Emerging role of community based midwife (CMW) in Pakistan: a case of district Lasbela, Balochistan province

Date of Award

2010

Document Type

Thesis

Degree Name

Master of Science in Health Policy & Management (MSc Health Policy & Mgmt)

Department

Community Health Sciences

Abstract

Background: It has been estimated that 276 women die for every 100,000 live births in Pakistan. 785 women die for every 100,000 live births in Balochistan which is the highest Maternal Mortality Ratio in the country. Traditional Birth Attendants (TBAs) are main source for delivery care provision as most of deliveries take place in homes in rural areas of country but failed in reducing the pregnancy related deaths especially the complicated cases due to deficient knowledge, skills and adherence to traditional practices. The Government of Pakistan has launched a National Community Midwives Program (NCMP) introducing Community based Midwife (CMW) as a new cadre of health professionals to fill the gaps in order to achieve the targets of Millennium Development Goals. These CMWs have been deployed at community level after getting training through midwifery schools in their respective communities in selected districts of Balochistan. Lasbela district is one of these districts. Objectives: This study aimed to explore the perceptions, expectations and willingness of the community along with the perceptions of Traditional Birth Attendants (TBAs) regarding acceptance of the new role of Community based Midwives (CMWs) in District Lasbela, Balochistan Province. The study also explored willingness of Community based Midwives to work independently at community level in the respective communities. Methodology: A Qualitative Exploratory study using In-depth interviews and Focus Group Discussions was conducted in District Lasbela during July to September, 2010 in order to meet the study objectives. The study participants included Community based Midwives (CMWs), Traditional Birth Attendants (TBAs) and General Population (male and female) inhabitant of catchment areas of these Community based Midwives. The data was collected through face to face in depth interviews with CMWs, TBAs and Focus Group Discussions with Community Members including both men and women. The study participants were selected through purposive sampling technique. Recruitment was done as per eligibility criteria. The data was analyzed by principal investigator. Data was tape recorded and transcribed. Thematic analysis was done manually. Results: Currently the community based midwives are providing range of maternal health care to their respective female community members. Level of knowledge, competency, skills, availability of equipments and cost has been identified the main difference between Community based Midwives and Traditional Birth Attendants as far as maternal health care is concerned. The Community based Midwives are playing their role at household and community level. The community members in urban area have perceived the role of Community based Midwives but the level of awareness about them was found lower in rural areas. Socio-cultural norms, Age, Marital status of midwives, Limited social mobility and Financial constraints were major obstacles found hampering service delivery rendered by Community based Midwives. The use of traditional birth attendants and home delivery were preferable for community members residing in the rural areas despite the availability of Community based Midwives. The Community based Midwives could not attain full community support till now. Conclusion: A comprehensive strategy to enhance the clinical competency of community Midwives for quality service provision should be considered for building trust among community members. Appropriate strategies are required for culturally acceptance and reorganization of community Midwives by the community members. Concrete steps at District, Provincial and Federal levels are required for the sustainability of the intervention.

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