LHWs, CMWs and Vaccinators are a vital force to prevent Maternal and Child deaths in Balochistan, Pakistan


Women queue to have their children weighed by a Lady Health Worker (LHW) in Pakistan. LHW’s regularly checks children’s weight and keep an accurate record, thereby allowing them to see the general health of the children over a period of time and pick up on any early signs of malnutrition. Photo: CJ Clarke/Save the Children

Save the Children’s report on neonatal deaths in Pakistan suggests that the rate of intra- partum stillbirths (death during childbirth) and first day neonatal mortality in Pakistan is the highest in the world at 40.7 per 1,000 total births countywide.

But being an infant or mother is not so easy in Balochistan. The women and children of Balochistan province are most ill-fated in this regard.

The recent study Pakistan Demographic Health Survey (PDHS 2012-13) shows that the Infant Mortality Rate (IMR) is 97/1000, the Under 5 Mortality Rate (U5MR) is 111 and neonatal Mortality Rate at 63/1000. Maternal Mortality Ratio (MMR) is 785 /100000.

According to the National Nutrition Survey (NNS) 2011), malnutrition among children under five is ranked as Severe stunting (Height For Age HFA) is 32.20 %, Wasting (Weight For Height WFH) is 18.60% and under weight (Weight For Height WFA) is 41.80%. On the other hand, 63.50% of children are food insecure.

The front line health workers who provide basic health care services, education and prevention include Lady Health Workers (LHWs) Vaccinators and Community Health Midwifes (CMWs).

Balochistan has 167 community midwifes rendering services in the field by the provincial Health Department. Tragically, only 29.1% deliveries are conducted by the skilled birth attendants. Currently there are 6720 Lady Health Workers (LHWs) covering only 43% of the province. Similarly, there are 943 vaccinators and measles coverage is only 22.9%. These poor health indicators further affect the condition of women and child health.

There is a glaring need to increase numbers of the LHWs, CMWs and Vaccinators, allocating fiscal and human resources for LHWs, Expended Programme on Immunization (EPI), Maternal, Newborn and Child Health (MNCH) and Nutrition programs to minimize the IMR, MMR, Neonatal Mortality Rate and Under 5 Mortality Rate (U5MR) to track the province toward achieving MDGs 4 and 5.

Only one intervention promotion of early initiation of Breastfeeding could save 22% of neonatal deaths. Taking a step toward promoting breastfeeding and discouraging bottle feeding a formula milk the Balochistan assembly recently passed legislation on “Protection and Promotion of Breastfeeding and Young Child Nutrition Law 2014” Arshad Mahmood – The Express Tribune Blog. To monitor and implement this in its true letter and spirit the government of Balochistan must notify the Infant Feeding Board and devise its Term Of Reference. Train the LHWs, Lady Health Visitors (LHVs) CMWS and Health Care providers in Infant & Young Child Feeding practices that teach and encourage mothers to practice optimal feeding and exclusive breastfeeding.

To minimize infants and mother deaths in the province the Balochistan government must allocate budget for Nutrition, Lady Health Workers (LHWs) and Expended Programme on Immunization (EPI) programme. Also, the number of LHWs should be doubled. There must be two of vaccinators union council level, and number of Community Midwives (CMWs) be increased.


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