Feb 17, 2023
By Bilal Baseer
KOHISTAN:
Thirty-three year old Mehnaz Bibi, a resident of Shalkan Abad village in Kolai Palas, Khyber Pakhtunkhwa, nearly fainted from the strain of her pregnancy in the cattle yard on Nov 13, 2022. With labour pains unlike any she’d felt before, Bibi was taken to a nearby midwife who recommended transferring her to a larger hospital.
Her journey was fraught with difficulty; compounded by a mechanical failure that caused the jeep she and her family were travelling in to veer off the road. Villagers came to their rescue, and she was transported to a hospital in Abbottabad, where she underwent surgery to address the complications of childbirth. Sadly, her baby boy did not survive.
The loss weighs heavily on Bibi, particularly considering that all her previous births have been girls, who traditionally aren’t considered heirs.
Bibi is currently in the ninth month of her tenth pregnancy, navigating the familial expectations for a male heir. She has given birth to four children at home without consulting a medical practitioner, while three others were born with the assistance of a local midwife. The last two deliveries took place in a hospital.
She resides in a joint family system, comprising her husband’s 11 brothers, his two wives, and their 16 children. Despite being in the final days of her pregnancy, she is expected to tend to household chores, such as preparing meals and herding animals.
The duty of childbirth
“Most childbirths in Kohistan occur at home, and complications prompt transport to local midwives or under-resourced health facilities like basic health units and rural health centers in the area,” says a female member of the Population Welfare Department.
She adds that in this area, most people view giving birth to more children as a religious and cultural duty.
Bakhtiar Khan, a district population officer in Kolai Palas, says that the government’s efforts to create awareness and curb the high birth rate have largely been in vain, as deep-rooted beliefs and widespread illiteracy continue to hinder progress – “Despite the establishment of awareness centres, their impact remains minimal”.
He adds that the people of this remote and impoverished area view contraceptive measures as “un-Islamic and unethical. They are influenced by clergy exploiting religious sentiments for personal gain.”
Family size
According to the 7th Population and Housing Census 2023, the population of Kolai Palas, Kohistan District, is 280,162, with 40,393 households and an average household size of 6.94. In Lower Kohistan District, the population stands at 340,017, with 52,318 households and an average household size of 6.50. Upper Kohistan District recorded a population of 422,947, with 71,543 households and an average household size of 5.91.
Waqas Qudoos, a civil society activist based in Kohistan doubts the accuracy of the 2023 census, claiming the true average is much higher, with families having 12 to 15 children. He alleges, “The population and health departments, failing in their duties, have submitted false reports to higher authorities.”
He says that despite significant government allocations to the Population Welfare Department, the department falls short in addressing basic healthcare needs. He points out that the department’s entire staff resides in Abbottabad with their families, drawing salaries from there.
Qudoos highlights early marriages as a significant issue in the area, with girls aged 14 or 15 getting married, leading to a high number of children by the age of 35. He notes a low divorce ratio and in the case of a male’s death, his wife is expected to remarry his younger brother, as “women cannot live without remarrying”.
He adds that basic health units (BHUs) are established on inaccessible hilltops with no appointed staff. “Although there is a tehsil headquarter (THQ) hospital in Pattan, it is understaffed and lacks resources. Of the appointed 150 medical and paramedical staff, only three, including a medical superintendent who runs a private clinic, serve the hospital.”
At high risk
Dr Sadia Muzaffar, a consultant gynecologist who serves under the Mother Newborn and Child Health (MNCH) programme in Shalkan Abad, shares harrowing tales of females grappling with medical hardships due to inadequate facilities. “One woman faced a life-threatening situation of internal bleeding from a ruptured pregnancy when she reached me. Her hemoglobin level was 7.”
Due to the absence of life-saving kits in her facility, she referred her to Abbottabad’s Tertiary Health Care Hospital where she received life-saving fluids and a blood transfusion.
Dr Siraj Khan, Additional Director General Health Services, Khyber Pakhtunkhwa, acknowledged the shortage of health facilities in Kohistan. He assured that the health department, in collaboration with INGOs, is actively working to safeguard maternal and child health through MNCH programmes in KP.
He pledges to bring the matter to the attention of the project director of the MNCH programme.