Page 206 - GHES-3-3

Global Health Economics and
Sustainability
Neonatal mortality in Pakistan

The United Nations present the Sustainable highlighting the significance of socioeconomic disparities
Development Goals (SDGs) with the principle of “leave no in obtaining high-quality maternal and child health
one behind.” SDG 3 explicitly targets maternal and child services. Meanwhile, Singh et al. (2021) examined how
health, aiming to reduce NM to 12 deaths/1,000 live births place of delivery can reduce neonatal and infant mortality
and under-5 mortality to 25 deaths/1,000 live births by 2030 rates in the Indian environment. Their study highlighted
(UNICEF, 2015). Although NMRs have been considerably the importance of a continuum of care spanning prenatal
reduced, they remain a critical public health issue in many and postnatal phases. They discovered that deliveries
developing nations. Hence, greater efforts are needed to in medical facilities significantly reduced NMRs due to
achieve the SDGs and improve child survival. prompt medical interventions, such as infant resuscitation
NM represents a major worldwide health concern, and infection control. Furthermore, the study emphasized
particularly in underdeveloped nations where access the importance of comprehensive prenatal care in lowering
to healthcare services is typically limited. Despite adverse delivery outcomes by preparing mothers for safe
international efforts, South Asia continues to experience deliveries. To promote institutional delivery and improve
disproportionately high NMRs. Achieving SDG 3’s targets NMR, the authors recommended strengthening healthcare
requires addressing the multifaceted determinants of NM, institutions, particularly in remote and underserved
such as socioeconomic circumstances, maternal healthcare locations.
quality, and — above all — delivery location. A systematic review and meta-analysis by Tura et al.
Extensive studies have established an association (2013) confirmed these patterns, with infants born in
between infant survival and place of delivery, emphasizing medical facilities showing markedly lower mortality risk
the role of institutional deliveries in lowering neonatal compared to homebirths. This decrease was ascribed to
fatalities. Compared to home births, deliveries in medical a number of factors, including the availability of trained
institutions have markedly reduced NMRs due to the birth attendants, clean delivery environments, and prompt
quality of care received during pregnancy, delivery, and medical attention to birth-related issues. However, the
the neonatal period. Notably, place of delivery has been analysis also identified persistent obstacles to facility-
identified as a critical indicator of maternal and child based deliveries such as cultural preferences for home
healthcare. Prior research has consistently demonstrated births, financial limitations, and geographic inaccessibility.
that the availability of trained birth attendants, emergency The findings recommended legislative measures, such as
obstetric care, and enhanced hygiene standards improves subsidized care and community education campaigns,
outcomes for deliveries in medical facilities (Ajaari, 2013; to improve the use of healthcare services for expectant
Alhassan et al., 2020; Kotsadam et al., 2018). To determine mothers and newborns. Moreover, Msemo et al. (2013)
the effect of hospital deliveries on infant mortality, contributed significantly to this discussion by studying
Gage et al. (2021) carried out an ecological study in 37 newborn survival in rural southern Tanzania. Their study
countries in South Asia and Sub-Saharan Africa, revealing examined whether infant survival was more influenced by
significantly higher infant mortality rates in regions with the continuum of care or the place of delivery. They found
prevalent home births. Their findings underscore how that access to postnatal care was as critical as the place of
institutional deliveries guarantee prompt access to trained delivery. According to the study, infants who did not receive
birth attendants and emergency medical interventions, proper postnatal care remained at risk even if they were
highlighting the need for healthcare infrastructure born in medical facilities. To improve newborn survival,
improvements and community education campaigns. the authors recommended combining postnatal care with
facility-based births. In addition, they emphasized raising
In a similar vein, Patel et al. (2021) investigated
whether the place of delivery affects NM in India. Neonatal awareness of the advantages of facility-based deliveries and
outcomes for home births, births in the public sector, and expanding community health initiatives as crucial tactics
to enhance infant health outcomes.
births in the private sector were compared in their study.
According to their findings, home births had the highest Pakistan is no exception to the high NMR, which
infant mortality rates, followed by public healthcare affects underdeveloped nations. The country has an infant
facilities, whereas private healthcare facilities had the mortality rate of 62/1,000 live births—8 times higher than
lowest infant mortality rates. These discrepancies were the average in developed countries (8/1,000 live births) —
ascribed to variations in resource availability, healthcare with 330,479 babies dying before 1 year of age (WHO,
quality, and medical personnel competency. The study 2017). Until the early 1990s, Pakistan’s infant mortality rate
also emphasized the need for specific measures to increase was much higher at 86 fatalities for every 1,000 live births.
healthcare accessibility for lower-income groups by Although this number has decreased by 24% over the last

Volume 3 Issue 3 (2025) 198 https://doi.org/10.36922/ghes.5089