Abstract:
Background: Despite global improvements in maternal and newborn health (MNH), maternal, fetal and newborn
mortality rates in Pakistan remain stagnant. Using data from the Global Network’s Maternal Newborn Health
Registry (MNHR) the objective of this study is to compare the rates of maternal mortality, stillbirth and newborn
mortality and levels of putative risk factors between the Pakistani site and those in other countries.
Methods: Using data collected through a multi-site, prospective, ongoing, active surveillance system to track pregnancies
and births in communities in discrete geographical areas in seven sites across six countries including Pakistan, India, Kenya,
Zambia, Guatemala and Argentina from 2010 to 2013, the study compared MNH outcomes and risk factors. The MNHR
captures more than 60,000 deliveries annually across all sites with over 10,000 of them in Thatta, Pakistan.
Results: The Pakistan site had a maternal mortality ratio almost three times that of the other sites (313/100,000 vs
116/100,000). Stillbirth (56.5 vs 22.9/1000 births), neonatal mortality (50.0 vs 20.7/1000 livebirths) and perinatal
mortality rates (95.2/1000 vs 39.0/1000 births) in Thatta, Pakistan were more than twice those of the other sites.
The Pakistani site is the only one in the Global Network where maternal mortality increased (from 231/100,000 to
353/100,000) over the study period and fetal and neonatal outcomes remained stagnant. The Pakistan site lags
behind other sites in maternal education, high parity, and appropriate antenatal and postnatal care. However,
facility delivery and skilled birth attendance rates were less prominently different between the Pakistani site and
other sites, with the exception of India. The difference in the fetal and neonatal outcomes between the Pakistani
site and the other sites was most pronounced amongst normal birth weight babies.
Conclusions: The increase in maternal mortality and the stagnation of fetal and neonatal outcomes from 2010 to 2013
indicates that current levels of antenatal and newborn care interventions in Thatta, Pakistan are insufficient to protect
against poor maternal and neonatal outcomes. Delivery care in the Pakistani site, while appearing quantitatively
equivalent to the care in sites in Africa, is less effective in saving the lives of women and their newborns. By the metrics
available from this study, the quality of obstetric and neonatal care in the site in Pakistan is poor.
