Page last updated at 10:39 GMT, Saturday, 24 October 2009 11:39 UK

Pakistan's many motherless babies

In Pakistan it is estimated that 30,000 women a year lose their lives during childbirth. Jill McGivering has been to Karachi, to find out the cause of these unnecessary deaths.

Great greatmother with baby
Elderly family members are often left to take care of motherless babies

The screams reached me first. The girl's cries were high-pitched and penetrating.

I found her in a shabby emergency room, lying on her back with her legs splayed.

There was an atmosphere of panic, junior doctors and nurses were running back and forth, shouting instructions.

"She has lost a lot of blood," cried the young doctor. I think the baby is dead.

The young girl, her eyes rolling, looked half-dead herself. It was her first child. No-one knew quite how long she had been in labour.

She had come from a village, a journey of more than six hours in the back of a taxi, bleeding heavily and tossed around on Pakistan's rough roads.

Sickly baby

Just a few days earlier, I had been in rural Sindh myself, meeting the families of women who had died in childbirth.

Women are low status here, many are forced to marry as young as 12 or 13 - and there are so many myths about the evils of contraception, it is seldom used.

Men say they will be made impotent, for example, if they use a condom.

Everyone is desperate for sons, so families of 10 to 15 children are common and women have little say in the matter.

I drove, then walked deep into the wheat and cotton fields to a cluster of mud houses. It was terribly poor. Outside an elderly woman was sitting on a rope charpoy under the trees, a sickly baby lying across her lap.

Map of Karachi

The child was feverish, with barely the strength to cry. When the woman put a metal cup of water to its mouth, it gulped thirstily. It was seven months old and seemed to be losing its own battle for life.

The baby's mother had died as she was giving birth. It was her seventh child. Older brothers and sisters stood round solemnly, staring at me as I heard about the excessive blood loss and the race round clinics which ended in tragedy.

Since then, the baby boy had been fed goat's milk, sweetened with sugar, but had a constant fever.

The elderly woman looking after all the motherless children was the great-grandmother. I asked how she was coping. "What do you expect at my age?" she said. "It is difficult."

This was the third generation she had been left to bring up, her daughter had also died in childbirth some years earlier, now her granddaughter had died too.

Home births

It was ironic because this elderly woman was a dai, one of the traditional birth attendants who preside over most births here.

Some said they put fresh herbs inside the uterus after a birth. Others, I heard, inserted cow dung.

The vast majority of women in Pakistan - more than 80% - give birth at home. The only help many of them can afford is from these untrained dais.

The great-grandmother told me she had no medical training and no equipment. She had learned the skills from her own mother who had been a dai before her.

I asked why she thought so many women died in childbirth. She sucked her teeth. "There are two main reasons", she said. "One is transport. If there are problems and women have to go to a clinic, they go by donkey cart and the roads are bumpy. And the second reason is that some doctors tell women they have had a girl. The shock can kill them."

I met several dais here. They all defended their work, saying experience, passed on from one generation to the next, was worth more than modern training.

Some said they put fresh herbs inside the uterus after a birth. Others, I heard, inserted cow dung.

It was clear from the cases I saw that poor diet, poverty and ignorance all lessened the mothers' chances - on top of a dearth of doctors and midwives.

Baby girl

Back in the hospital in Karachi, the screaming young girl was suddenly giving birth, a misshapen bundle squirmed - then mewling crying started.

It was a baby girl - and she was indeed clinging to life

The junior doctor sounded shocked. "It is alive," she said.

It was a baby girl - and she was indeed clinging to life.

The midwife cut the umbilical cord and I followed her out of the blood-spattered emergency room with the tiny baby in her arms.

The baby was massaged with oil, covered with a cloth, then left alone, paddling the air and giving weak, thin cries. Her skull was elongated, her skin blue and so thin it was almost transparent.

I touched the tiny fingers. "Hello, pet".

The world of the emergency room was one of brash lighting and hard noises. I wanted to whisper something comforting, to tell her she had a lovely Mum and that it was ok, she need not be afraid, her life would be a happy one.

I opened my mouth to speak and found nothing honest to say.

The truth was, there was every chance that she would lose her young mother in her battle to have more children and produce sons - and that in 16 or 17 years time, she too would be married and giving birth, risking her own life in the process.

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