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Contextual determinants of maternal mortality in rural Pakistan

Author

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  • Midhet, Farid
  • Becker, Stan
  • Berendes, Heinz W.

Abstract

Maternal mortality is high in Pakistan, particularly in the rural areas which have poor access to health services. We investigated the risk factors associated with maternal mortality in sixteen rural districts of Balochistan and the North-West Frontier (NWFP) provinces of Pakistan. We designed a nested case-control study comprising 261 cases (maternal deaths reported during last five years) and 9135 controls (women who survived a pregnancy during last five years). Using contextual analysis, we estimated the interactions between the biological risk factors of maternal mortality and the district-level indicators of health services. Women under 19 or over 39Â yr of age, those having their first birth, and those having a previous history of fetal loss were at greater risk of maternal death. Staffing patterns of peripheral health facilities in the district and accessibility of essential obstetric care (EOC) were significantly associated with maternal mortality. These indicators also modified the effects of the biological risk factors of maternal mortality. For example, nulliparous women living in the under-served districts were at greater risk than those living in the better-served districts. Our results are consistent with several studies which have pointed out the role of health services in the causation of maternal mortality. Many such studies have implicated distance to hospital (an indicator of access to EOC) and lack of prenatal care as major determinants of maternal mortality. We conclude that better staffing of peripheral health facilities and improved access to EOC could reduce the risk of maternal mortality among women in rural Balochistan and the NWFP.

Suggested Citation

  • Midhet, Farid & Becker, Stan & Berendes, Heinz W., 1998. "Contextual determinants of maternal mortality in rural Pakistan," Social Science & Medicine, Elsevier, vol. 46(12), pages 1587-1598, June.
    • Handle: RePEc:eee:socmed:v:46:y:1998:i:12:p:1587-1598
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    Cited by:

    1. Hai Gu & Hua You & Zhiwen Yan & Nichao Yang & Yun Kou & Jun Sun & Ting Yu & Ning Zhang, 2018. "Determinants of the utilization of postpartum family visits: Evidence from rural areas of Eastern China," PLOS ONE, Public Library of Science, vol. 13(3), pages 1-12, March.
    2. Lisa Cameron & Diana Contreras Suarez & Katy Cornwell, 2019. "Understanding the determinants of maternal mortality: An observational study using the Indonesian Population Census," PLOS ONE, Public Library of Science, vol. 14(6), pages 1-18, June.
    3. Shandana Dar & Uzma Afzal, 2015. "Education and Maternal Health in Pakistan: The Pathways of Influence," Lahore Journal of Economics, Department of Economics, The Lahore School of Economics, vol. 20(2), pages 1-34, July-Dec.
    4. L. Cuna, 2004. "Assessing Household Vulnerability to Employment Shocks: A Simulation Methodology Applied to Bosnia and Herzegovina," Working Papers 528, Dipartimento Scienze Economiche, Universita' di Bologna.
    5. Varley, Emma, 2010. "Targeted doctors, missing patients: Obstetric health services and sectarian conflict in Northern Pakistan," Social Science & Medicine, Elsevier, vol. 70(1), pages 61-70, January.

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