DefinePK

Abstract

Maternal and neonatal deaths remain the major public health issues in Pakistan, which has one of the highest death rates in the world.1 The country did not meet Millennium Development Goals (MDGs) 4 and 5 by 2015, even though it had spent more money and worked on public health projects over the past 20 years. A significant problem has been the ongoing lack of trained birth attendants, especially in rural areas where home births are still common.1,2,3 In 2006, the Government of Pakistan started the Community Midwives (CMWs) Program to fill this gap. The CMW initiative in Pakistan enrolled female candidates with ten years of formal education from underfunded rural areas for midwifery training. These women are expected to establish maternity stations and provide maternal, neonatal, and child health services in underserved areas. The goal of this program was to train skilled birth attendants from the rural communities they serve. However, there are still many systemic problems that make this program less effective.1,2,3 Despite the initiative’s vision, implementation has faced obstacles, and the Pakistan Nursing Council's role in career development and professional support remains limited The purpose of this paper is discussing the state of midwifery education and practice in Pakistan right now, the Challenges that CMWs face, and the immediate need for significant changes to lower the maternal and child death rates.
CMW practices face hurdles and constraints, including financial problems, accessibility issues, security concerns, lack of adequate infrastructure, unavailability of institutional support, and training capacity issues (such as unskilled non-practicing midwifery faculty.1,4 These challenges not only impaired midwives’ capacity to deliver standard care but also led to midwife exhaustion, moral decline, attrition, and consequently compromised the health safety of mothers and newborns, especially in underprivileged areas.1,4,5 A system-level strategy change is necessary for empowering midwives and safeguarding mother and neonatal health. Strengthening midwifery education to align with practice, improving infrastructure, allocating ample resources, and providing institutional support, besides professional support with an enhanced working environment, are essential considerations.4,5 To further standardize the system, emphasis on practical experience, appointment of certified midwifery trainers, Arrangement of mandatory community-based internships, provision of continuous professional development for higher, and allocation of resources for referral and transfer systems are all integral aspects for positive reform initiatives.4,5,6
The transformation of the mother and child health program in Pakistan solely depends on well-qualified and trained midwives with a complete support system. Their influence ranges across the healthcare, including: antenatal risk assessment, quick referral and transition, intrapartum safe care, competent delivery, newborn resuscitation, encouraging breastfeeding, and education of mothers regarding family planning and reproductive health.2,3 The midwife’s role is crucial to promote trust among women who belong to rural areas who face obstacles in institutional care and provide care in underserved areas.2,5,7 It is imperative to invest in the midwifery profession to address maternal and neonatal mortality in Pakistan. This covers crucial infrastructure, clinical training, financial stability, and high-quality education. In addition to being a wise investment in Pakistan’s development, equity, and health, midwives’ empowerment is morally required.