Women & Population

It was late in the evening when Samina started feeling labor pains from her first pregnancy. Samina lives with her parents in the Dera Ghazi Khan district of Pakistan. Since the women in her neighborhood delivered at home, she prepared to do the same.

By the following morning, the baby was still not born. As Samina’s condition worsened, her mother telephoned Nagma, the area’s female health worker. As she waited for Nagma to arrive, Samina’s mother felt helpless.

More than three-quarters of births in Pakistan take place at home. Maternal mortality is estimated to be 279 per 100,000 live births and infant mortality is 78 per 1,000 live births ( Pakistan Demographic and Health Survey 2006-07).

These health indicators, coupled with Pakistan’s large and fast-growing population, which is expected to double by mid-century, do not bode well for its women.

To help reduce maternal and infant mortality, Greenstar Social Marketing, PSI’s local affiliate in Pakistan, along with the Pakistan Initiative for Mothers and Newborns (PAIMAN – a USAID-funded, John Snow International-led project), began implementing a pilot voucher program.

Women, like Samina, from resource-poor communities purchase the Sehat (Urdu for “health”) vouchers at a highly subsidized price, entitling them to reproductive health services from private health providers that are part of Greenstar Social Marketing’s provider network.

When a woman uses the voucher at the clinic, the health-care provider gives her money to pay for transport costs. The woman pays nothing out of pocket for the health services. Greenstar reimburses the provider for the transportation costs and pays for the services provided.

The Dera Ghazi Khan district, where Samina lived, was selected as the pilot for the Sehat voucher scheme. It was a low-income district with the highest unmet need in Pakistan.

Samina was one of the women who had purchased this voucher. When Nagma saw the Greenstar voucher, she called the staff, who instructed her to take Samina to the hospital immediately. The Greenstar staff also contacted Dr. Numera, the physician who was assigned to Samina.

At the hospital, Dr. Numera found Samina in severe pain, lethargic, dehydrated and very anemic. Complications continued to develop. Samina had obstructed labor and her baby was in severe distress. Dr. Numera performed an episiotomy, allowing for a normal delivery. However, the baby, who was unconscious and didn’t cry, had to be revived with CPR and oxygen. Samina then had postpartum hemorrhage, or severe bleeding after the birth, and was given emergency treatment. Greenstar staff found someone in the hospital willing to donate blood. In the end, both mother and baby survived.

Samina was one of the 1,968 women who had purchased the vouchers and gave birth in a health facility during the pilot.

– By Jyoti Kulangara, Coordinator, Corporate Marketing & Communications, Washington, D.C., and Greenstar team, Pakistan