And then came the massive floods this summer. Bibi’s home in the city of Rajanpur in southern Pakistan was flooded.
When he spoke to the Associated Press last month, he was living in a camp for displaced families. As her due date approached, she feared the possibility of a breech birth with almost no accessible health care.
“What if my health suddenly deteriorates?” Shakeela said. She has a shortage of blood and sometimes low blood pressure, but she said she cannot follow a proper diet in the camp. “I have been in a field for two months, I sleep on the ground, and this is making my situation worse”.
Pregnant women are struggling to get treatment after the unprecedented flood in Pakistan, which flooded a third of the country at its peak and drove millions of people from their homes. There are at least 610,000 pregnant women in flood-affected areas, according to the Population Council, a United States-based reproductive health organization.
Many live in tents for displaced people or try to make it alone with their families in villages and towns devastated by the floods. Women have lost access to health services after the destruction of more than 1,500 health facilities and large stretches of roads. According to the United Nations, more than 130,000 pregnant women are in need of urgent care, with about 2,000 a day giving birth mostly in dangerous conditions.
Experts fear increased infant mortality or health complications for mothers or babies in a country that already has one of the highest maternal mortality rates in Asia. They also warn of dangerous long-term repercussions for women, such as an increase in early marriages and unwanted pregnancies due to disruptions in the lives and livelihoods of families.
Rasheed Ahmed, a humanitarian analyst at the United Nations Population Fund, said the health system was already poor before and has now warned of “death, disability and disease” if the health of pregnant women is ignored.
“The biggest shortage is women who work in healthcare, medical supplies and medicine,” she said. “Resources are another challenge. What are the government’s priorities? Are they willing to spend the money? “
In camps in the flood-affected cities of Fazilpur and Rajanpur, pregnant women told the PA that they have not received treatment or services for their pregnancies since arriving in the camps nearly two months ago. The clinics distributed medicines for minor ailments, but nothing for expectant mothers. The next day, after the PA visited a local medical center to alert them to their plight, the health workers went to check on the women and distributed sachets of calcium and iron supplements.
Shakeela Bibi and her family eventually left the camp, taking their tent with them and setting it up near their destroyed home. The authorities gave them a month’s worth of flour, ghee and lentils. She is now past her due date, but the doctors have assured her that her baby is fine and they don’t think she will need a cesarean.
Perveen Bibi, an 18-year-old five months pregnant and unrelated to Shakeela, said the lack of health facilities in the camp forced her to go to a private clinic and pay for an ultrasound and a checkup. But she has been prescribed medicines that she cannot afford to buy.
“I had a good diet, with the dairy products from our cattle,” he said. The family had to sell their livestock after the flood because they had nowhere to keep them and no way to feed them.
“We need doctors, nurses, gynecologists,” said Bibi, who has a daughter and is expecting a boy. She had a son about a year ago, but he died a few days after his birth. “We can’t afford the ultrasound or the IV. We’re just arranging. “
In the camps, families of five, seven or more eat, sleep, and spend days and nights in a tent, sometimes with only one bed in between. Most sleep on rugs. Some survivors have only the clothes they fled in and rely on donations.
External faucets are used for washing clothes, washing dishes and bathing. The pregnant women said there was a shortage of clean water and soap. They were afraid of infections due to open defecation in the fields. A bathroom has been set up, but it has no roof and curtains surround it.
Amidst the devastation, organizations and individuals are doing what they can: UNFPA is providing baby supplies and safe delivery kits to four flood-affected provinces.
A Karachi-based NGO, the Mama Baby Fund, has provided 9,000 safe birth kits, which include items for newborns, in the provinces of Sindh and Baluchistan, as well as antenatal and postnatal checks for 1,000 women. The Association for Mothers and Babies, also based in Karachi, has provided more than 1,500 kits for safe delivery, mainly in Sindh.
UNFPA’s Ahmed says pregnant women have different needs than the rest of the displaced population, needs that are not being met by the state’s efforts.
“The government’s response is very general, it is for the masses. It is a refuge, a transfer, ”Ahmed said. “I have heard of women having abortions due to mental stress, physical stress due to displacement and relocation”,
According to Saima Bashir of the Pakistan Institute of Development Economics, the health crisis triggered by the floods will reverberate among women because it will take a long time to rebuild health facilities and restore family planning.
“Women and girls are very vulnerable in this situation,” Bashir said. He pointed to the increase in reports of child marriages.
Even before the floods, 21% of Pakistani girls were married before the age of 18 and 4% before the age of 15, according to UN data.
The rate is increasing for several reasons. Some parents marry their daughters as a way to get financial support from the boy’s family so they can rebuild their homes. Others fear for the safety of their girls in refugee camps and believe that marrying them will protect them from abuse or secure their future. Furthermore, the destruction of schools during the flood excludes other possibilities; some girls who would have received an education or perhaps continued to work will remain at home instead.
Over the next few years, those girls will become pregnant, Bashir said, especially given limited access to contraception.
“There will be more unwanted pregnancies,” she said. “This is … aggravating this crisis and adding to the population.”