Samina

It was late in the evening when Samina started feeling labor pains from her first pregnancy. Since women in her village deliver at home, Samina reluctantly prepared to do the same.

By the following morning, Samina’s condition had deteriorated — the baby was still not born.

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 network member 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 from an outreach worker. As her condition worsened, Samina told her helpless mother about a voucher she had purchased.

Samina arrived at the clinic in severe pain, lethargic, dehydrated and very anemic. Complications continued to develop. She had obstructed labor, and her baby was in severe distress. The physician performed an episiotomy, allowing for a normal delivery. The baby, who was unconscious, was revived with CPR and oxygen. After the birth, Samina developed severe bleeding and received emergency treatment and blood.

Today, both mother and baby are thriving.

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