Islamabad: Pakistan, the world’s sixth most populous country, faces significant challenges in delivering reproductive health services due to natural disasters, a large youth population, and entrenched poverty and inequality. This has contributed to the country having the third highest rate of maternal, fetal, and child mortality globally. The nation also struggles with high maternal mortality ratios, adolescent birth rates, and a substantial unmet need for contraception.

According to United Nations Population Fund, the Pakistan Demographic Health Survey (PDHS) 2017-2018 revealed that rural mothers have, on average, one more child than their urban counterparts (3.9 versus 2.9 births per woman). Despite nearly universal knowledge of family planning methods, the modern contraceptive prevalence rate is low at 25%, having decreased by 1% since 2012-2013. This indicates a large gap between awareness and actual usage of birth control methods.

There has been a notable improvement in the number of deliveries taking place in health facilities, increasing from 13% in 1990-91 to 66% in 2017-18. Despite this progress, a third of births still occur outside of health facilities, exposing many women, particularly in rural areas, to the risk of serious injuries from obstructed labor and other complications.

Following the administrative devolution of health services in 2010, each of the four provinces established its own department of health. These departments aim to enhance maternal and child health; however, significant service delivery and policy gaps remain, hindering many women and young people’s access to basic healthcare.

A recent Emergency Obstetric and Newborn Care (EmONC) Health Facility assessment of 358 facilities in 22 UHC districts showed that only 9% of these facilities are fully functional for EmONC services. The assessments identified capacity needs within the health system, including staff skills, health facility services management, and supervision systems. The lack of skilled providers at health facilities has resulted in poor quality of care and low rates of service utilization.