title: Reproductive, maternal, newborn, and child health in Pakistan: challenges and opportunities.
abstract: Globally, Pakistan has the third highest burden of maternal, fetal, and child mortality. It has made slow progress in achieving the Millennium Development Goals (MDGs) 4 and 5 and in addressing common social determinants of health. The country also has huge challenges of political fragility, complex security issues, and natural disasters. We undertook an in-depth analysis of Pakistan's progress towards MDGs 4 and 5 and the principal determinants of health in relation to reproductive, maternal, newborn, and child health and nutrition. We reviewed progress in relation to new and existing public sector programmes and the challenges posed by devolution in Pakistan. Notwithstanding the urgent need to tackle social determinants such as girls' education, empowerment, and nutrition in Pakistan, we assessed the effect of systematically increasing coverage of various evidence-based interventions on populations at risk (by residence or poverty indices). We specifically focused on scaling up interventions using delivery platforms to reach poor and rural populations through community-based strategies. Our model indicates that with successful implementation of these strategies, 58% of an estimated 367,900 deaths (15,900 maternal, 169,000 newborn, 183,000 child deaths) and 49% of an estimated 180,000 stillbirths could be prevented in 2015.
authors.affiliation: Department of Paediatrics and Child Health, Division of Women and Child Health, Aga Khan University, Karachi, Pakistan. zulfiqar.bhutta@aku.edu
authors.forename: Zulfiqar A
authors.initials: ZA
authors.lastname: Bhutta
authors.forename: Assad
authors.initials: A
authors.lastname: Hafeez
authors.forename: Arjumand
authors.initials: A
authors.lastname: Rizvi
authors.forename: Nabeela
authors.initials: N
authors.lastname: Ali
authors.forename: Amanullah
authors.initials: A
authors.lastname: Khan
authors.forename: Faatehuddin
authors.initials: F
authors.lastname: Ahmad
authors.forename: Shereen
authors.initials: S
authors.lastname: Bhutta
authors.forename: Tabish
authors.initials: T
authors.lastname: Hazir
authors.forename: Anita
authors.initials: A
authors.lastname: Zaidi
authors.forename: Sadequa N
authors.initials: SN
authors.lastname: Jafarey
mesh_terms: D000328:Adult; D001294:Attitude to Health; D002648:Child; D046688:Child Mortality / Q000639:trends*; D002669:Child Welfare; D002675:Child, Preschool; D003906:Developing Countries; D005260:Female; D005102:Health Expenditures; D007722:Health Knowledge, Attitudes, Practice; D006291:Health Policy; D006293:Health Promotion / Q000458:organization & administration; D006801:Humans; D007226:Infant Mortality / Q000639:trends*; D007231:Infant, Newborn; D008297:Male; D008428:Maternal Mortality / Q000639:trends*; D020380:Needs Assessment; D010154:Pakistan; D011247:Pregnancy; D060728:Reproductive Health; D018570:Risk Assessment; D012959:Socioeconomic Factors; D055815:Young Adult