Where Distance Should Not Decide Survival: Strengthening Midwifery Care in Balochistan

In the remote border districts of Chagai and Chaman in Balochistan, access to maternal healthcare has long been limited by distance, poverty, and difficult terrain. Many women must travel 10 to 40 kilometers to reach emergency obstetric care, often on rough roads and with limited transport. As a result, nearly 70–80% of births in districts like Chagai still take place at home without skilled birth attendants.

Balochistan continues to face some of the highest maternal and infant mortality rates in Pakistan. Maternal mortality stands at 298 deaths per 100,000 live births, while neonatal mortality is 34 per 1,000 live births and infant mortality is 66 per 1,000.

To address these challenges, the PATRIP Community Midwife Competency-Based Training Initiative is being implemented by the Indus Hospital & Health Network with financial support from the International Rescue Committee. The project aims to strengthen maternal and newborn health services in Chagai and Chaman by equipping 60 Community Midwives with enhanced clinical skills through a three-month competency-based refresher program aligned with Pakistan Nursing Council standards.

Beyond training, the initiative is also investing in sustainable infrastructure, including a functional midwifery skills laboratory, improved learning resources, renovated hostel facilities, and stronger coordination with district Maternal, Newborn and Child Health (MNCH) authorities. The program will run multiple training batches until October 2026.

For many midwives, the program is deeply personal. Haseena Haider, a midwife from Dalbandin, joined the training to strengthen her ability to manage complications such as postpartum hemorrhage, eclampsia, and newborn resuscitation.

“Now I can recognize danger signs early and act immediately,” she says. “In our areas, hesitation can cost lives.”

Similarly, Razia Dastageer chose midwifery after witnessing the consequences of limited healthcare access in her community. She later established her own birth station to serve women in remote areas. In one case, she successfully managed a premature delivery and stabilized the newborn before arranging referral for advanced care.

Beyond improving clinical care, trained Community Midwives are also helping strengthen trust within communities. In border districts where host populations and Afghan refugees live side by side, health facilities have become shared spaces where women receive respectful care regardless of background.

“Each trained Community Midwife contributes to numerous safer pregnancies every year,” says Dr. Mah Talat, Executive Director of the Community Health Directorate at the Indus Hospital & Health Network. “By strengthening frontline skills, we are improving maternal and newborn outcomes in some of the most underserved districts.”

Through initiatives like PATRIP, skilled midwives are becoming the first line of care in remote communities — reducing risky journeys, preventing avoidable deaths, and ensuring that childbirth no longer depends on distance.