ISLAMABAD: Even though the health of the newborn depends on the health of the mother, Pakistan reports 1.4 million cases of low birth weight leading to at least 11,000 maternal deaths every year whereas 62 infants (per 1,000 live births) die before seeing their first birthday.

The data from the Population and Housing Census 2023 and National Nutrition Survey 2018 further showed that 40pc children (under the age of five) were stunted, 29pc were underweight, and 18pc were wasted.

On the other hand, Nutrition International claims that in Pakistan as many as 41.7pc women suffer from anaemia, 14.4pc are underweight and 24pc are overweight. The state of maternal nutrition is so bleak that 186 women die per 100,000 live births and suboptimal breastfeeding leads to 2,000 deaths in mothers.

The Ministry of National Health Services (NHS) spokesperson Sajid Shah agreed that despite the improvement, maternal and child health needed further attention in Pakistan and the ministry was focused on the issue.

1.4m cases of low birth weight, 11,000 maternal deaths occur annually; 62 infants out of 1,000 die before first birthday

However, the National Nutrition Survey (NNS) 2018 shows that 54pc children and mothers are anaemic, 52pc are Vitamin A deficient and 63pc are Vitamin D deficient.

It further shows that 80pc women of reproductive age are Vitamin D deficient and 27pc are Vitamin A, calcium, and zinc deficient. The survey shows 31.9pc women do not get antenatal care during pregnancy and 67.8pc do not get postnatal care.

The survey reveals that during pregnancy only 33.4pc women get Iron-Folic Acid (IFA) supplementation, 26.8pc take calcium supplementation, and only 6.2pc get multivitamins, which causes stunting and wasting. The World Health Organisation uses wasting to refer to a child who is too thin for their height.

On the other hand, the survey claims a number of children were overweight or too heavy for their height. This form of malnutrition results from expending too few calories for the amount of food consumed and increases the risk of non-communicable diseases later in life.

Dr Abdul Jabbar Bhutto, paediatrician and public health expert at Polyclinic Hospital, told Dawn a number of neonates could not survive because of weakness and in most cases, their mothers were also anaemic.

“If a baby has less than 1.5kg weight at the time of their birth, it is called very low birth weight. Even 2.5kg is considered to be low birth weight. However, I have seen cases in which babies were born with extremely low weight of 1kg,” he said.Dr Bhutto said the common causes were weak mothers, early child-bearing age of the mother, and low and poor socioeconomic status. He said babies became more vulnerable if their mother died at the time of birth or they did not get breastfed.

Population increase

Population Council Programmes Senior Director Dr Ali Mir told Dawn Pakistan was among the few countries that have a high number of maternal deaths globally.“This alarming statistic is impacted by a high rate of unintended pregnancies, primarily due to a staggering 17.3pc unmet need for family planning… Malnourishment of mothers and newborns is a direct result, with 11,000 maternal deaths occurring annually,” Dr Mir added. He said an increase in Contraceptive Prevalence Rate from 34pc to 52pc could prevent 3,800 maternal deaths each year. Additionally, 37pc of children born in Pakistan have a gap of less than two years between them, a major contributing factor to adverse maternal health outcomes,” he said.

Economic cost

According to Nutrition International, undernutrition costs Pakistan at least $17 billion every year. The cost of low breastfeeding in Pakistan is $2.8 billion, as the country reports 6.9 million cases of diarrhoea, 19,000 cases of obesity, 30,525 child deaths (diarrhoea/pneumonia), and 3,196 maternal deaths (breast/ovarian cancer and Type II diabetes).

There are 918,154 new cases of anaemia among pregnant women and adolescent girls (15-49) every year. Pakistan has the fourth highest prevalence of anaemia in adolescent girls and women in South Asia and ranks 35th in the world out of 201 countries.

Govt’s perspective

Ministry spokesperson Sajid Shah said the ministry and provincial health departments in 2016 agreed on a 10-point action plan for improved maternal and child health.“Efforts have been made to improve mother and child health services through empowering lady health workers (LHWs), strengthening Emergency Obstetric and Neonatal Care (EmONC) and referral services, pursuing universal health coverage through Essential Package of Health Services (EPHS), digital innovations in Healthcare Electronic Data Management System, revised Pregnancy Childbirth Postpartum and New Born Care (PCPNC) training package, managing complications in pregnancy and childbirth (MCPC) guide, investing in the nutrition of adolescent girls, mothers and children,” he said.

Mr Shah claimed that as health was largely a devolved subject to provinces, coordinated efforts were being made to strengthen health services in the country mainly through public sector financing and with the help of development partners.

“The ministry is regularly monitoring the Reproductive Maternal Newborn and Child Health (RMNCH) status at national, provincial and district levels…using RMNCH Service Coverage Index (SCI) at 64.7 per cent in 2022 against the target of 80 per cent by 2030,” he claimed.

Recommendations

Representative of the Population Council Ikramul Ahad said statistics highlighted the urgent need for improved healthcare access and effective family planning initiatives. “Increasing the contraceptive use rate from the current 34pc to 52pc could save approximately 140,000 infant lives annually.”

Nutrition International has suggested achieving the World Health Assembly (WHA) Global Nutrition Target (2025) on stunting, low- birth weight and anaemia will generate at least $4.3 billion in economic benefits annually. It has also suggested accelerating the implementation of ‘Pakistan Maternal Nutrition Strategy (PMNS) 2022-27’ through a unified maternal nutrition package. It may be mentioned that after a countrywide series of consultations, the PMNS strategy was formulated to protect and promote diets, practices and services that support the optimal nutrition, health and well-being of all women in Pakistan.

Meanwhile, Nutrition International Country Director Dr Shabina Raza suggested ensuring good nutrition during pre-conception and in the first 1,000 days, from conception to the child’s second birthday. She said there should be more global and national commitments and investments in maternal nutrition.The health ministry spokesperson called for collective and coordinated efforts from all stakeholders to develop a holistic approach built on the Pakistan Costed Multi-Sectoral National Nutrition Action Plan 2023-2030.

Published in Dawn, September 1st, 2024