Progress towards achieving Millennium Development Goals remains a challenge for Pakistan. MDG 4 requires a two third reduction in child mortality, whereas, MDG 5 demands a reduction of maternal mortality ratio by three quarters. There is a need to accelerate the efforts to achieve the desired results by 2015.
Globally child mortality remains a major public health problem with over 9 million children under five years of age dying each year. Of those 9 million deaths, an estimated 4 million babies die in the first 4 weeks of life (the neonatal period). Ten countries, including Pakistan, account for two-thirds of these neonatal deaths. MDG 4 cannot be met without substantial reductions in neonatal mortality.
In Pakistan 423,000 children die every year before reaching their fifth birthday (87 deaths per 1000 live births) with 46 percent of them dying in the first 4 weeks of life. Infant mortality rate is 70 per 1000 live births and under 5 mortality rate 87 per 1000 live births. The maternal mortality ratio stands at 260 deaths per 100,000 live births. Malnutrition is one of the contributing factors that accounts for 35% of all under-5 deaths in Pakistan. The National Nutrition Survey 2011 identified 15.1% under 5 children wasted, 43.6% stunted and 31.5% under weight. Child anemia is recorded at 62.5% and maternal anemia at 51%.
According to a 2008 UNICEF report, poor children with uneducated mothers, who live in rural areas or are from marginalised social and ethnic groups, are at greatest risk of early death. A Save the Children report in 2010 states, “Children in conflict-affected countries are particularly vulnerable: almost 70% of the countries with the highest child mortality burden have experienced armed conflict over the past two decades”. In Pakistan, a great majority of population is living in rural areas and literacy ratio for rural women is alarmingly low. Similarly, the situation in FATA, parts of Khyber Pakhtunkhwa and Balochistan have also exposed children to various risks.
This calls for the federal and provincial governments to take appropriate legislative, administrative and other measures to save these precious lives. There is a need to ensure full coverage of immunization and to reduce high rates of malnutrition. Similarly, it is also important to increase the number of Lady Health Workers (LHWs) as presently they are covering only 60% of the population. There is a need to invest in building their capacity for improved skills.
Furthermore, the federal and provincial governments should prioritize policies and programs on nutrition, vaccination and health workers and make sufficient budgetary allocations. Following the 18th Constitutional Amendment, provincial governments need to take lead and initiate ventures to improve the situation in their respective provinces. Donors also have an important role to play to support the provincial governments to effectively handle the added responsibilities.