When an ultrasound showed that Lubna Khan was having a little boy, she began shopping for baby things and making tiny clothes. Her husband, Zarif, couldn’t wait to welcome their new son.

Hope turned to tragedy months later when 25-year-old Lubna bled to death during childbirth. The baby, too, did not survive.

In early October, Zarif found himself mourning beside her coffin. His wife of 10 years is also survived by two daughters and two sons.

The family in Khyber Pakhtunkhwa endured a tragedy that happens all too often in the region – a reality social workers and non-governmental organisations are struggling to change. For decades, Pakistan’s maternal mortality rate was on the decline, but recently it has risen.

According to Pakistan’s latest maternal mortality survey, from 2019, 186 women died for every 100,000 live births in 2019 – about 11,000 maternal deaths each year in a country with the highest fertility rate in South Asia.

About 1,900 of those deaths occur in the northwestern province where the fertility rate is higher than the national average.

Experts say many women lack proper treatment during pregnancy and can’t get to hospitals quickly enough when things go wrong. In KP’s urban areas, doctors and hospitals are generally available. But most rural areas don’t have enough doctors and health facilities.

When Lubna Khan was unwell, she told her husband to take her to a doctor. Instead, he took her to a lady health worker near their house, who he said was neither well-trained nor had the necessary medical equipment. Lubna had been a lady health worker herself, helping vaccinate children in her village for polio.

Experts say lack of access to care is just one of several things pushing up the maternal mortality rate. Another problem is that women – including Lubna Khan – marry and begin having children in their teens, when they are likely to face more health problems during pregnancy and birth. 

Her brother Nizam Khan said they later took Lubna to a nearby healthcare centre that lacked qualified doctors and her condition deteriorated. At one point, Nizam Khan said, doctors decided that she needed a C-section. When things took a dangerous turn, they told the family to take her to another hospital.

It took more than four hours to get there. By the time they arrived, the doctors told them that it was too late. Her brother Nizam, who was with her as her condition deteriorated, said no one could stop her bleeding.

“We not only lost our sister, but our nephew as well,” Nizam Khan said.

Experts say lack of access to care is just one of several things pushing up maternal mortality. Another problem is that women – including Lubna Khan – marry and start having children in their teens, when they are more likely to face health problems during pregnancy and birth.

Sana Ahmad, a social worker who supports women’s rights, says it’s worrying that in Khyber Pakhtunkhwa many girls are married at the age of 14 or 15.

With a rising population and more families struggling with low incomes, she says, most parents want to marry off their daughters as soon as possible.

She urges the government and civil society to discourage child marriages. She says the government should also provide healthcare units for women in remote areas.

The writer works for The Express Tribune and tweets at  @WisalYousafzai