ISLAMABAD: Pakistan ranked third among the top 10 countries with the largest number of maternal deaths, neonatal mortality and stillbirths in 2020, according to a progress report published by three specialised agencies of the United Nations.

The latest estimates, published jointly by WHO, Unicef and UNFPA in the report titled, ‘Improving maternal and newborn health and survival and reducing stillbirth -- the progress report 2023’ show there were a combined 4.5 million deaths; maternal deaths (0.29 million), stillbirths (1.9 million), and newborn deaths (2.3 million).

Sub-Saharan Africa and Central and Southern Asia are the regions experiencing the largest number of deaths, although across all regions, there is variation regarding the pace at which countries are progressing in their efforts to achieve the global 2030 targets.

The top 10 countries with the highest burden account for 60 per cent of global maternal deaths, stillbirths, and newborn deaths, and 51 per cent of the world’s live births.

UN report says the total number of maternal, neonatal deaths and stillbirths stood at 474,000

India leads the top 10 countries followed by Nigeria, Pakistan, Congo, Ethiopia, Bangladesh, China, Indonesia, Afghanistan and Tanzania. The estimates were published ahead of the World Population Day being observed on Tuesday.

In Pakistan in 2020, the total maternal deaths, stillbirths and neonatal deaths were 474,000. The share of total maternal deaths, stillbirths and neonatal deaths was 10 per cent, while the share of total live births was 5 per cent. There were 10,000 maternal deaths during the year, with 207,000 stillbirths and 257,000 neonatal deaths.

The report says that over the past two decades, Pakistan has endured natural disasters and humanitarian crises which significantly affected resource allocation, planning, service provision and uptake at both national and sub-national levels.

Such emergencies hamper routine care and cause widespread displacement. While sub-national or provincial level leadership played an important role in risk mitigation and resource mobilisation, maternal and perinatal health were not always prioritised at the service delivery level.

At the beginning of the Covid-19 pandemic, the number of antenatal care (ANC) visits or contacts, facility births and postnatal care (PNC) declined. The pre-existing National Technical Working Group (TWG) for reproductive, maternal, newborn, child and adolescent health (RMNCAH), of which 33 per cent of members represented provincial governments, guided formulation of sub-committees and response bodies at both federal and provincial levels to provide oversight for the continuation of routine and emergency services.

In response to the pandemic, Pakistan developed policies, guidelines and plans. Its strategic framework for provision of maternal and newborn health services during and post-Covid-19 included advocacy for non-diversion of health care resources at the expense of RMNCAH and nutrition (RMNCAH-N) resources; disaggregating surveillance and overall response efforts, including case management, by age, gender, pregnancy status; segregating maternal health units from Covid-19 cases; protecting the health care workforce from exposure to Covid-19 with various measures; and ensuring continuous supply of life-saving drugs and equipment for essential health services.

The progress report shows that trend data reveal global progress in reducing maternal and newborn deaths and stillbirths has slowed during the last decade. Gains made between 2000 and 2010 were faster than they have been in the years since 2010.

It is critical to determine the reasons for this slowed pace, and take action to address them. Global challenges posed by the Covid-19 pandemic, climate change, conflicts and other emergencies, as well as cost of living increases within countries have the potential to further slow progress in this decade, warranting greater urgency and investment towards maternal and newborn health targets.

Published in Dawn, July 11th, 2023