“I was just 17 when I got married and I almost immediately became pregnant,” says 24-year-old Rukhsar Abdul Wasiq, who is the mother of a six-year-old daughter and an 18-month-old son. Her first delivery, by Caesarean section, is something she remembers with fear. “I was terrified throughout my pregnancy,” she says. “When the doctor mentioned a C-section, I thought I would die.”

Training at the midwifery school at the Sindh Government Qatar Hospital with 27 others, she now exudes confidence. Five months into the two-year diploma, she says her understanding of childbirth has transformed. She, like most of her classmates, is from Orangi Town in northwest Karachi, a settlement where the hospital is based, but the facility also serves the nearby neighbourhoods of Baldia, SITE and Manghopir.

“A mother doesn’t have to die to bring a new life into the world,” she says. “Pregnancy and childbirth don’t have to be traumatic.” Her confidence reflects the vital role midwives can play in transforming maternal care in Pakistan.

However, in many parts of the country, this role is still fulfilled by unregistered dais, or traditional birth attendants, who have no formal training when it comes to delivering babies. The reality is that systemic gaps in Pakistan’s healthcare systems and a lack of public awareness help sustain a parallel, largely unregulated system of childbirth care.

Behind Pakistan’s high maternal and infant mortality rates lies a fractured system, in which trained midwives are sidelined while unregulated practices continue unchecked. As trained midwives struggle to replace traditional dais, their profession is undermined by weak healthcare structures, undefined career paths and a lack of trust in their work

Behind Pakistan’s high maternal and infant mortality rates lies a fractured system, in which trained midwives are sidelined while unregulated practices continue unchecked. As trained midwives struggle to replace traditional dais, their profession is undermined by weak healthcare structures, undefined career paths and a lack of trust in their work

A THRIVING, UNSAFE BIRTH TRADE

In Karachi’s shadows, an unchecked network of untrained, unregistered dais continues to deliver babies — right under the noses of health authorities. With no official data, anecdotal evidence points to a vast, hidden market of unsafe deliveries.

Dr Azra Ahsan, an obstetrician and secretary-general of the Association for Mothers and Newborns, says, “Many dais overstep their scope — some even attempt C-sections and keep patients until it’s too late. Without clear referral pathways — knowing when and where to send patients — cases are often critical by the time they are put in a car and referred elsewhere.”

Dr Fatima Jehangir has run a primary care clinic supported by the Ziauddin University Hospital in Gulshan-i-Sikandarabad (an informal neighbourhood next to Clifton) for the past 15 years. She has observed dais in the area using ultrasound machines: “They double as sonologists and issue reports — I’ve seen these myself,” she says. “I can’t even read what they scribble on printed forms they pass as reports. And nearly every patient is diagnosed as having some infection or another.” Dr Jehangir sees the consequences of such medical neglect daily — such as children with cerebral palsy, which is often linked to birth asphyxia.

Neha Mankani, a midwife with 16 years’ experience, has seen similar cases at Baba Island, where she runs a maternity boat clinic. She explains, “It stems from unsafe birth practices — prolonged obstructed labour and misuse of oxytocin [a hormone that stimulates uterine contractions during childbirth].”

Over the past five years, her work has expanded across coastal communities around Karachi, reaching a population of 60,000. She describes a system rife with “dispensers acting as surgeons, midwives performing C-sections, and one where there was almost no pharmacological control, and no oversight of the dais.”

Neha recalls harrowing cases of pregnant women harmed by quacks in the city’s shadows. “I often receive women after they’ve already suffered at a maternity clinic run by a charity in Keamari,” she says. “One case still haunts me —........

© Dawn (Magazines)