Midhet Farid, Khalid Samina Naeem, Baqai Shehla, Khan Shahzad Ali
Public Health Department, Bahria University Karachi Campus, Karachi, Karachi City, Sindh, Pakistan.
Public Health Department (MNCH), Health Services Academy, Islamabad, Islamabad Capital Territory, Pakistan.
PLoS One. 2025 Jan 13;20(1):e0311730. doi: 10.1371/journal.pone.0311730. eCollection 2025.
Maternal mortality ratio (MMR) has decreased worldwide but Pakistan is still striving towards achieving the SDG targets for maternal health. This study highlights the trends in maternal mortality levels and risk factors in Pakistan between 2007 and 2019.
This study compares the results of secondary data analysis of the Pakistan Maternal Mortality Survey 2019 with the Pakistan Demographic and Health Survey 2007. A nested case-control study was carved to compare maternal deaths with the women who survived a pregnancy, in the same sampling clusters during the same period. Logistic regression was used to estimate odds ratios (OR) for major risk factors of maternal mortality after adjusting for the women's age, parity, education, and wealth quintile.
In 2019, Pakistan's MMR was 186 per 100,000 live births, registering a 33% decline from 2007 (rural 42% vs. urban 11%). The leading causes of maternal mortality were postpartum hemorrhage, hypertensive disease of pregnancy, postpartum infection, and post-abortion complications. Women > 35 years and those expecting their first child were more likely to die from childbirth, while those who had ever used family planning had a lower risk according to the data for both years. In 2007, a distance of > 40 kilometers to a hospital significantly increased the risk of mortality but this association was not significant in 2019. In 2019, women who died were more likely to receive antenatal care than those who survived (adjusted OR 9.3); this association was not significant in 2007.
The modest reduction in MMR can be attributed to improved access to maternal health services in rural areas with increased antenatal care and institutional deliveries. However, most maternal deaths were caused by poor accessibility to quality emergency obstetric care. Lack of family planning remains a major risk factor for high maternal mortality in Pakistan.
全球孕产妇死亡率（MMR）已有所下降，但巴基斯坦仍在努力实现孕产妇健康方面的可持续发展目标（SDG）。本研究突出了2007年至2019年间巴基斯坦孕产妇死亡率水平及风险因素的趋势。
本研究将2019年巴基斯坦孕产妇死亡率调查的二次数据分析结果与2007年巴基斯坦人口与健康调查结果进行比较。开展了一项嵌套病例对照研究，以比较同一时期相同抽样群中孕产妇死亡情况与妊娠存活妇女情况。在对妇女的年龄、胎次、教育程度和财富五分位数进行调整后，采用逻辑回归估计孕产妇死亡主要风险因素的比值比（OR）。
2019年，巴基斯坦的孕产妇死亡率为每10万例活产186例，较2007年下降了33%（农村地区下降42%，城市地区下降11%）。孕产妇死亡的主要原因是产后出血、妊娠高血压疾病、产后感染和流产后并发症。根据这两年的数据，35岁以上的妇女以及初产妇死于分娩的可能性更高，而曾经使用过计划生育的妇女风险较低。2007年，距离医院超过40公里会显著增加死亡风险，但在2019年这种关联并不显著。2019年，死亡妇女比存活妇女更有可能接受产前护理（调整后的OR为9.3）；这种关联在2007年并不显著。
孕产妇死亡率的适度下降可归因于农村地区孕产妇保健服务可及性的改善，包括增加了产前护理和机构分娩。然而，大多数孕产妇死亡是由于难以获得高质量的急诊产科护理。计划生育服务的缺乏仍然是巴基斯坦孕产妇死亡率高的一个主要风险因素。
