In Pakistan, one in 89 women die because of pregnancy and childbirth-related complications, and Pakistan’s Maternal Mortality Rate (MMR) is 299 per 100,000 live births.

Twenty percent of the deaths of women of childbearing age are caused by maternal complications. The majority of these deaths are caused by postpartum hemorrhaging. Hemorrhages can be extremely problematic, especially if hospitals do not have enough blood for transfusions to replace the blood loss. Maternal mortality is also high due to puerperal sepsis and eclampsia. Sepsis is when infections during pregnancy, even those not directly related to the pregnancy, trigger the body’s inflammatory response to infection. Sepsis is also called blood poisoning, and it can only be cured with the prompt treatment of antibiotics.

Eclampsia, the third leading cause of maternal deaths in Pakistan, is convulsions in a pregnant woman resulting from high blood pressure. Eclampsia is often followed by a coma.

Rural women are less likely to have access to a hospital. The rate of maternal mortality is consequently higher in rural areas than urban areas—23 percent rather than 14 percent. Home births are extremely common in rural areas. A total of 74 percent of women in rural areas give birth at home, compared to 43 percent of women in urban areas.

If women have an education, they are more likely to seek out prenatal care. Ninety-six percent of women with education had prenatal care visits with a doctor, rather than 50 percent of women who were not educated. One-third of pregnant women in Pakistan do not get prenatal care at all, due to feeling it is unnecessary or that it costs too much money. Prenatal care can help prevent complications and decrease the maternal mortality rate. While prenatal care visits have increased, as of 2007, only 28 percent of Pakistani women went to the recommended four prenatal care visits.

Another reason why Pakistan has a high maternal mortality rate is due to the fact that contraceptive use has not increased much in recent years. In 1984, the Total Fertility Rate (TFR) was six children per woman in Pakistan. By 2008, this number declined to about four children per mother, with a rate of about three children per mother for women in urban areas. However, contraceptive use has remained steady, and only about 30 percent of married women of childbearing age use contraceptives. Contraceptive use is still stigmatized by religious members of the community, such as Mohammed Zakaria, the mufti of Jamia Islamia, an Islamic religious school. Zakaria argues that “family planning is wrong and un-Islamic if practiced routinely.” Educated mothers are more likely to use contraceptives, but many women in Pakistan are uneducated. NPR argues that an increase in education would lead to an increase in contraceptive use and a corresponding decrease in maternal mortality, citing Sri Lanka as an example. In Sri Lanka, the literacy rate is 91 percent (compared to 62 percent in Pakistan).

Maternal mortality is also a problem in Pakistan due to a shortage of doctors, nurses and beds at government hospitals. Many of the regular staff members are postgraduate trainees who are not able to handle pregnancy-related complications.

Pakistan currently only spends less than 1 percent of its GDP on healthcare. In order for maternal mortality rates to decrease, more money has to be devoted to improving hospital care and making hospitals more accessible. The stigma around contraceptive use also has to end, and an increase in education would also lead to a lower MMR.

– Ashrita Rau

Sources: NPR, UNICEF, NIH, The Express Tribune, USAID The DHS Program
Photo: Pakistan Today