Page 207 - GHES-3-3

Global Health Economics and
Sustainability
Neonatal mortality in Pakistan

three decades, the nation still faces formidable obstacles in selection allows for a comparative analysis of NM based on
lowering NMR. According to earlier research, deliveries the delivery setting.
outside medical institutions and the lack of postpartum The dependent variable, NMR, is defined as the rate
checks for both the mother and the child account for over of death of an infant within the first 28 days of life and is
half of NM (Demisse, 2017; Yasmin et al., 2001). expressed as the number of deaths/1,000 live births. This

Notably, NM remains one of the most significant measure is widely used to assess newborn survival and the
disparities between developed and developing nations in effectiveness of maternal and child health services. Given
the global public health data. Prioritizing prenatal and that the neonatal period is the most vulnerable time for
postnatal care from medical professionals can help prevent an infant, understanding the factors influencing NM is
infant deaths early (Agha, 2000; Fentaw et al., 2022; Patel critical for shaping healthcare policies and interventions.
et al., 2021). Key contributors to NM include unsanitary The main independent variable, place of delivery, was
conditions, the place of delivery, poor maternal health, divided into two groups:
insufficient prenatal and postpartum care, and ineffective i. Within a health facility: This covers deliveries that
management of postpartum complications (Agha, 2000; take place in private clinics, government hospitals,
Roro et al., 2018; and Sharrow et al., 2022). Although and health centers with access to qualified medical
research on NM is increasing, many studies have not fully personnel. These facilities offer critical newborn
explored the specific impact of place of delivery.
services, emergency obstetric care, and expert birth
This study aims to examine the impact of place of attendance — all of which are critical in lowering
delivery on NM in Pakistan within the framework of the delivery-related risks.
SDGs 2030 agenda. Specifically, it seeks to ascertain how ii. Outside of a medical facility: Births that take place
the place of delivery affects NM in the broader context at home or while traveling to a medical facility fall
of reducing infant mortality. In addition, this study will under this category. The absence of trained medical
explore other demographic factors and maternal and staff during home deliveries frequently increases the
child characteristics that contribute to newborn death. By hazards of childbirth. In addition, these births may
highlighting the relationship between the place of delivery take place in unsanitary settings, increasing the risk of
and, this research aims to inform policy interventions infection and other birth-related issues.
that can enhance healthcare services for mothers and To isolate the effect of place of delivery on NM, the study
newborns, ultimately improving newborn survival rates in controlled for several confounding factors, which serve as
Pakistan and other developing countries.
covariates in the analysis. These variables included:
2. Methods i. Size of the child at birth (as a proxy for birth weight,
which influences survival chances).
2.1. Data and variables ii. Sex of the child (male infants are biologically more
This study utilized data from the Pakistan Demographic vulnerable to neonatal complications).
and Health Survey (PDHS) 2017 – 2018 conducted by iii. Birth order (firstborns and later-born children may
the National Institute of Population Studies with financial have different risks).
and technical support from the United States Agency iv. Mother’s employment status (which may affect access
for International Development. It is the fourth round of to healthcare services).
surveys conducted in Pakistan as part of the Demographic v. Mother’s age at delivery (younger and older mothers
Health Survey. Households were selected using two-stage face higher risks).
stratified random sampling. In the first stage, 580 areas for vi. Mother’s education level (higher education is linked to
enumeration were chosen, of which 561 households were better healthcare access).
surveyed. In the second stage, 28 households per cluster vii. Residence (urban vs. rural) and region (to account for
were selected, resulting in a total sample size of 16,240 geographic disparities in healthcare access).
households. From these, a random sample of 15,068 By incorporating these factors, this study aimed to
ever-married women aged 15 – 49 years was selected for provide a comprehensive analysis of how place of delivery
interview. influences neonatal survival. A detailed definition of the
The main variable of interest in this study was the variables is in Table 1.
place of delivery, which plays a crucial role in determining
neonatal health outcomes. Given this focus, the sample 2.2. Methodology
was restricted to 12,425 women who had given birth The study employed a binary logistic regression model
either in a health facility or at home before the survey. This to examine the impact of place of delivery on NM. Given

Volume 3 Issue 3 (2025) 199 https://doi.org/10.36922/ghes.5089