Pakistan performs badly on mother-child health targets

Islamabad: Pakistan is far behind neighbouring and nearby Muslim-majority countries, including Iran, Bangladesh and Tajikistan, on fundamental mother and child health targets, claims a major global study published in The Lancet, a leading medical journal.

Researchers from the Aga Khan University, Karachi, the Centre for Global Child Health at the Hospital for Sick Children in Toronto, Canada, and the Dalla Lana School of Public Health, Toronto, analysed data from 1990 to 2015 relating to 75 high-burden countries across the world with a specific focus on rates and drivers of change in the Islamic world.

Their findings have been published in the Lancet paper, "Status and drivers of maternal, newborn, child and adolescent health in the Islamic world: a comparative analysis."

The study found Pakistan to be in the second-worst performing group of countries on reducing the deaths of children under the age of five. Pakistan has also made far slower progress in reducing maternal mortality than other developing countries in South and Central Asia.

The researchers found no indication that religion per se had a direct impact on health outcomes and pointed to issues such as conflict, migration, political instability, government effectiveness, literacy, and female empowerment as key drivers of differences in maternal and child mortality.

“While rates of maternal and child mortality are generally higher in Muslim-majority countries such as Pakistan, there are also several success stories,” said lead author Professor Zulfiqar A Bhutta, founding director of the Centre of Excellence in Women and Child Health at the AKU.

“Major successes, especially in child mortality reductions, have been achieved in child mortality in Niger, Maldives, Morocco, Azerbaijan, Senegal, Bangladesh and Egypt.” He however said notable were the unacceptably low rates of skilled care for mothers in childbirth, poor coverage of essential childhood immunisations and low rates of sanitary services.

According to authors, every year, worldwide, an estimated 303,000 mothers and 5.9 million children younger than five years die from largely preventable causes. More than 95 per cent of these deaths occur in 75 countries of the world predominantly in South Asia, the Middle East and Africa. Around the world, the study found that Muslim-majority countries have higher maternal, stillbirth, newborn and child mortality rates compared to the global average and compared to non-Muslim-majority countries.

On average, Muslim-majority countries had lower contraceptive use (60% vs 79%), family planning needs satisfied (83% vs 91%), antenatal care with a skilled birth attendant (79% vs 96%), skilled birth attendance (59% vs 96%), measles vaccination (76% vs 98%), diphtheria-tetanus-pertussis (78% vs 98%) vaccination, and worse access to improved water (87% vs 94%) and sanitation facilities (61% vs 76%). On average, exclusive breastfeeding was higher in Muslim-majority countries (39% vs 27%).

The total health expenditure was lower for Muslim-majority countries (4.2% vs 5.4% of GDP) and out-of-pocket health expenditure was higher (55% vs 43%). The average density of health workers including physicians, nurses, and midwives was lower in Muslim-majority countries (20 vs 31 per 10,000 people) and was below the WHO recommended threshold of 23 workers per 10,000.

“Insufficient empowerment and lack of social support for women can limit their accessibility to basic healthcare, including family planning, and adversely impact health, nutrition and well-being of the entire family. Used as facets of female empowerment, the low levels of female literacy, high fertility rates, and early marriage of young girls seen in many Muslim-majority countries need urgent remediation,” said Nadia Akseer, first author of the report from the SickKids Centre for Global Child Health in Toronto, Canada.