Emergency obstetric care in Pakistan: potential for reduced maternal mortality through improved basic EmOC facilities, services, and access.
OBJECTIVE
To ascertain and compare compliance with UN emergency obstetric care (EmOC) recommendations by public health care centers in Pakistan's Punjab and Northwest Frontier Province (NWFP) provinces.


METHODS
Cross-sectional data were collected from July through September 2003 using UN process indicators. From each province, 30% of districts (n=19); were randomly selected; all public health facilities providing EmOC services (n=170) were included.


RESULTS
The study found that out of 170 facilities only 22 were providing basic and 37 comprehensive EmOC services in the areas studied. Only 5.7% of births occurred in EmOC health facilities. Met need was 9% and 0.5% of women gave birth by cesarean section. The case fatality rate was a low 0.7%, probably due to poor record keeping. Access and several indicators were better in NWFP than in Punjab.


CONCLUSIONS
Almost all indicators were below UN recommendations. Health policy makers and planners must take immediate, appropriate measures at district and hospital levels to reduce maternal mortality.
Ali
M
M
Department of Health Policy and Planning, Institute of International Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo 113-0033, Japan.
Hotta
M
M
Kuroiwa
C
C
Ushijima
H
H
D003430:Cross-Sectional Studies; D036861:Delivery, Obstetric; D004632:Emergency Medical Services; D005260:Female; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D006801:Humans; D008427:Maternal Health Services / Q000592:standards* / Q000706:statistics & numerical data; D008428:Maternal Mortality; D008429:Maternal Welfare; D009774:Obstetrics / Q000592:standards*; D010154:Pakistan / Q000453:epidemiology; D011247:Pregnancy; D011295:Prenatal Care; D011635:Public Health Administration / Q000592:standards; D014480:United Nations