“I had been in pain for days, but when it became intolerable and I started to bleed and fainted, the elders decided to take me to the hospital in a tuk tuk.” Sita, 30, had given birth just five days earlier to baby Kinayat in the village of Ghulam Shabbir Kaladi in the Khairpur district of Sindh province. A traditional birth attendant sat with her on the way, but she went into labour during the journey and delivered on the side of the road. The birth attendant cut the cord with a blade and cleaned the baby with a cloth. Sita is one of some 650,000 pregnant women whose lives and well-being have been jeopardized by the flooding disaster in Pakistan, and who are in need of urgent reproductive health services. UNFPA is providing training and supplies to help women access skilled birth attendants and medical supplies as the country reels from the destructive floods.

Sitting outside a tent by the side of a highway, a woman prepares breakfast for her family near the village of Mullah Hussain Sahro in the Dadu district of Sindh province. Villages in the Dadu district are some of the worst affected by the floods, with most people unable to commute, work or access essential services. Water has started to recede in some areas but standing pools of water breeds millions of mosquitoes. Many families that survive on daily wages remain out of work due to the massive damage to the infrastructure and agriculture fields. People are suffering from diseases like malaria, diarrhoea, malnutrition and dehydration. Pakistan is one of the countries that contributes the least to climate change yet is suffering some of the most devastating fallout.

Gohar Khatoon, 20, sits with her four-month-old son Karim Buksh, and her other two children, Irum, 3, and Younus, 2, in their flood-damaged home in Sindh province. Most of the homes in her area were completely destroyed. As the water has started to recede, villagers have returned to try to rescue what they can. More than 170,000 women affected by the floods will give birth in the next year and are in dire need of health services, trained midwives and supplies to ensure a safe birth and critical postnatal care.

Guddi sits with 8-month-old Akshara and her two other daughters outside their home in the village of Ghulam Shabbir Kaladi in the Khairpur district of Sindh Province. Akshara is suffering from severe acute malnutrition and was taken to a clinic to be treated. She still had a cannula attached to her hands so she could be given medication quickly when needed again. When asked if she is breastfeeding Akshara, she replied, “Do you think I have anything in me to feed her?” Even before the floods, Pakistan had one of the highest rates of maternal mortality in Asia – this is now likely to rise further still as women lose access to health care and conditions such anaemia – a leading cause of maternal death in the country – soar with malnutrition.

Zaib is three months pregnant and suffering from malaria. Her husband Ahmad tries to comfort her while holding their three-year-old son Zoya. The family are currently living in a temporary shelter Ahmad built on the side of a road after the flooding destroyed their home in the Shikarpur district, Sindh province. Where possible, pregnant women are being treated in temporary camps.

Holding her newborn baby, Guddi, 36, sits with all her six children on a charpai in her one-room mud home in the village of Rasool Buksh Channa in the Khairpur Mirs District of Sindh province. The baby was born during the height of the flooding crisis and delivered by an village traditional birth attendant. Guddi works picking cotton in fields near her home. She worked until the rain started and had to stop due to heavy rain followed by floods. She said,“Everyone has been out of work since the floods, but we still have to find a way to feed our children. We will have to somehow pass these difficult times and survive.”

Many pregnant women in remote areas have no access to skilled medical care and rely on traditional birth attendants like Bashiran, 40, who is the only birth attendant in her village. She has received no formal training on safe deliveries but has assisted over 200 births. Sitting on the rubble of her destroyed home in the village of Ghulam Shabbir Kaladi in Sindh province, she told UNFPA, “It started to rain a lot. When it entered our homes we ran for higher ground around the village. We could not take anything. The children were crying and screaming from hunger. No one came to help.”