A major challenge to address the maternal mortality issue is the strengthening of awareness campaigns. It has been witnessed that despite an extensive network of infrastructure and significant amount of resources spent on maternal health programmes, maternal mortality indicator does not show a promising picture.

Safe and healthy maternal care is the constitutional right of every women in Pakistan. Maternal health standards surround the respectful maternal care at all levels of pregnancy including prenatal care, safe child birth and postpartum checkups. So, it is the responsibility of the government to ensure these rights by establishing enabling environment to support safe maternal health. The constitutional rights of women health are violated when pregnant as well as birthing women are prone to death due to maternal complications such as mistreatment, illness, injury due to domestic violence, abuse, and renunciations of information and other social and cultural issues. After devolution, it is the obligations of provincial governments in Pakistan to ensure maternal health rights. At a time once most, when different countries are showing drastic progress on maternal health, pregnant and birthing, within this geographical region, women are suffering death and injury at ever-increasing rates.

Although, Women’s health during pregnancy has been an important priority in provincial health plans and programmes in Punjab over the last decade due to the government’s commitment towards achieving the worldwide agenda of Millennium development Goals initially and later the Sustainable Development Goals (SDGs). There are over 6000 children born every day in Punjab. According to MICS 2018 data, 73.3 percent of the deliveries in Punjab are institutional deliveries. This implies that a large number of childbearing women and newborns account for hospital stays each year, making childbirth by far the most common reason for hospitalization and a cause of public health care expenditure. The efforts for improving the maternal mortality indicator have not been able to achieve the desired outcomes because according to the latest data (MICS 2018) there has been a substantial increase in the maternal mortality ratio. Maternal mortality figures in the Punjab have reached high of 180 deaths per 100,000 live births in 2018, these figures have increased from 178 deaths per 100,000 live births as per United Nation estimates of 2015. This rise in maternal mortality may be due to various inadequacies in the maternal health programmes and policies of the government. The current maternal mortality figures of Pakistan are worse than those of India and Bangladesh. According to recent World Health Organization (WHO) rankings of countries on maternal mortality rates (MMRs), Pakistan ranks at 130 number. The highest MMRs are found in Sub-Saharan Africa (547) and in low-income countries (496). Conversely, the lowest rates of maternal death are found in high-income countries (10), the European Union (8) and North America (12). The global MMR is 216 per 100, 000 live births. Globally, the MMR fell by nearly 44perecnt over the past 25 years, to an estimated 216 maternal deaths per 100 000 live births in 2015, from an MMR of 385 in 1990.

According to Population Council estimates, each year, nearly 8.6 million women become pregnant in Pakistan, of these, 15percent, i.e., 1.2 million women are likely to face maternal complications. Each year, about 14000 women including 6000 from Punjab die due to pregnancy related complications in Pakistan. With this high MMR, Punjab as well as Pakistan would not been able to achieve its Sustainable Development Goal (SDG) target of reducing maternal mortality to 70 per 100,000 live births by 2030. The situation is upsetting for a province which has a relatively larger health infrastructure than the other provinces. Punjab currently has 3913 health facility units which includes BHUs, RHCs, THQs, DHQs, MCHs and teaching hospitals in the public sector and the sector is on average spending 0.8 percent of its GRP on healthcare. Private sector health care delivery is also a major part of health care system in Punjab which caters a major chunk of the population at their ‘Out of Pocket Expenditure’. The share of private sector spending as a percentage to GRP is relatively higher than the public sector with 1.5 percent of GRP. Despite all these spending, one woman loses her life in every 37 minutes in Pakistan and in 100 minutes in Punjab either due to pregnancy complications or during child-birth. Since every mother has the right to stay alive and healthy therefore, maternal mortality is also a crucial human rights issue. As most of the causes of maternal mortality are not only treatable but also preventable, the rising rate of maternal mortality amounts to the violation of basic human rights of health and life. The mothers in Punjab are facing birth complications and the related untimely deaths because there is no focus on raising the demand for maternal healthcare. There were 26.7 percent of the deliveries which were non institutional or home deliveries by untrained personnel. If pregnant women are given awareness about the health benefits of giving birth in a health facility or hospital, the risk factors associated with maternal morbidity and mortality may be reduce.

The risk of maternal death is associated with various economic, cultural and social factors such as maternal age, income, access to health care facilities and regional disparities. The analysis of these factors is very important for both the preventive and curative measures of maternal health care. For example, according to PDHS 2007 data, maternal mortality ratio in rural areas was 1.8 times higher than that of urban areas. Similarly, the maternal mortality ratio in women aged above 40 was observed to be 4 times higher than those aged below 30. The reason being that the older women are more likely to develop complications during pregnancy or delivery. Effective strategies to promote maternal health should therefore not only include health awareness campaigns targeting women in this age bracket but the government should also have specially designed health and nutrition programmes and policies which cater to the needs to these women.