, initiated the Chitral Child Survival Program (CCSP) in partnership with the National Maternal Neonatal and Child Health program. The CCSP was an intervention package deploying 28 CMWs in remote villages of the district and supported by several strategies to ensure successful transition of these CMWs in remote settings. Aim: This study aims to assess the effectiveness of CCSP’s package of interventions and to identify the push (facilitating) and pull (hindering) factors that may have an impact on the CMW’s service utilization. Methods: A three-year longitudinal prospective qualitative design, using individual in-depth CMWs and focus group interviews of key informants conducted in Chitral district of Khyber Pakhtunkhwa province, Pakistan in localities where the CMWs were deployed. Using purposive sampling, 27 CMWs (all part of CCSP), key informants and other stakeholders were recruited. Data analysis was done concurrently with data collection by the researcher, using Creswell’s six steps. Findings: The major themes emerging from this study are: Safe and competent care in isolated villages, community’s support and satisfaction from the CMW work, Supportive supervision, dynamics of CMWs with other healthcare professionals, CMW’s referral systems and its challenges, CMW remuneration and fee for service , and Sustainability of the CMW services Recommendations: Continued support, ongoing in-service education of CMWs and constant engagement of the community, certainly plays a crucial role. TheGoP could consider incorporating CMWs in the service structure with a salary based on their scope of practice. This may ensure the sustainability of the CMW model and would allowcommunity to access the MNCH services provided by them