It is alarming that in Pakistan the maternal mortality ratio (MMR) is still higher than several developing countries. The MMR reflects the number of maternal deaths during a time period for every one hundred thousand live births. According to the latest data available from 2020, the MMR in Pakistan is 186 deaths per 100,000 live births. It is noteworthy that nearly 12 percent of the deaths among married women between the ages of 15 and 49 years since 2017 were due to maternal causes. Though the MMR has improved in the past 20 years, this improvement is not impressive. Compared with neighbouring countries, we see that in China it is just 27 and in India it is 140. All this boils down to a simple fact that antenatal care (ANC) and delivery care coverage in Pakistan has not improved much in the past 20 years. Though it has shown some betterment, this is not an impressive development. ANC coverage by a skilled provider has improved from 26 percent in 1990 to 90 percent in 2020 but again it has not translated into a corresponding reduction in MMR.
Perhaps the key lies in deliveries in health facilities rather than just by skilled service providers who may be lacking in the required wherewithal to ensure full health and hygiene precautions. At the moment, just 70 percent of births take place in health facilities and nearly one-third of deliveries are done at homes. This puts both mothers and babies at risk and results in higher MMR. There is a need to conduct regular maternal mortality surveys so that vital data can help health administrators at the local level to make the right decisions. Reducing MMR should now be a priority of the governments at both the federal and provincial levels. It is a pity that the first exclusive nationwide survey on maternal mortality in Pakistan took place only in 2020. Such surveys play a vital role the world over in evidence-based decision-making to improve maternal healthcare.
Most countries that have improved their MMR in the recent past have learned to avoid obstetric complications during pregnancy and labour. They have also focused on maternal care after delivery or at the end of pregnancy. The same applies to non-obstetric complications that get aggravated by pregnancy. There is a need to develop a comprehensive plan and strategy to train health staff in containing obstetric haemorrhage that is one of the most common causes of MMR in Pakistan. Then there are hypertensive disorders that many birth attendants are unable to control as they lack the required preparation and training for it. Accessibility of health services available in the country is another issue, especially in rural areas. If we have achieved little in the past 20 years, there is no need to wait for another two decades before we can match other countries in containing MMR in Pakistan. This is the right time to act and allocate more resources to health by curtailing non-development expenses at both the federal and provincial levels.