ISLAMABAD, Aug 28 (Reuters) - Insecurity, curfews and a lack of female medics are hindering proper care for thousands of pregnant women caught up in Pakistan's war against the Taliban, according to the head of a leading health aid agency.
Around 2.3 million people have been forced from their homes, mostly since government forces launched an offensive against militants in the country's northwest in April.
While more than half of the displaced have returned to their areas of origin in the past month, aid workers say providing health services to the some 4,000 conflict-affected women who give birth every month poses a serious challenge.
Some areas where the displaced are returning are still not secure and there are often curfews imposed, Maria-Luiza Galer, country director for Merlin, told Reuters in an interview earlier this week.
"This not only prevents our movement to access the pregnant women but also impairs their movement in terms of getting them to a health facility in time for delivery or if there are complications."
Galer said there was a dire need for hundreds of trained female staff -- doctors, midwives and health workers -- in the conflict-affected areas due to cultural norms in a region where women generally do not mix with men who are not family members.
Pakistan has one of the highest maternal mortality rates in South Asia.
According to the Pakistan Red Crescent Society, one in 38 women dies from pregnancy-related causes.
In the war-affected region of North West Frontier Province, experts believe maternal deaths are much higher than the national average mainly due to lack of awareness of obstetric health and the shortage of skilled birth attendants and facilities.
Galer said the trauma for mothers -- after fleeing the fighting, living in camps or with host communities for months and now, for some, returning to see their home areas destroyed -- was also having an impact on breast-feeding children.
A lot of the displaced have experienced post-traumatic stress syndrome which manifests itself through sleeping and eating problems and generalised pain without any cause, she said.
It also affects the breast-feeding pattern of the women and definitely affected the health of the infants where many women who were lactating before stopped due to mental stress.
Aid workers assessing the damage to areas such as Buner and Swat districts say providing adequate health care to those returning is going to be difficult given that an estimated 1.6 million people have returned since the beginning of July.
Hospitals and clinics have been looted, vandalised or destroyed by the fighting. Many of the health staff have not returned.
"The hard work has just begun. It's been a very fast return to areas not fully secured and not fully recovered so it's a very challenging environment," said Galer. (Editing by Simon Cameron-Moore and Jerry Norton)