MATERNAL health involves different aspects of women`s physical, social, emotional and mental well-being during pregnancy, childbirth and post-delivery. Currently, Pakistan carries a heightened burden of maternal and child health vulnerabilities, with unusual maternal and neonatal mortality, stillbirth, and preterm birth rates that are said to be higher than many other low-resource countries.

Pakistan has worked to improve its maternal and child health by integrating the district health system and strengthening service delivery, and has witnessed reduced child, infant and maternal mortality rates. However, stark inequalities still exist in terms of geographical locations, and the availability of and access to healthcare services. These contribute to elevated levels of neonatal, infant and maternal mortalities.

These rates are alarming in rural areas where socioeconomic, geographical and cultural factors influence maternal health negatively and exacerbate the situation.

Rural and remote localities, low household wealth, the young age of the mother, and limited education are key drivers of maternal and neonatal mortality. The main reason for poor maternal health and pregnancy outcomes in Pakistan is that a vast majority of women in their reproductive years in Pakistan are poorly educated, live in underprivileged areas, lack resources and awareness, and are undernourished. These women are subjected to oppressive sociocultural practices, which contribute to their disempowerment.

According to Unicef, around 700 babies under one month die each day in Pakistan, whereas there are 665 stillbirths daily in the country. The leading causes of these deaths are premature deliveries and preterm births with complications.

Pakistan`s infant and maternal mortality rates are higher in the rural areas: the neonatal mortality rate is 47 per 1,000 live births in the urban areas but jumps to 62 deaths per 1,000 in the rural areas, indicating a strong link with unsafe delivery usually performed by inexperienced midwives in an unhygienic environment. Lack of standard healthcare facilities, poverty, malnutrition, and the prevalence of gender-based violence, are the main contributing factors to elevated child and maternal mortality rates in the rural areas.

Rural Pakistani women experience various sociocultural and geographical challenges inseeking maternal health services. Economic factors make it harder for them to access quality healthcare facilities. Poverty remains a strong barrier to maintaining a healthy diet, and being able to afford services, transportation, and essential medicines needed for pregnant women and neonates. Studies suggest a strong correlation with economic deprivation and delayed access to antenatal care. Poverty discourages underprivileged women from trying to access recommended antenatal care and, instead, propels them towards home births, which are likely to result in poor pregnancy outcomes. This creates a hostile environment where maternal health problems are worsened and further perpetuate poverty.

Apart from geographical and economic barriers, maternal and child health is greatly affected by various social and cultural factors such as childmarriage, adolescent motherhood, poverty, gender inequality, and the extended family system.

These factors often intersect and compound an already bad situation.

Adolescent motherhood is a growing public health concern in many countries. It has been estimated that in 2020, 13 to 17 million women had their first baby when they were not yet 20, indicating enhanced risk of adverse maternal and child health consequences. In Pakistan, there is great pressure on women to embrace early maternity.

Adolescent motherhood is a direct consequence of child marriages. It is the single most significant factor increasing the risk of early pregnancy as well as leading girls to go on having babies without proper intervals. This results in unwanted and unplanned pregnancies.

Child marriages are frequent in South Asia, which carries 44 per cent of the burden of the total global share of child brides. It is estimated thatone in four young girls marries in South Asia before their 18th birthday. On a global scale, Pakistan ranks sixth among countries with the highest number of child marriages. The southern region of the country frequently witnesses child marriages due to extreme poverty and gender inequality. The districts of Jacobabad and Kashmore in Sindh are recognised as hotspots for child marriages, with the former district reporting the highest number of marriages of children under the age of 15. As child marriages are driven by poverty, many districts are expected to witness a rise in such cases due to economic deprivation as well as climate-induce d disaster s, which are likely to worsen maternal health vulnerabilities for already underprivileged women and girls.

Child marriage has an overwhelmingly disproportionate impact on the health and well-being of girls. It robs them of their right to education and economic opportunities. Girls marrying as children are highly vulnerable to adolescent motherhood because they are too weak to make decisions regarding their reproductive health and family planning. Most child brides are forced to abandon their schooling and are trapped in the vicious cycle of household chores and early motherhood, which limits the potential of a better future.

The journey to making tangible improvements in maternal and child health in Pakistan is a challenging one. Although greater attention is now being paid to quality healthcare for childbearing women, more inclusive policies are needed to bring the rural population into the ambit of healthcare and family planning policies and interventions and to eliminate gender-based disparities in the health system.

In this regard, removing the sociocultural barriers that limit women`s autonomy is crucial.

Research on the needs of a community, its beliefs and practices regarding maternal health, and the fertility decisions of families can help us study other factors associated with improved maternal health. Empowering women and families through educational and awareness campaigns, and giving female healthcare workers access to young girls living in less privileged areas can help them make informed decisions, leading to better health outcomes.• The writer is professor of sociology and gender studies at Shah Abdul Latif University, Khairpur.