Introduction
Maternal mortality refers to when a woman dies during pregnancy or within six weeks after delivery. There are many factors such as biological, socio-economic, cultural and availability of quality Reproductive Health Services (RHS) in the country which contribute to the alarming figure of Maternal Mortality Ratio (MMR). Pregnancy is a normal process in which women experience some physiological changes as it is essential for fetal growth and development. During pregnancy women need healthy diet, antenatal checkup for pregnancy progress and identification of dangers signs and proper treatment. Unfortunately due to certain reasons these needs are not satisfied and resulted in death of the mother. This paper aims to in-depth analysis of the determinants of MM.
Significant of the Issue
Every year more than 500,000 women die during childbirth or from pregnancy-related causes worldwide. 99% maternal deaths occur in developing country (WHO, 2005) as RHS, and family planning services are not easily accessible and affordable. According to UNDP’s report Roca (2013) Pakistan has highest mortality ratio 260/100,000 per live births in the region.
Socio economic determinants
Poverty
Poverty plays as a barrier to satisfy basic human needs and to access reproductive health services which contribute to maternal mortality. Current global economic crises adversely affected specially marginalized poor women. Escalation in fuel prizes made the food items so expensive that it is beyond the capacity of the poor to buy. Due to inadequate quantity and quality of food intake, the pregnant women suffer with nutritional deficiency anemia. A study conducted by Khan, Fatima, Imran and Khan (2010) in Rawalpindi, to assess the risk factors associated with the nutritional deficiency anaemia revealed that majority of the pregnant women were anaemic due to iron deficiency followed by folate and cobalamin and all these belonged to low socio-economic group. Moreover, these nutritional deficit anemic women are at greater risk of having postpartum hemorrhage and sepsis. Furthermore, cost of RHS such as formal fee, screening, purchasing of medicine and travelling acts as barrier for women to obtain care. In case of emergency obstetric complications the cost of treatment goes much high and causes the delay in treatment. A qualitative study by Ronis, Mehboob, Masood, Amjad, & Nishtar (2012) revealed that seventy percent of the patients sold their belonging or borrowed money in order to pay for delivery charges.
Poverty is a great barrier for pregnant women in approaching family planning and counseling services. National Institute of Population Study (NIPS) [Pakistan] and ICF International. 2013. depicts that in rural areas twenty percent of married women have an unmet contraception needs that increase the chances of unwanted pregnancies leading to abortion. A study conducted by Fawad, Naz, Islam, Zaffar, & Abbasi (2011) over the period of 5 years in Abbottabad calculated the MMR 1,057/100,000 live births. All the 78 patients who died belonged to low socioeconomic status and majority of them were illiterate.
Female literacy
Poverty effects female education as they cannot afford even primary education. These women are not aware of their reproductive health rights and utilization of RHS. According to Lynd, (2007) the literacy rate of youth between the age 15 to 24 years of Pakistan’s female is (53%) comparatively lower than the boys’ literacy rate (77%) in the same age group. In-fact educated women are more autonomous in decision making and utilization of quality ante natal and perinatal services. It is also illustrated in National Institute of Population Studies (NIPS) [Pakistan] and ICF International. 2013National Institute of Population Study (NIPS) [Pakistan] and ICF International. 2013. that the antenatal care is widely received by women with secondary or higher education. Moreover, an international cross sectional study was conducted by Karlsen, et al. (2011) revealed that lower levels of maternal education were associated with higher maternal mortality. This depicts RHS are not being utilize by illiterate women.