DYING in the process of giving birth is a particularly poignant tragedy. And yet that is how a shockingly high number of women across the globe will continue to lose their lives unless governments recognise the monumental injustice of a situation where most of these deaths can be prevented by ensuring easily available medical interventions. According to Trends in Maternal Mortality, a report by several UN agencies released recently, a woman dies during pregnancy or childbirth every two minutes. That came to over 280,000 fatalities in 2020, a toll aptly described by the UNFPA executive director as “unconscionable”. Alarmingly, the maternal mortality ratio has either stagnated or increased in most parts of the world. Sub-Saharan Africa accounted for 70pc of the fatalities, 82,000 of them in Nigeria alone. The report says that roughly a third of women across the world do not undergo even four of the eight recommended antenatal checkups or receive essential postnatal care; around 270m women lack access to modern family planning methods.

While South Asia is one of two regions where the MMR has shown a significant decline over the years, including in Pakistan, the country’s MMR remains unacceptably high at 154 in 2020, when 9,800 women died during pregnancy or childbirth. MMR in the same year for India was 103; in Bangladesh, it was 123. Pakistan’s MMR also provides a window into the inequity in human development indicators across the country. As per the Pakistan Maternal Mortality Survey, the MMR for Punjab is 157, while for Balochistan it is 298. There is likewise considerable disparity of around 25pc between rural and urban MMR with the latter registering a lower figure. These statistics also have a symbiotic link with gender inequality in Pakistan’s patriarchal culture where many women do not have agency over decisions about their reproductive health, including how many children to have and spacing between births. According to the Pakistan Demographic Health Survey 2018-19, only 10pc women can take decisions about their health in Pakistan. Couple that with inadequate antenatal care and lack of awareness, and it all adds to the risks incurred by pregnant women as well as the underweight babies they often bear.

Last year’s devastating floods and the prevailing economic crisis have pushed millions more into poverty and made the achievement of SDGs on reducing maternal and infant mortality even more unlikely. The already poor nutritional status of Pakistani women — especially in the rural areas — is sure to worsen, thereby contributing to an even higher prevalence of anaemia among them. This is a critical concern in a country where 41pc of maternal deaths are due to excessive blood loss during childbirth. Special interventions are needed if Pakistan’s modest gains in MMR are not to be reversed.

Published in Dawn, February 27th, 2023