As far as paperwork is concerned, the country has a strong health infrastructure, but according to official figures, there is currently one doctor for 1,500 patients across Pakistan, while only 756 basic facilities for pregnant women and newborns across the country.
According to official statistics, the number of government hospitals in the country was 948 in 2008, while after 11 years in 2019 it has just increased to 1282. Experts say these government hospitals have a huge patient load and are too small for a country with a population of more than 220 million. The centres, which were supposed to operate 24 hours a day, are only open to women for six to eight hours.
According to the United Nations, Pakistan has the highest maternal mortality rate among South Asian countries. One in five women experience complications during childbirth. Health experts believe that if there are trained Lady Health Workers (LHWs) and Community Midwives (CMWs), 9 out of 10 children can be born safely at home. But for that, basic health centres will have to make functional and adequate training has to be provided to community health workers.
Another major tragedy in maternal health is that Pakistani women are severely iron deficient. About 45% of women with anemia are said to be from Pakistan. According to a study, 70% of women in Pakistan suffer from anemia, including women from well-educated families.
In pregnancy, iron deficiency also increases the risk of having a low birth weight baby and a premature delivery. After giving birth, iron deficiency (anemia) can also affect women by causing tiredness and reduce milk production. It is also associated with postnatal depression. Additionally, iron deficiency in pregnancy increases the risk of having a pre-term baby. Above all, if the mother's haemoglobin is low, even a small amount of blood loss during childbirth can be life-threatening.
The health of the mother is as important as the birth of the new baby, but if there is no proper interval between the births of the children, the health risks to the future life of both the mother and the child increases. According to statistics, about 178 out of every 100,000 women in Pakistan lose their lives during pregnancy-related complications, while about 42 out of every 1,000 children die from birth to one year of age.
Healthy Timing and Spacing of Pregnancy (HTSP) is a valuable intervention developed by the World Health Organization (WHO), which help women and families delay or space their pregnancies to achieve the healthiest outcomes for women, newborns, infants, and children, within the context of free and informed choice, taking into account fertility intentions and desired family size.
By the intrusion of HTSP, WHO recommends a minimum inter-birth interval of 33 months between two consecutive live births in order to reduce the risk of adverse maternal and child health outcomes.
If we look at the rapidly growing population, we can see that Pakistan has become the 5th largest country in the world in terms of population size. The government launched a Family Planning Program to stabilise the health and population of its citizens. According to official figures for 2018-2019 in Pakistan, 34% of married women aged 15-49 in the country use some form of contraception. And 43% have used a contraceptive at least once. Educated women are more likely to use such methods. 30 percent of illiterate women use some form of contraception, 34 percent of those educated up to first or second grade, 36 percent of those educated from third to seventh grade. And 39% of women are those who have some knowledge of any contraceptive method.
The reason for people shying away from using contraceptives is skepticism and side effects. Similarly, there are many misconceptions about birth control pills. Some women believe that if they take birth control pills for too long, they will get cancer or they will not be able to breastfeed other babies.
According to Pakistan Demographic and Health Survey (PDHS) 2017–18, with a 34% Contraceptive Prevalence Rate (CPR), 17% of the currently married women still have an unmet need for family planning services while only 34% of married women are currently using a contraceptive method.
As per a 2012 report by the Population Council, Pakistan has the highest abortion rate i.e., 50 abortions for every 1,000 women aged between 15 and 44 which is four times high than the United States. According to Pakistan law, abortion is only allowed at the time of need. However, the law doesn’t elaborate on the term need. According to the research, most of the women are married and belonged to the unprivileged segment, hence, without any medical information and access to contraceptives.
If family planning facilities are properly utilised the number of unwanted pregnancies can be reduced, thus reducing the need for unsafe abortion. As per a study of the Population Council, out of 4.5 million unwanted pregnancies each year, about 700,000 ends up in post-abortion complications and 500 women die because of unsafe abortion, accounting for 5-13 percent of the maternal mortality rate in Pakistan.
Women’s empowerment is the only way to enable women to make informed decisions about the use of family planning, involving men as equal, responsible, and active partners is an important step to promote reproductive and sexual health.
Since traditional gendered roles for men and women often deny women the power to make decisions about family planning, etc, experts recommend educating both women and men on the importance of gender equality and reproductive rights to create a world where women can take control of their reproductive rights.