Observational studyReproductive health2020
Why are the Pakistani maternal, fetal and newborn outcomes so poor compared to other low and middle-income countries?
Observational study in Reproductive health, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 54 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
54 citing papers in PubMed, 1 synthesis or guideline pooled it, 101 citations in OpenAlex.
- Narrative synthesis systematic review of Pakistani women's health outcomes from primary care interventions.BMJ open · 2022Pooled it
- Understanding stillbirths and maternal deaths in Pakistan: evidence from a national household survey.Journal of global health · 2026Article
- Identifying delays impacting maternal and perinatal deaths using a facility-based death audit review system integrated with community engagement: a mixed methods study.Journal of global health · 2026Article
- Maternal circulating sFlt-1/placental growth factor is a biomarker of fetal death associated with placental lesions of maternal vascular malperfusion.Journal of perinatal medicine · 2026Article
- Disproportionate climate burden of rising temperatures on low birth weight in Pakistan.BMC medicine · 2026Article
- Why & where perinatal deaths: trends and determinants in Pakistan.Maternal health, neonatology and perinatology · 2026Article
- Bridging the gap in pediatric nutrition: a narrative review of nutritional support strategies and their impact on child health inequalities.Frontiers in public health · 2026Review
- Article
- Contraceptive implant continuation among postpartum women at tertiary care center.Pakistan journal of medical sciences · 2026Article
- Challenges to community midwives in the provision of maternal services to rural communities of Pakistan.BMC health services research · 2025Article
- Global, regional, and national burden of neonatal infectious diseases from 1990 to 2021.Translational pediatrics · 2025Article
- Preeclampsia and Prematurity: Implications for Maternal and Perinatal Outcomes in a Low-middle Income Country.Oman medical journal · 2025Article
- Exploring challenges in accessing primary healthcare for pregnant women in Pakistan: a qualitative descriptive study.BMC health services research · 2025Article
- Mortality Projections, Regional Disparities in the Burden of Neonatal Disorders, and the Status of Achieving SDG Targets by 2030 in South Asia: Insights from the Global Burden of Disease Study 2021.Journal of epidemiology and global health · 2025Article
- Predictors of pregnancy loss among urban and rural women aged 15 to 49 years in Pakistan.BMC public health · 2025Article
- Critical analysis of maternal healthcare delivery systems and mortality patterns: A commentary on research from a tertiary care center in Pakistan.Pakistan journal of medical sciences · 2025Article
- Community health needs assessment: findings from a community-university partnership strengthening program on maternal and child health in Pakistan.BMC public health · 2025Article
- Transcriptomics reveals preterm birth risk: identification and validation of key genes in monocytes.BMC pregnancy and childbirth · 2025Article
- Maternal Mortality: Causes, trends and delays in care at Tertiary care hospital, Pakistan.Pakistan journal of medical sciences · 2025Article
- Article
Corrections and comments
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Authors and funding
25 authors at 17 institutions in 7 countries.
Funding
Abstract
backgroundPakistan has among the poorest pregnancy outcomes worldwide, significantly worse than many other low-resource countries. The reasons for these differences are not clear. In this study, we compared pregnancy outcomes in Pakistan to other low-resource countries and explored factors that might help explain these differences.
methodsThe Global Network (GN) Maternal Newborn Health Registry (MNHR) is a prospective, population-based observational study that includes all pregnant women and their pregnancy outcomes in defined geographic communities in six low-middle income countries (India, Pakistan, Democratic Republic of Congo, Guatemala, Kenya, Zambia). Study staff enroll women in early pregnancy and follow-up soon after delivery and at 42 days to ascertain delivery, neonatal, and maternal outcomes. We analyzed the maternal mortality ratios (MMR), neonatal mortality rates (NMR), stillbirth rates, and potential explanatory factors from 2010 to 2018 across the GN sites.
resultsFrom 2010 to 2018, there were 91,076 births in Pakistan and 456,276 births in the other GN sites combined. The MMR in Pakistan was 319 per 100,000 live births compared to an average of 124 in the other sites, while the Pakistan NMR was 49.4 per 1,000 live births compared to 20.4 in the other sites. The stillbirth rate in Pakistan was 53.5 per 1000 births compared to 23.2 for the other sites. Preterm birth and low birthweight rates were also substantially higher than the other sites combined. Within weight ranges, the Pakistani site generally had significantly higher rates of stillbirth and neonatal mortality than the other sites combined, with differences increasing as birthweights increased. By nearly every measure, medical care for pregnant women and their newborns in the Pakistan sites was worse than at the other sites combined.
conclusionThe Pakistani pregnancy outcomes are much worse than those in the other GN sites. Reasons for these poorer outcomes likely include that the Pakistani sites' reproductive-aged women are largely poorly educated, undernourished, anemic, and deliver a high percentage of preterm and low-birthweight babies in settings of often inadequate maternal and newborn care. By addressing the issues highlighted in this paper there appears to be substantial room for improvements in Pakistan's pregnancy outcomes.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.