Maternal mortality and morbidity in Pakistan: a situational analysis
The maternal mortality rate in Pakistan is high, which has been attributed partly to delays in accessing healthcare for women who are pregnant and in labour. This study aimed to explore the community's perspectives of delays to use of health services in pregnancy and labour, using the ‘three delays’ model and the framework for determinants of maternal mortality.
An explorative-descriptive approach was used, with purposeful sampling of 382 participants selected from across Pakistan. Four groups of participants were selected: married women, married men, adolescent girls and adolescent boys.
Several factors led to delays seeking healthcare. Women were unable to decide for themselves whether to attend a healthcare facility, there were issues reaching a facility in time and at the facility, either the resources or healthcare workers were lacking.
Women must be given education and access to healthcare in order to reduce maternal mortality and morbidity.
Since the inception of the millennium development goals, and with the subsequent sustainable development goals, maternal mortality and morbidity have been highlighted as major global issues. However, reduction of these rates on a global level appears stagnant (Mehboob et al, 2020). In 2017, the global maternal mortality rate was 140 per 100000 live births (UNICEF, 2018). The sustainable development goals aim to reduce the global neonatal mortality ratio to 12 per 1000 live births and the maternal mortality ratio to 70 deaths per 100000 live births by 2030 (National Institute of Population Studies and The DHS Program, 2019).
In Pakistan, the maternal mortality rate was 319 per 100000 live births in 2017, and other indicators showed similarly high levels (neonatal mortality: 49.4 per 1000 live births, stillbirth: 53.5 per 1000 births) (UNICEF, 2018). Although the proportion of births attended by skilled birth attendants in Pakistan increased to 71% in 2019, compared to 52% in 2013 (UNICEF, 2022), it has been found that compared to other countries, including Kenya and Zambia, there is less frequent implementation of safety measures, such as the use of gloves, to reduce maternal and neonatal morbidity and mortality (Aziz et al, 2020).
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