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Every woman counts { 28 images } Created 31 Jan 2010

"Every woman counts"

Pakistan loses one women every 30 minutes to preventable complications of pregnancy and childbirth, while about 3,000 cases of obstetric fistula occur each year in the country. One in every eleven children born in Pakistan dies before his or her fifth birthday. It's estimated that around 52% of women in Pakistan give birth at home, usually without skilled or trained birth attendants.
Heartbreakingly, most of the deaths and complications surrounding childbirth are treatable. Young women die because they have no access to sufficiently equipped medical facilities, or because the traditional midwife (dai) doesn't refer the women in time to the hospitals when complications arise and a caesarean section is needed. In a place where poverty is rife, most families can't afford the medicine or care they require.
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  • Conditions in the rural and desert area of Pakistan are very rough. Lots of people are living in huts and lacking basic facilities like electricity and water. <br />
In these areas the maternal and neonatal mortality rates are the highest. <br />
Mithi, Tharparkar, Pakistan 2010
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  • A full term pregnant woman in labor awaits the delivery of her first baby in a rural medical center.<br />
In most rural villages the conditions to deliver a baby are very poor and lack skilled birth assistants, basic facilities and hygiene. Kandiaro, Pakistan 2010
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  • 70 year old Samani has been the village dai (traditional midwife) in Mithi for the past 40 years. With her hands she demonstrates how she uses her hands instead of instruments in post-abortion care to clean the whomb. <br />
She learnt her 'skills' from her mother in law, she now passes on her knowledge to her own daughter in law. Mithi, Tharparkar, Pakistan 2010
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  • A delivery room at home of a local dai (traditional midwife) shows the poor and unhygienic conditions in which a majority of women deliver their babies in the rural areas. <br />
Lack of skilled medical help and extremely poor hygienic conditions are some of the major causes of complications during childbirth and the high maternal and neonatal mortality rate in Pakistan. Kandiaro, Pakistan 2010
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  • 21-year-old Suni is 7 months pregnant and expecting her second baby lays on the bed while her dai (traditional midwife) Afroos checks the position of the baby. <br />
She lives in the Orangi town slum, where only one government hospital provides medical care for around 2.5 million inhabitants. Most women still rely on their community dais to assist their deliveries. <br />
Afroos has been a dai for over 20 years and learned her skills from her blind grandmother. She also works as a dai in the government hospital and did educate her further by following courses provided by the hospital. Orangi town, Karachi, Pakistan, 2010
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  • Bloodstains on the bed. A young woman was brought into the hospital after she continued bleeding heavily two days after her home delivery assisted by a dai (traditional midwife). <br />
Most maternal deaths occur when complications arise during or shortly after home births and untimely referral to hospitals. Lahore, Pakistan, 2009
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  • A baby sleeps in a makeshift hammock by a hospital bed. Kandiaro, Pakistan
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  • A young woman in labour is about to have her second baby. Most women still deliver their babies at home with unskilled help or a dai (traditional midwife). Lahore, Pakistan, 2009
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  • Rabia waits to have her c-section done by the visiting doctors and surgeons from Karachi that passed through her area during a surgical camp tour across the Sindh province. Thari Mirwah, Pakistan, 2010
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  • 25 year old Shamila bleeds heavily during a spontaneous miscarriage because of a malformed fetus. <br />
Her second pregnancy was a result of a rape. Her foot stands in a pool of blood. Karachi, Pakistan 2010
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  • A dirty delivery table at home where a dai (traditional midwife) performs deliveries. Most dai are unskilled and learned their trade from generation to generation, causing for many problems and complications. Most families can't afford the care in private hospitals or don't trust the government hospitals and rely on the dai for assistance. Kandiaro, Pakistan, 2010
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  • A young pregnant woman visits the local dai for a medical check up. Young midwives today are becoming more educated and working in a more professional manner, using the right equipment and under better hygienic conditions. Kandiaro, Pakistan, 2010
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  • A doctor prays in between surgeries. Karachi, Pakistan
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  • 30-year-old Rani gives birth to her first baby in the Qatar government hospital in the Orangi town slum. The ‘State of the world mothers report’ by ‘Save the Children’ says that the poorest children were at least twice as likely to die as the richest urban children. The disparity in child survival between rich and poor in urban areas has even widened in the past two decades. , Karachi, Pakistan 2010
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  • A woman in pain on a stretcher has contractions and waits to have a Caesarian section performed. Qatar hospital, Orangi town, Karachi, Pakistan 2010
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  • Rabia is being taken to the operating theatre to get her baby delivered by a caesarean section. In rural areas surgery is rare and most people can't afford the expensive treatments in private hospitals. Thari Mirwah, Pakistan, 2010
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  • Doctor Shershah Syed and his team perform a fistula repair operation on a woman in Qatar hospital. Obstetric fistula is a severe medical condition in which a hole develops between either the rectum and vagina or between the bladder and vagina. Often occuring after severe or failed childbirth, when adequate medical care is not available causing the woman to leak urine uncontrolably. Qatar hospital, Orangi town, Pakistan 2010
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  • Word to mouth reaches people in the village and causes chaos in the corridor with new patients arriving non stop hoping to also see the visiting doctors from Karachi and having free surgery that they couldn't otherwise afford. Thari Mirwah, Pakistan, 2010
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  • A woman safely delivers a healthy baby girl in one of the government hospitals in Lahore. Male gender preference is still deeply culturally embedded and girls are often given less care, nourishment and access to family resources and therefor experience a higher mortality. Lahore, Pakistan 2009
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  • A newborn baby cries while nursing staff at the Qatar Government hospital clean her up with oil. Neonatal and child mortality rates in Pakistan are very high. The under-five-year-old mortality rate is 89 deaths per 1.000 births.  Karachi, Pakistan 2010
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  • A 20 year old young woman from Balochistan waits for her fistula repair operation in the Koohi Goth Womens hospital. During the delivery of her 3rd baby that was stillborn, she develloped fistula. Koohi Goth Womens hospital, Karachi, Pakistan, 2010
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  • A woman gets an encouraging pad on the head from the doctor after just having given birth to a baby boy. The baby suffered from lack of oxygen, but due to the skilled staff at the hospital the baby was fine after some needed care. Most maternal and neonatal deaths in Pakistan occur due to lack of skilled help during the delivery. Qatar hospital, Orangi town, Pakistan 2010
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  • Rabia sleeps and recovers after her emergency caesarean section, while her mother Nazia waves a fan to make her daughter more comfortable during the night. <br />
In rural villages in Pakistan women like Rabia often can't afford emergency care when major complications arise and are likely to fall victim to conditions like obstetric fistula or in the worst case die during childbirth. Rabia was lucky when doctors from Karachi visited the villages during a surgical camp and she safely delivered a healthy baby boy in a medical facility otherwise lacking the resources to treat her properly. Thari Mirwah, Pakistan, 2010
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  • Two midwifery students sleep a bit during their night shift. Karachi, Pakistan
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  • A young baby receives oxygen on a bench in the outside courtyard of a rural medical centre. The syringe next to the baby is dirty and already used. <br />
Lack of hygiene and proper medical care cause many of the neonatal deaths, making the neonatal mortality rate in Pakistan very high. In the villages hepatitus B and C is very common because of unsafe bloodtransfusions and unhygienic conditions in treating patients. Kandiaro, Pakistan 2010
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  • 20 years old student Farheen Wakeel, from the interior of Sindh came to Karachi to become a midwife.  She hopes one day to open her own clinic. “Not just to make money but to help needy women that now often are handled by a dai (traditional midwife) and often suffer complications because they don't get the skilled help they need.” <br />
The new generation of midwifes go to school to get educated instead of learning the trade from their elders before returning back to their villages and working in a more professional and hygienic environment. Karachi, Pakistan, 2010
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