Maternal mortality in Pakistan--compilation of available data.

OBJECTIVE To compile available information - both hospital and community based--on the maternal mortality ratios (MMRs) and the causes of maternal deaths in Pakistan METHODS Data was collected from articles published in Medical Journals, in Proceedings of Conferences and of Workshops as well as from Newsletters of the National Committee for Maternal Health (NCMH). The data was then tabulated in order of the year of publication. RESULTS The MMRs reported from hospitals vary between 17 in a private tertiary hospital to 2,736 in a government tertiary hospital. In the community the range is from 160 in Sindh to 673 in Khuzdar. Data for different periods of time from three tertiary public hospitals, two in the south and one in the north of Pakistan, show no decrease in MMRs. The trend remains the same. In the hospitals over 80% of the deaths are due to direct causes. The most common cause of death is hemorrhage, followed by eclampsia and sepsis. The causes of death in the community are also the same though the proportions vary. Direct causes account for 78.1% of deaths, hemorrhage being the most common followed by sepsis, eclampsia, rupture of the uterus, and abortions. CONCLUSIONS Available data shows that the Maternal Mortality Ratios in Pakistan continue to remain high despite attention paid to maternal health. To address the unacceptable state of maternal health, a policy change with a more comprehensive and integrated approach to maternal health services is needed. Strategies need to be developed which are short term, medium term and long term. This includes competency based training, deployment and supervision of a cadre of skilled attendants for delivery at the community level. In addition upgrading of health care systems especially availability of emergency obstetric care is urgently required.