Review article
DOI: 10.1111/j.1471-0528.2011.03114.x www.bjog.org
Achieving Millennium Development Goals 4 and 5 in Pakistan G Mahmud,a,b,c F Zaman,d S Jafarey,e,f RL Khan,g R Sohail,g S Fatima,a a
Department of Obstetrics and Gynaecology, Maternal and Child Health Centre, Pakistan Institute of Medical Sciences, Islamabad, Pakistan Quaid-e-Azam Postgraduate Medical College, Pakistan Institute of Medical Sciences, Islamabad, Pakistan c Faculty of Medicine, Quaid-e-Azam University, Islamabad, Pakistan d Department of Obstetrics and Gynaecology, Rashid Latif Medical College, Lahore, Pakistan e Department of Obstetrics and Gynaecology, Ziauddin University, Karachi, Pakistan f National Committee for Maternal and Neonatal Health, Karachi, Pakistan g Department of Obstetrics and Gynaecology, Postgraduate Medical Institute, Lahore, Pakistan Correspondence: Dr S Fatima, H no 33 Army Officers Housing Colony, National Park Road, Rawalpindi, Pakistan. Email
[email protected] b
Accepted 21 July 2011.
Pakistan is a signatory of many international development strategies including the Millennium Development Goals, and the government is committed to achieving a reduction in infant mortality rate from 72 to 90
350 75
52.1 48 >43
MTDF, medium-term development framework; PRSP, poverty reduction strategy paper. Source: PDHS 2006–7; www.ddp-ext.worldbank.org/ext/ddpreports World Bank Group, 10 September 2008.
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ª 2011 The Authors BJOG An International Journal of Obstetrics and Gynaecology ª 2011 RCOG
Intrapartum care The percentage of deliveries that take place in a health facility has doubled in the past 10 years, increasing from 17% in 1996 to 23% in 2000–17 to 34% in 2006–7.8 Eleven percent of these deliveries are in the public sector health facilities and 23% in private facilities. The rest, that is, over 65%, take place at home. Health facility deliveries in urban areas are over twice (56%) as common as those in rural areas (25%). Delivery in a health facility also varies by province, being lowest in Balochistan (18%) and highest in Sindh (42%). About two-fifths (34%) of deliveries take place with the assistance of a skilled birth attendant (doctor, nurse, midwife, or lady health visitor). Traditional birth attendants (TBAs) assist with more than half (52%) of deliveries. The rest are by friends and relatives (7%) or lady health workers (1%). A tiny fraction of births take place without any assistance at all. Deliveries in urban areas are twice as likely to be assisted by a skilled health provider (60%) than births in rural areas (30%). Births in Sindh province are most likely to be attended by a skilled health provider (42%)6 (Figure 1).
Postnatal care According to the PDHS survey, two-fifths (43%) of women received postnatal care for their last birth, making it far less common than prenatal care (65%). More than a quarter of women received postnatal care within 4 hours of delivery, 6% within the first 4–23 hours, 7% within 2 days after delivery and 3% were seen within 3–41 days of delivery.
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71 56
84
55 25
33
42
41 30 18
22
Mother's educaƟon No educaƟon Primary Middle Secondary Higher
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Province Punjab Sindh Kyber Pakhtoonkhaw Balochistan
90 80 70 60 50 40 30 20 10 0
Residence Total urban Major city Other urban Rural
Urban women are more than twice (48%) as likely to seek antenatal care compared with rural women (20%).4 Younger mothers (
