A national survey counts Pakistan's stillbirths and maternal deaths, and their causes

Maternal deaths and stillbirths are among the hardest events in global health to count, because so many happen at home and never enter a health record. A new study in the Journal of Global Health sets out to fill that gap for Pakistan, using a national household survey to estimate not just how many women and babies die, but from what [s1].

How the count was done

The researchers ran a cross-sectional household survey with retrospective ascertainment across all four provinces — Sindh, Punjab, Balochistan and Khyber Pakhtunkhwa — and three administrative regions: Gilgit Baltistan, Azad Jammu and Kashmir, and the Islamabad Capital Territory [s1]. They built on the sampling frame of the Pakistan National Nutrition Survey 2018 and aimed for a target sample of 2,100 stillbirths, allocated to provinces and regions in proportion to population [s1]. Deaths among married women aged 12 to 49 were identified through the same household enumeration [s1].

To assign causes, trained physicians reviewed each case through physician-certified verbal autopsy, and two computer-coded methods — InterVA-5 and InSilicoVA — were run in parallel [s1]. The design matters because it is what lets the study speak to cause of death, not only its frequency.

What the survey found

Across the identified households during the 2017–2018 study period, the team recorded 2,076 stillbirths and 848 maternal deaths [s1]. The overall stillbirth rate at the country level was 30.5 per 1,000 total births, and the maternal mortality ratio was 176.2 per 100,000 live births, with higher rates in rural areas [s1].

The leading causes were strikingly similar across both stillbirths and maternal deaths: pregnancy- induced hypertension, obstetric haemorrhage, sepsis and obstructed labour [s1]. These are, in the main, conditions medicine knows how to treat when a woman reaches skilled care in time — which is what makes the study's second finding the more pointed one.

Where the deaths come from

The survey traced the deaths to delays rather than to any exotic clinical cause. For both stillbirths and maternal deaths, the authors describe failures at each step: recognising that an illness was severe, deciding to seek care, reaching a facility through often-inadequate transport, and receiving timely care once a provider was reached [s1]. That framing — delays in seeking, reaching and receiving care — is the long-standing "three delays" model of maternal death, and the study reports all three at work, concentrated in rural Balochistan and Khyber Pakhtunkhwa [s1].

The authors conclude that the observed rates — a stillbirth rate of 30.5 per 1,000 births and a maternal mortality ratio of 176 per 100,000 live births — exceed both Pakistan's national targets and the Sustainable Development Goals 2030 targets [s1]. Closing the gap, they argue, will require provincial investment in emergency obstetric and newborn care, scaling up skilled birth attendance, and community awareness of the danger signs that should trigger a trip to a facility [s1].

The global backdrop

Pakistan's numbers sit inside a worldwide burden the study puts at over two million stillbirths and maternal deaths each year [s1]. WHO's own accounting is that in 2023, over 700 women died every day from preventable causes related to pregnancy and childbirth — a maternal death almost every two minutes — and about 260,000 women died during and following pregnancy and childbirth that year [s2]. Just over 90% of those deaths occurred in low- and lower-middle-income countries, and approximately 92% of all maternal deaths were concentrated there [s2]. Between 2000 and 2023, the global maternal mortality ratio dropped by about 40%, but WHO is blunt that the level "is unacceptably high" [s2].

What it means, and its limits

A single national survey is a snapshot, not a monitoring system, and its estimates carry the usual caveats of retrospective household ascertainment and verbal autopsy — methods that reconstruct cause of death from an interview rather than a clinical record. The study's value is less in any one decimal place than in what it establishes: that Pakistan's stillbirths and maternal deaths cluster around a short list of treatable conditions, and that the decisive failures are in the system of recognition, transport and timely care rather than in medicine's ability to intervene [s1]. On the authors' reading, the routes to lower numbers are known — round-the-clock emergency obstetric care, skilled attendants, and communities that know when to act — and the open question is provincial investment [s1].

Sources

• Understanding stillbirths and maternal deaths in Pakistan: evidence from a national household survey, Journal of Global Health, 11 September 2026
• Maternal mortality — fact sheet, World Health Organization, 7 April 2025