QUETTA, 18 June 2007 (IRIN) - For many women in Pakistan's remote southwestern Balochistan Province, giving birth can be deadly.

"I cry every day I see my children without their mother," said Abdul Ghafoor, 38, in the Balochi village of Shakoor Kili. Ghafoor lost his wife four months ago as she tried to give birth to their sixth child.

Heartbroken, Ghafoor has no choice but to care for his surviving five children alone - forever conscious of the fact that had he been able to find the right medical help for his wife, she might well be alive today.

Such stories are not unusual in Pakistan where, according to the UN Population Fund (UNFPA), a woman dies from pregnancy and childbirth-related complications every 20 minutes.

However, in Balochistan, Pakistan's largest, but least developed province, and where the vast majority of its eight million inhabitants have only limited access to adequate health care, the situation is far worse, say officials.

"The maternal mortality ratio [MMR] is 650 per 100,000 live births in Balochistan - nearly two times the national average," Dr Mohammad Tariq Jaafar, chief planning health officer for Pakistan's Ministry of Health, told IRIN in Quetta, the provincial capital.

According to the Pakistan Red Crescent Society, the MMR for the country ranges from 350 to 400 per 100,000 live births.

Lack of trained health personnel

Ghafoor had succeeded in getting his wife to the local hospital, 20km away, but it lacked adequately trained health personnel to deal with the birth, sealing his wife's fate from the outset.

In addition to severe poverty and a lack of prenatal care facilities in the sparsely populated region, Balochistan suffers from an acute lack of trained health personnel, including midwives, as well as access to properly equipped hospitals.

Almost 80 percent of all Pakistani women give birth at home, Jaafar said.

Moreover, in rural areas skilled medical staff attend a low proportion of births in rural areas, he added.

"The main problem we have here is a lack of female health workers at district level, coupled with poor awareness and misinformation amongst the population at large," Dr Tajaddin Kakar, officer in charge of Kilasaifullah district hospital, 250km east of Quetta, said.

"This is the main reason our MMR is so high," Kakar said.

Call for more training

Describing the state of maternal health in Balochistan as the worst in the country, Kakar appealed to UN agencies and non-governmental organisations to provide greater community-based health training in Balochistan.

That may be easier said than done. Despite its vast mineral wealth, education levels in the province remain poor, with many female health workers coming from outside the area and consequently often resistant to travelling to rural and remote areas for security reasons.

At 34 percent, Balochistan's literacy rate - against a national average of 52 percent - is the poorest in Pakistan, the country's recently issued National Economic Survey (NES) said. The literacy rate among women in the province was just 27 percent.

According to the Balochistan Planning and Development Department, which collaborated with the Federal Bureau of Statistics and UN Children's Agency (UNICEF) 2004 district-based multiple indicator survey, the proportion of births attended by skilled health professionals for the whole province was just 21 percent.

The situation can be further explained by the sharp disparity between urban and rural areas in the province, with 47 percent of urban births being attended by skilled health professionals, while only 16 percent of rural births were, according to the report.

"This [latter figure] is extremely low," Mobashar Malik, UNFPA's national programme manager, said in Islamabad. He described health services in Balochistan's rural areas as being particularly poor.

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