40 year old Gulshan gives birth to her tenth child, a baby girl, at the MSF clinic at the District Headquarter Hospital in Dera Murad Jamali, Balochistan, Pakistan (Oct, 2018)
Married at the age of 14, Gulshan has been conceiving children for almost 25 years with many pregnancies resulting in miscarriages.
This is the first time Gulshan has given birth in a hospital and that too only because she was very weak, having miscarried less than one year ago in her 8th month of pregnancy.
Gulshan’s mother and aunt take her home in a rickshaw a short while after she has given birth at the MSF facility in Dera Murad Jamali (Balochistan). Gulshan’s 22 year old son, Hamza, came to pick them up.
At home, the entire family of nearly 25 people is waiting for their arrival. They immediate start massaging the baby with oil.
The baby’s maternal and paternal grandmother plan to pierce her ears after six days as per tradition popular in Baloch culture.
The grandmother shows her piercings. Before leaving the clinic, an MSF health educator had explained to Gulshan’s mother and aunt that the baby is too small for such piercings and that there is a high risk of developing tetanus which could cause her to go in shock. Tetanus in the first 28 days of life (neonatal tetanus) was long recognized by clinicians in resource-poor settings as an important cause of neonatal death.
All the female children in the household had their ears pierced shortly after their birth.
As per tradition, the family also plans on feeding the baby some herbal concoctions. These herbal concoctions are potentially dangerous for babies but it is hard for health educators to convince families not to practice age old custom.
Lack of education is one of the biggest issues in Dera Murad Jamali. Pakistan Education Statistic 2016-17 launched by the National Education Management Information System (NEMIS) – a subsidiary of the Ministry of Federal Education and Professional Training revealed that 70% of the children in Baluchistan were not in school.
Poor literacy rates in Baluchistan have lead to men and women never learning about basic health practices that result in lack of proper hygiene, acute malnutrition and following of dangerous cultural practices that are harmful to children.
Lack of family planning in these regions have also lead to large families that are ultimately difficult to provide for. These factors also contribute to the high infant mortality rate in Pakistan.