Page 211 - GHES-3-3

Global Health Economics and
Sustainability
Neonatal mortality in Pakistan

1.4 times more likely to experience NM than non-working with previous studies (Gage et al., 2021; Nathan &
women. The results also showed that the likelihood of NM Mwanyangala, 2012; Verma & Cleland, 2022). This trend
was less likely in urban residences of Pakistan compared to may be due to older mothers being more experienced,
rural residences. In addition, the ORs for NM were lower mature, and health conscious. Maternal employment also
for women residing in Sindh, KP, and Balochistan than plays a crucial role in improving maternal and neonatal
for those women who lived in Punjab. Mothers in Sindh health. The findings of the current study are consistent with
province exhibited 0.64 times lower ORs for NM than the results of previous studies, indicating that NM risk is
women living in Punjab. Across all four models, a negative lower among non-working women than among working
association was found between place of delivery and NM. women (Ajaari, 2013; Agha, 2000; Chishtie et al., 2021).
The likelihood of NM decreased when deliveries occurred Moreover, education plays an important role in reducing
in health facilities and increased when they took place NM, as educated mothers are more likely to access
outside these facilities. antenatal care, deliver in healthcare facilities, and follow
postnatal care recommendations (Ajaari, 2013; Chishtie
4. Discussion et al., 2021; Hug et al., 2019; Patel et al., 2021).
This study highlights the significant relationship between Based on these findings, this study recommends several
NM and the place of delivery in Pakistan. The data were measures to improve NMR in Pakistan, particularly in
obtained from the PDHS, which collects information rural areas, by enhancing the accessibility and quality of
through interviews with selected women of reproductive age. maternal and neonatal healthcare services. Investments
These findings indicate that delivery within a health facility should be made to improve the infrastructure of medical
significantly reduces NM. These results are consistent with facilities and provide training for medical staff on neonatal
those of previous studies (Ajaari, 2013; Demisse et al., 2017; emergencies. In addition, educating entire families about
Patel et al., 2021; WHO, 2017). Deliveries in healthcare birth spacing and implementing initiatives to upgrade
facilities attended by skilled staff reduce both neonatal and medical facilities can benefit mothers and improve
maternal mortality compared with deliveries outside health household finances. Enhancing the quality of care and
facilities (Ajaari, 2013; Alhassan et al., 2020; Chishtie et al., ensuring the availability of high-quality healthcare services
2021; Demisse et al., 2017). for unwell and low-birth-weight newborns is essential
The high NMRs observed in the rural areas of KP for accelerating progress toward neonatal survival and
and Balochistan are consistent with previous studies promoting health and well-being.
(Patel et al., 2021). These higher rates can be attributed One of the key limitations of this study is that it did
to inadequate healthcare infrastructure, a lack of medical not differentiate between types of healthcare facilities,
equipment, and understaffed facilities. In addition, delays such as public versus private hospitals, primary care
in reaching healthcare facilities, reluctance to seek timely centers versus tertiary care hospitals, or urban versus rural
care, and financial constraints further contribute to these health facilities. Furthermore, some potential confounding
outcomes.
factors, such as the quality of healthcare services, distance
Higher birth order has a significant impact on NM, to healthcare facilities, and cultural or religious practices,
as an increase in birth order is associated with a higher were not included in the analysis due to data limitations.
likelihood of NM. These findings align with existing These factors may influence both the place of delivery and
literature (Chishtie et al., 2021; Demisse et al., 2017; Iqbal NM.
et al., 2017). Larger family sizes often lead to insufficient
healthcare resources, a lack of focus on neonatal care, and 5. Conclusion
a higher risk of complications during childbirth. Moreover, This study highlights the significant impact of place of
underweight or small birth size faces a high risk due to delivery on NM, showing that facility-based deliveries
preterm birth and other complications compared to larger greatly reduce the risk of neonatal deaths compared
birth size. The findings of the current study also confirmed to home deliveries. Access to skilled birth attendants,
that smaller-than-average birth size is a significant risk medical interventions, and hygienic delivery conditions
factor for NM, which is consistent with previous research contribute to improved neonatal survival rates. Disparities
(Das et al., 2021; Patel et al., 2021; WHO, 2017; Yasmin in healthcare access between urban and rural areas remain
et al., 2001). important factors that affect neonatal outcomes. NM is
Compared with younger mothers, middle-aged and also influenced by a number of maternal and demographic
older mothers had decreased odds of NM and were found factors. Birth order plays a critical role, with children born
to be a significant predictor. These findings are consistent at higher birth orders facing higher risk, possibly due to

Volume 3 Issue 3 (2025) 203 https://doi.org/10.36922/ghes.5089