Lodhran is a backward district of Southern Punjab, Pakistan. It is located on the northern side of River Sutlej and southern side of River Sukh Byas. It is bounded to the north by the districts of Multan, Khanewal and Vehari, to the south by Bahawalpur District, to the east lie the districts of Vehari and Bahawalpur; while district Multan lies on the western side.
The district is neglected in many aspects by the government. Education, health and other municipal services are not provided properly to the residents of the district. Due to unavailability of appropriate reproductive health services in the district, maternal mortality rate and infant mortality ratio are higher than many other districts of the province. According to the government, infant mortality ratio is 158/100,000 while maternal mortality rate is 550/100,000 in District Lodhran. Let’s take a look on the causes of this situation.
Health facilities available in District Lodhran don’t meet the requirements of the district. Even in the district headquarter Lodhran, a single District Headquarter Hospital exists which was just renamed from Tehsil Headquarter Hospital in 1991 without proper up-gradation. The hospital nor has modern facilities neither capacity of the hospital is sufficient to cater the needs of the citizens. Similarly, two Tehsil Headquarter Hospitals are much less than the needs of other two tehsils of the district. Apart from unavailability of proper reproductive health facilities, misconceptions and unawareness are some of other factors affecting the overall state of reproductive health in the district. This situation provides alternative reproductive health service providers an opportunity for business. There are hundreds of quacks, hakeems, unskilled birth attendants and practitioners working to provide reproductive health services in the district without proper knowledge, staff, equipments and facilities. Government’s imperfect monitoring system and staff has led to free-hand for such “businesses”. Following alternative mechanisms are used in District Lodhran at this time to deal with maternity and reproductive health.
* Unskilled Traditional Birth Attendants
* Quacks and Hakeems
* Traditional Knowledge
Skilled birth attendants, doctors and medical practitioners are, though, serving the urban population yet larger part of rural area still has none of them. Even in the cities, many private “surgical” hospitals are being operated without any doctor. Such hospitals enlist the names of a few doctors on signboards without their physical presence in the hospital. Some of these hospitals have hired Lady Health Visitors (LHVs). These LHVs also don’t serve full time rather they are primarily employed by Basic Health Units or other government-run medical centers. In these hospitals, traditional birth attendants serve for the needs of reproductive health to the patients. These unskilled birth attendants are sometimes listed as LHVs or doctors by the so called hospital and no government-department has taken its notice till now. This sort of business is flourishing rapidly in the district and dozens of such “fake” hospitals are established in rural as well as urban areas. This practice has put the lives of innocent rural and illiterate women on risk and both maternal mortality ratio and infant mortality ratio are on rise due to these circumstances.
Quacks and Hakeems are also capturing majority of rural patients. In areas where no doctor is available, quacks and hakeems serve for this purpose. In case of complexity/emergency, unskilled birth attendants refer the patients to quacks. If quacks are also unable to handle the situation, the patient is then taken to the hospitals in cities for proper treatment. Many times, delay in delivery of child, extreme blood flow or excessive labor pain results in death of either the mother or the child; or both. This is a main cause of high infant mortality ration and higher maternal mortality ratio in District Lodhran.
Quacks have setup their outlets everywhere in the district. In urban areas, even on main roads, many quacks can be found practicing their “skill”. A number of huge neon signs, prominent sign boards and giant hoardings can’t attract any official of district administration or any other relevant department to take notice of these fake doctors and quacks and nobody takes action against them. The issue has been discussed by media personnel and social workers many times but in vain. This insensitive attitude of the government officials is affecting the state of health very negatively. The number of quacks is rising on every passing day, especially in rural areas. If appropriate action is not taken against this practice, the situation of reproductive health will get even worst in District Lodhran.
Lodhran is third district where literacy rate is lowest in Punjab province. Due to illiteracy, majority of the citizens is not aware of many social and medical issues. While we talk of reproductive health in the district, majority of the population consults unskilled birth attendants/TBAs for the purpose of maternity. Apart from unavailability of skilled birth attendants, illiterate especially elder women of the family don’t permit the younger women to go to hospital or consult a doctor for problems regarding reproductive health. They believe if they have had no problem with them, their younger women shall also have no problem with unskilled birth attendants. Many NGOs are working to raise awareness among local inhabitants about various social issues however the issue of reproductive health is neglected by majority of them. In a result, the perception is getting even stronger by everyday. Following tables show ratio of deliveries by skilled and unskilled birth attendants in Punjab as compared to District Lodhran.
Due to ignorance, traditional knowledge is also used in some areas for dealing with reproductive health. These types of practices are usually exercised by illiterate and conservative elder women of the family. Another reason for such practice is poverty. People can’t afford paying higher fee to the consultants in private clinics and hospitals while they are not satisfied with the performance of government hospitals despite many reforms in recent years. Religious misconceptions are also hurdles in the way of women to go to hospitals or clinic for their medical checkups. Although there is a minor part of the population who believes in these misapprehensions yet it is affecting the situation of reproductive health in the district. These people perceive Islamic teachings in a way that the women should stay within the boundaries of their homes in any case. So, they don’t like to take women to the hospitals because unfamiliar men may be present there. In a result, traditional birth attendants are consulted for RH matters in order to protect the so called privacy of the women. The patient is referred to the hospitals only in case of high complexity.
The role of alternative reproductive health providers is affecting the overall state of reproductive health in District Lodhran. Government should adopt appropriate policies for eliminating the involvement of unskilled practitioners in the health, especially reproductive health sector. In the meantime, non-profit organizations should come ahead for raising awareness among the population regarding reproductive health. If appropriate actions are not taken to deal with this worst situation, the Millennium Development Goals (MDGs) regarding reproductive health can’t be achieved in District Lodhran.