Abstract:
Background: Pakistan has among the poorest pregnancy outcomes worldwide, signifcantly worse than many other
low-resource countries. The reasons for these diferences are not clear. In this study, we compared pregnancy out‑
comes in Pakistan to other low-resource countries and explored factors that might help explain these diferences.
Methods: The Global Network (GN) Maternal Newborn Health Registry (MNHR) is a prospective, population-based
observational study that includes all pregnant women and their pregnancy outcomes in defned geographic commu‑
nities in six low-middle income countries (India, Pakistan, Democratic Republic of Congo, Guatemala, Kenya, Zambia).
Study staf enroll women in early pregnancy and follow-up soon after delivery and at 42 days to ascertain delivery,
neonatal, and maternal outcomes. We analyzed the maternal mortality ratios (MMR), neonatal mortality rates (NMR),
stillbirth rates, and potential explanatory factors from 2010 to 2018 across the GN sites.
Results: From 2010 to 2018, there were 91,076 births in Pakistan and 456,276 births in the other GN sites combined.
The MMR in Pakistan was 319 per 100,000 live births compared to an average of 124 in the other sites, while the
Pakistan NMR was 49.4 per 1,000 live births compared to 20.4 in the other sites. The stillbirth rate in Pakistan was 53.5
per 1000 births compared to 23.2 for the other sites. Preterm birth and low birthweight rates were also substantially
higher than the other sites combined. Within weight ranges, the Pakistani site generally had signifcantly higher
rates of stillbirth and neonatal mortality than the other sites combined, with diferences increasing as birthweights
increased. By nearly every measure, medical care for pregnant women and their newborns in the Pakistan sites was
worse than at the other sites combined.
Conclusion: The Pakistani pregnancy outcomes are much worse than those in the other GN sites. Reasons for these
poorer outcomes likely include that the Pakistani sites’reproductive-aged women are largely poorly educated, under‑
nourished, anemic, and deliver a high percentage of preterm and low-birthweight babies in settings of often inad‑
equate maternal and newborn care. By addressing the issues highlighted in this paper there appears to be substantial
room for improvements in Pakistan’s pregnancy outcomes