Pakistan's Maternal Health Gap: Progress, Setbacks and What Comes Next

Maternal health outcomes are one of the clearest indicators of how well a health system reaches its most vulnerable populations — and by most available measures, Pakistan continues to lag behind several regional peers, despite meaningful long-term progress.

The scale of the gap

Long-term trends show maternal mortality declining significantly since the 1990s, reflecting real gains in healthcare access and skilled birth attendance nationally. The most recent Pakistan Maternal Mortality Survey, conducted in 2019, put the national maternal mortality ratio (MMR) at 186 deaths per 100,000 live births, down from 276 in 2006-07 — though the pace of improvement has been uneven, and Pakistan's MMR remains higher than in several neighboring countries with comparable or lower per-capita incomes, pointing to health system factors beyond income alone.

Where the gap is widest

Aggregate national figures obscure sharp disparities. Provincial MMR estimates illustrate the gap concretely: Balochistan (298 per 100,000) and Sindh (224) sit far above Punjab (157), Khyber Pakhtunkhwa (165), and Gilgit-Baltistan (157), while Azad Jammu and Kashmir reports the lowest figure nationally at 104. One caution from the survey itself: because the provincial estimates rest on relatively few deaths, their confidence ranges overlap, so the survey does not treat the differences between provinces as statistically significant. The pattern is consistent with gaps in access to skilled care, but it is not proof of exact provincial rankings.

• Rural versus urban access. Skilled birth attendance and access to emergency obstetric care are markedly lower in rural areas, where the nearest functioning facility capable of handling complications may be hours away.
• Provincial disparities. As the figures above show, this isn't a marginal gap — Balochistan's MMR is nearly triple Azad Jammu and Kashmir's, reflecting broader differences in health infrastructure and provider density.
• Socioeconomic disparities. Wealthier, more educated households consistently show better maternal health outcomes, reflecting both better access to antenatal care and greater ability to reach facilities quickly during emergencies.

Structural factors behind the gap

Health policy researchers generally point to a consistent set of underlying issues:

• Health workforce shortages, particularly of skilled birth attendants, midwives and obstetric specialists in rural and remote areas.
• Underinvestment in primary and emergency referral systems, meaning complications that arise during childbirth often can't be managed quickly enough at the local level.
• Low health spending relative to need. Pakistan's public health expenditure as a share of GDP remains low by international comparison, constraining the health system's overall capacity to expand access.
• Limited antenatal care coverage in underserved areas, which reduces early identification of pregnancy complications before they become emergencies.

What's worked, and what could scale further

Several approaches have shown measurable impact where implemented:

1. Community midwife and Lady Health Worker programs, which have extended basic maternal health services into areas historically underserved by formal facilities.
2. Emergency transport and referral networks, connecting rural communities to functioning emergency obstetric care, have reduced delays that are often the deciding factor in maternal emergencies.
3. Conditional health financing programs, including incentives for facility-based deliveries, which have shown positive effects on skilled birth attendance rates in several provinces.
4. Telemedicine and mobile health pilots, extending specialist consultation to remote areas, though scale remains limited by connectivity infrastructure.

The path forward

Sustained progress will likely require continued investment in rural health workforce expansion, stronger primary-to-emergency referral pathways, and increased public health financing — paired with the political continuity needed to see multi-year health system investments through, rather than restarting priorities with each change in government.

Build Better Pakistan's Health Desk covers public health access and outcomes across the country.