Adults worldwide can today look forward to a life-expectancy of 60 plus. But not young Pakistani women: they die like flies, daily, during childbirth

Recently, in one of our routine early-morning meetings in the hospital, the obstetric registrar presented a report of the last 24 hours.

She told us about 17 normal deliveries, five caesarian sections, eight gynecological admissions and details of the antenatal patients with medical disorders. In the end she added as an afterthought one more thing. We'd received a woman aged 31 years, mother of nine, at 3:00 a.m. She had delivered at home and had a massive postpartum hemorrhage. That is, bleeding after the baby's delivery. Actually, when she came to our hospital she was already dead. One more D.O.A dead on arrival.

The report of this death should have been the first item of that day but even a lady doctor, a female physician, did not understand the significance of this death.

Maternal death is so common that it is no longer news. It's not even worth mentioning. Like menstruation, premenstrual tension and climacteric symptoms, it is women's lot. Since mankind's earliest history, women have been dying in pregnancy and they will continue to die. It is common, so common as to be normal.

This situation prevails all over Pakistan. In cities and villages, in slums and rich communities, and in the affluent segments of the population:

Women do not understand their right to maternal health.
They are ignorant of their rights concerning their fertility.
They do not fight for their rights related to pregnancy.
They are convinced that the present situation will not change, and there is no need to fight to bring about change. It is a war not worth fighting for.

According to WHO, one mother is dying every one minute, and the majority of these women come form underdeveloped countries. By a rough estimation, for every maternal death 16 women suffer severe illness during the antenatal and postnatal periods.

Women throughout the world bear the burden of their gender. This starts from infancy to childhood and adulthood. Despite the fact that women are a stronger species than men, girls are more likely to die before the age of five than are boys.

All over the world, two-thirds of the workload is borne by women. They get ten per cent of the total salaries or wages and own one per cent of world's property.

Girls are more likely to be undernourished and uneducated. According to United Nations statistics, about two-thirds of the 950 million illiterate people in the world are women. Even in the Alma Ata Conference in 1978, maternal and child health were the key components of discussion, but women were given importance only as a vehicle for the child. Maternal health and maternal care received less attention during the conference.

In our country, traditionally, we have high-sounding slogans for women and mothers, but the government, culture, tradition and the system all have failed to provide even basic facilities to those women who are pregnant, or will become pregnant in the near future. We are sure that "heaven lies beneath the mother's feet", but we are not ready to rescue pregnant women from a dilemma that is worse than hell. Attitudes popularly prevalent in our country include the following:

A fear of pregnancy.
A belief that it is normal to die to pregnancy.
A conviction that God is responsible for the death of a mother and there's nothing we can do about it.
Insecurity regarding women's health and maternal death.
Lack of will in society to change the status of women.
Women are victims of tradition

There is an Old Swedish saying that woman delivered herself to death. Starting out with the same kind of traditions and backward cultural beliefs as ourselves, the Swedes were able to create an awareness to change the situation, about 250 years ago. We are still at a loss about women's right to maternal health.

Woman has the right to live, to educate herself, to have control over her fertility, to become pregnant when she chooses, to receive care during and after pregnancy.

When a group of Karachi women from a lower socio-economic class were asked about their rights during pregnancy, they were not able to phrase a single sentence about their rights.

When the question was explained and some examples of developed countries regarding care of pregnant women were given, unanimously they all said that it is not possible in Pakistan. A majority of them expressed disbelief, the overall impression being that of hopelessness and helplessness. Somehow, they were content with the situation. They accepted it without a murmur. They were trained, or they'd learned from circumstances that death is not an abnormal occurrence in pregnancy even at the early start of their lives.

This is a sad situation. Our women are so hopeless that they strongly believe that maternal care and maternal rights are not achievable in Pakistan. They lack social awareness. They are unaware of the changing conditions all over the world. They believe that Pakistani women can never achieve these so-called rights.

Illiteracy is a curse on them and there is a conspiracy of silence at all levels to keep women away form education. The family, tradition, culture and the government are all responsible for women's unbelievable unpleasant situation.

What are the women's rights for maternal health? It is still a question in Pakistan. We and our lawmakers were not able to answer this question.

The following are proposed rights for women's maternal health in our existing setup:

1. The right to become pregnant by choice

   A majority of women have no control over their marriage and fertility. The men of the family take all crucial decisions most of the time. This results in lot of tension and frustration in the family unit especially on the part of women. This situation will not change as long as women are not aware of their rights. They are only aware of their duties and sacrifices. They are heavily involved in creating wealth, especially in the rural areas, but are totally deprived of the benefits of their hard work.

   An awareness campaign focussed on men is required on the electronic and print media to bring about a change. The time ahs come for all women to known their rights.

2. Right to adequate caloric intake and proper food during pregnancy

   Severe maternal problems are a direct result of severe malnutrition and inadequate caloric intake. Anemia is one of the major cause of maternal morbidity and mortality in our country.

   In ideal circumstances, every human being has a right to good food and good caloric intake. Unfortunately in our country it is the multigravida pregnant who sacrifices at all levels. She starves to feed her children, husband and other family members. Society should recognise the right of pregnant women for better food and good caloric intake.

3. Availability of social services

   Despite the close-knit biradri (community) system and joint-family efforts to survive, surprisingly, it is not uncommon to see social services being unavailable to pregnant women. If it is not possible to invest in social services, the family and the community need to be educated regarding their social responsibility. It is the pregnant women's right o exploit and use the resources of the community at all stages of her pregnancy.

4. Access to healthcare near the community (Accessible, affordable arid sustainable transport system)

   Facilities should be developed according to the needs of the female population. They should be situated in the community, with the help of the community and should enjoy the community's trust. In the case of distant health centres, an accessible affordable and sustainable transport system is required. Women should not have to rely on ignorant daies for their gynae-related problems.

   It is women's basic right to have access to a modern, scientific, updates and accessible healthcare system. It is the moral duty of educated women and aware men to fight for this right of women.

5. Emergency obstetrical services and access to them

   It is every pregnant woman's basic right to have emergency obstetrical services available round the clock. No woman during pregnancy should die because of unavailability of emergency services like blood bank and operation theatre facility.

6. Right to safe abortion

   Without going into a philosophical debate on the rights of the unborn, it is important to recognize the right of women to safe abortion. Even in the case of medically-indicated abortions, the pregnancy termination often results in maternal death, and may cause serious morbidity.

7. Financial assistance during and after pregnancy for maternal needs

   It is woman's right to look after herself during and after pregnancy. She should receive financial help not for their child, but for herself. Such help should be allocated to her in addition to a child allowance. The government should be pressurised for this kind of scheme. A healthy and confident mother is a national asset. She is not a burden on the nation.

8. Apportioning of blame for delivering female babies only

   During a discussion with a group of women, they unanimously came out with this suggestion: if a number of girls are born one after another, the women should not blamed. While most of these women had a male child yet they were seriously concerned for other women who delivered daughters only. Not a single woman thought that only the woman could be held responsible for the birth of numerous daughters.

   It is women's right that society and tradition should not make them the target when they bear only girls. This gender based attitude should be discouraged and an awareness campaign should target men.

Traditionally, culturally and historically our priorities are wrong. Hundreds of years ago when Mumtaz Mahal dies because of severe bleeding during child birth, the mighty King of Hindustan built the magnificent Taj Mahal in her memory. At the same time a King in Sweden depressed by the death of a pregnant woman, ordered the recruitment of two girls from each village for midwifery training in Stockholm. Slowly there developed an organized system of midwifery and maternal care.

Today, Sweden ahs the lower maternal death rate in the world. Less than four women die out of 100,000 pregnancies. The Sweden can be proud of their king but when I look at the Taj Mahal I feel a twinge of sorrow. The King remembered his beloved but was unable to do something about dying mothers.

In today's Pakistan, priorities are wrong again. There is no long term investment in maternal care and there is nothing for our future generation to be proud off.