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Maternal mortality in Pakistan. A success story of the Faisalabad district
Introduction: Maternal-child health care interventions in Pakistan's Faisalabad District have produced dramatic reductions in maternal mortality and are potentially replicable in other developing country settings. In the late-1970s, health personnel became concerned with the high rates of maternal mortality, infant mortality, malnutrition, fertility, and illegal abortion in the district.
Methods: Since 80% of deliveries in Pakistan are carried out by traditional birth attendants (TBAs), the author initiated a program of refresher courses for TBAs in the district. In the 10 years since 1978, 5500 urban and rural TBas have participated in these annual seminars and been provided with information on detection of high-risk pregnancies for referral, sepsis prevention, prenatal care, neonatal resuscitative measures, and family planning. During this same 10-year period, maternal mortality dropped from 10.1 to 1.86/1000, largely as a result of referral of complicated cases to the District Headquarters Hospital. Another innovation was the Faisalabad FLying Squad service, an emergency ambulance equipped with medicines and trained staff that can rapidly transport women who develop complications during delivery to the hospital.
Results: In the 1 year since program inception in January 1989, there have been 73 calls for the emergency service. In 1990, designated The Year of the Mother and Child, lectures on family planning, maternal-child health, and the availability of the obstetric Flying Squad were given throughout the district. The main causes of the 48 maternal deaths in the district in 1989 (maternal mortality rate of 0.86/1000) were insistence on home delivery and reluctance to go to the hospital.