Of the 146 maternal deaths recorded in 2002, 116 were due to obstetric causes and 30, to non obstetric causes.

Manual for dealing with obstetric emergencies.

There are 3 upper level obstetric centres.

And the most devastating injury is obstetric fistula.

62 138. Supporting efforts to end obstetric fistula

Table 11 Maternal mortality, by obstetric cause, 2002

Table 13 Non obstetric maternal mortality, 2001 2002

Most maternal deaths are directly due to obstetric complications.

There are obstetric and gynae wards in most major hospitals.

They are the general guidelines for the organization and standardization of emergency obstetric care (2000), the protocol for obstetric and paediatric care (2001) and the abortion care protocol (2002).

The following table shows the distribution of direct and indirect obstetric deaths.

Deeply concerned that early childbearing and limited access to sexual and reproductive health care, including in the area of emergency obstetric care, causes high levels of obstetric fistula and maternal mortality and morbidity,

The following table shows the primary causes of direct obstetric death in 2002

The number of obstetric wards (maternity hospitals) has remained unchanged (19 in total).

Obstetric wards of county hospitals and private hospitals are institutions of the secondary level.

One of the consequences of such traditional practices, particularly early marriage, is obstetric fistula.

By 31 December 2003, 93.2 of ward clinics have midwives and obstetric pediatric assistant doctors.

Apart from these measures, the Government has encouraged the establishment of Mother Friendly Hospitals and Mother Friendly Sub Districts that provide appropriate obstetric emergency care and monitor pregnant women for early detection of obstetric complications, referrals and emergency preparedness.

(b) To strengthen the capacity of health systems to provide the essential services needed to prevent obstetric fistula and to treat those cases that do occur by providing the continuum of services, including family planning, prenatal care, skilled birth attendance, emergency obstetric care and post partum care, to young women and girls, including those living in poverty and in underserved rural areas where obstetric fistula is most common

Emergency obstetric Care facilities through Women friendly hospitals in 20 districts of Pakistan under the Women Health Project.

(d) To develop a national strategy of prevention and treatment to effectively address the condition of obstetric fistula and to further develop a multisectoral, comprehensive and integrated approach to bring about lasting solutions and a meaningful response to the problem of obstetric fistula and related morbidities

(i) To develop means of transportation and financing that enable women and girls to access obstetric care and treatment, and provide incentives and other means to secure the presence in rural areas of qualified health professionals who are able to perform interventions to prevent obstetric fistula

For example, the provision of maternal health services, including emergency obstetric services, must be available to all young women.

In February 2004, a National Seminar on Obstetric and Neonatal care was held to establish the Pact's strategic actions.

12. Invites Member States to contribute to efforts to end obstetric fistula, including, in particular, the United Nations Population Fund global Campaign to End Fistula, with the goal of eliminating obstetric fistula by 2015, in line with the targets of the millennium development goal of improving maternal health

In the health sector, the United Nations Population Fund (UNFPA) supported the improvement of emergency obstetric care in district hospitals.

Examples of synergies are found in the IMCI and ACSD initiatives, in some obstetric care programmes and as described in paras.

Lastly, a survey had been conducted in 2003 with a view to measuring the availability and use of emergency obstetric services.

(g) To bring obstetric fistula to the attention of policymakers and communities, thereby reducing the stigma and discrimination associated with it and helping women and girls suffering from obstetric fistula so that they can overcome abandonment and social exclusion together with the psychosocial implications thereof, inter alia, through support of social reintegration projects

Among the main causes of maternal mortality, the most prevalent are obstetric haemorrhaging, severe forms of gestosis, and other complications of pregnancy.

With respect to the Goal on maternal health, all women should have access to skilled care during childbirth, as well as to emergency obstetric care.

In 61 Centers for Mother and Child Protection and Family Planning, there are 321 obstetric doctors, 60 pediatric doctors, 228 pediatric assistant doctors and 367 midwives.

UNICEF will also support pilot and other initiatives for Goal 5, including emergency obstetric care and training of skilled birth attendants, where warranted by country circumstances.

In addition, the presence of a trained attendant at delivery and access to emergency obstetric care are essential to preventing deaths occurring because of complications during delivery.

The Government was committed to reducing maternal mortality by improving obstetric care and providing assistance for abortions, and was reviewing punitive legislation on the voluntary termination of pregnancy.

Recognizing also that early pregnancy and early childbearing entail complications during pregnancy and delivery and a much higher risk of maternal mortality and morbidity, and deeply concerned that early childbearing and limited access to the highest attainable standard of health, including sexual and reproductive health, including in the area of emergency obstetric care, cause high levels of obstetric fistula and other maternal morbidities as well as maternal mortality,

Deeply concerned that early childbearing, malnutrition and limited access to sexual and reproductive health as well as emergency obstetric care causes high levels of fistula and maternal mortality and morbidity,

Collaborating with UNFPA and others, UNICEF supported capacity building and services for emergency obstetric care in some 65 countries and roughly 3,700 health facilities, an increase of over 300 since 2003.

In addition to these services provided by all healthcare facilities, the Government has also established separate obstetric and gynae facilities, maternal and child health centers staffed by lady health workers etc.

In partnership with non governmental organizations and the Palestinian Authority, UNICEF also provided emergency health kits, midwifery and obstetric kits, and generators to assist 10,000 people residing in Gaza Strip enclaves.

Deeply concerned that early childbearing and limited access to sexual and reproductive health care, including in the area of emergency obstetric care, causes high levels of fistula and maternal mortality and morbidity,

Deeply concerned that early child bearing and limited access to sexual and reproductive health care, including in the area of emergency obstetric care, causes high levels of fistula and maternal mortality and morbidity,

(c) To redouble their efforts to meet the internationally agreed goal of improving maternal health by increasing access to skilled attendance at birth and emergency obstetric care, and appropriate prenatal and post natal care

UNICEF support to facility based emergency obstetric care, the Integrated Management of Childhood Illness (IMCI), PMTCT plus and the care, treatment and support of children infected and affected by HIV will prioritize poor districts.

10. Urges the international community to address the shortages of doctors, nurses and other health workers trained in lifesaving obstetric care, and of space and supplies, which limit the capacity of most of the fistula centres