very two minutes, a woman dies during pregnancy or childbirth, according to the latest estimates released in a report by the World Health Organisation. The report reveals alarming setbacks for women’s health over recent years. Maternal deaths either increased or degraded in nearly all regions of the world.

The UNFPA report on the State of the World Population-2024 says discrimination continues to adversely affect sexual and reproductive health for women and girls in many parts of the world. The report is a wake-up call for understanding the risks associated with structural inequalities in the countries with humanitarian crisis and conflicts. It says these have resulted in nearly 500 deaths a day.

Pakistan has one of the highest maternal mortality rates in South Asia. Despite being a signatory to Agenda 2030, the country still lags considerably when it comes to achieving Sustainable Development Goals. Nearly 20 percent of the deaths among women of childbearing age are related to maternal complications.

Pakistan Maternal Mortality Survey-2019 had reported a decline in maternal mortality in the country to 276 per 100,000. Yet there is a dire need to do more for women who are least likely in South Asia to receive adequate healthcare while residing in remote areas. 178 women die of pregnancy-related causes for every 100,000 live births. The ratio is far higher than the regional average. Not surprisingly, only about 20 percent of births are attended by a trained health professional.

A three-year gap between pregnancies is imperative to maternal and neonatal health. On average, women lose between 380ml-400ml of blood during a C-section.

Even if they have a vaginal birth, there is still postpartum bleeding which lasts around 40-45 days. In some cases, women can develop postpartum haemorrhaging, and then there are dietary deficiencies; all these can lead to anaemia in new mothers.

The anaemia, though treatable, becomes a health concern for the mother and the children when there is not enough gap between two pregnancies. A woman’s uterus needs to heal before the next pregnancy. If they have had a C-section, the scar must heal fully before the uterus is ready to take on a long term pregnancy.

There are seven layers of tissue that are incised in a C-section. A woman getting pregnant a year after her caesarian has little chance of carrying a baby fullterm.

A woman may give early birth because she developed scar tenderness and pain between 30 and 34 weeks of her pregnancy.

Children born between 24 and34 weeks of pregnancy are premature; between 34 and 37 weeks they are called early births. They are normal if born between 37 and 42 weeks.

Neonatal health is acutely dependent on maternal health during and after pregnancy. For it, regular prenatal checkups, proper supplement and food intake and timely supportive medication and vaccinations are needed.

Public hospitals can provide the much needed support to lower- and middle-income mothers, but there is a need for proper awareness campaigns targeting women, so that they know how important it is for them to be healthy to have safe pregnancies and births.

Maternal and newborn health are closely linked. Newborn survival is further complicated by other poorly performing cross-sectoral family care practices and interventions, including those for adequate breastfeeding, hygiene and sanitation.

The factors responsible for this sad state of maternal health in Pakistan include high levels of illiteracy, lack of access to health services, lack of sanitation and anaemia among pregnant women. Two most significant contributory factors to maternal mortality are lack of access to effective referral/ support services and absence trained health professionals at the time of delivery.

Many rural women are deprived of essential healthcare facilities. Many die while travelling to far-off hospitals. Rural poverty is another factor in the prevalence of women seeking healthcare facilities during, before or after pregnancy. It is therefore imperative that political stability be restored and long-term policies made to develop healthcare infrastructure in the underprivileged areas. Tele-clinics can guarantee safer pregnancies and positive maternal health outcomes in many cases.

In most rural areas, almost 70 per cent of the population, traditional birth attendants (TBAs) deliver 90 per cent of the babies. These attendants have a crucial role in the delivery of maternal health care.

Keeping this in view the Government of Pakistan launched the Community Mid-wives (CMWs) programme in 2006 as a major initiative to provide birth attendance skills to women living in rural areas of the country. The main purpose of the program is to extend maternal and newborn services to the communities, through selection and training of community midwives from rural areas, and to deliver services to their local communities. This can be the foundation of a strong health system and contribute to achievement of Universal Health Coverage.

Within the context of the Decade of Action-2019, UN has called for accelerating sustainable solutions to all the world’s biggest challenges ranging from poverty and gender, reproductive health and climate change to deliver the 2030 promise. This needs mobilising more government efforts, civil society contributions, businesses community’s role and calling on all people to make the SDGs a priority, particularly the SDG 3 - Good Health and Well-being; and SDG 5, Gender Equality and Empowering All Women and Girls. This needs to be considered in line with the ICPD Programme of Action that stresses promoting gender equality and women’s empowerment, with particular attention to vulnerable and marginalised groups.

The Universal Health Coverage remains depressingly low at only 21 per cent in Pakistan. Every 50 minutes a woman dies due to pregnancy complications. At this rate, Pakistan is likely to achieve zero maternal deaths in 122 years and meet family planning needs in 93 years.

According to the WHO, Pakistan has the highest mortality rate in Asia. It is a shame that women in pre-natal and post-natal periods are dying from preventable causes. The high mortality is an indication of lack of treatment opportunities for women. The Covid-19 pandemic may have held back progress on maternal health.

Most of the maternal deaths in Pakistan are preventable. The healthcare solutions to prevent or manage the complications are well known. All women need access to high-quality care in pregnancy and during and after childbirth. Maternal and newborn health are closely linked. Newborn survival is further complicated by other poorly performing cross-sectoral family care practices and interventions, including adequate breastfeeding, hygiene and sanitation. The UNICEF reports that the national neonatal mortality rate in Pakistan is 42 per 1,000 live births. The relevant SDG aims for12 per 1,000 live births.

Pakistan has done well to reduce maternal mortality. In order to continue reducing the rate, it is essential that the governments continue to work with international organisations to fund new facilities to create more qualified healthcare workers and educate the masses in the benefits of specialised care.

The writer is a playwright and a freelance journalist. He can be reached at pashajaved1@gmail.com. He also blogs at soulandland.com