Pregnancy, Poverty and Patriarchy: Unpacking Maternal Mortality in Pakistan

Her name was Ayesha- the girl who loved mangoes and dreamed of teaching. Or maybe Rubina, who could stitch the most beautiful shalwar kameez in her village.

Every 20 minutes, Pakistan loses another mother like her - not to fate, but to a perfect storm of preventable causes. While we debate statistics, real women are dying because of choices being made for them: the choice to marry too young, the choice to avoid 'shameful' hospital visits, the choice to wait for a man's permission while haemorrhage sets in. These aren't isolated tragedies - they're systemic failures dressed up as 'cultural values.' Until we confront these uncomfortable truths, the clock will keep ticking, and mothers will keep dying.

Maternal mortality refers to the death of a woman during pregnancy or within 6 weeks after childbirth. With a maternal mortality rate of 186 deaths per 100,000 live births, Pakistan’s rising crisis demands urgent attention and action!

The tragedy lies in the fact that 99% of these deaths are preventable. The leading causes – postpartum haemorrhage, sepsis, and eclampsia – are all conditions that modern medicine knows how to treat. Postpartum haemorrhage is the leading cause of maternal deaths in Pakistan, turning fatal within minutes if hospitals lack blood for transfusions. Sepsis, or blood poisoning, can spread rapidly without prompt antibiotic treatment, while eclampsia—a severe complication of high blood pressure—often leads to seizures and coma. Many women miss early diagnosis due to inadequate antenatal care, leaving them vulnerable to these life-threatening conditions.

Maternal mortality disproportionately affects rural Pakistan, where access to quality healthcare is scarce. A total of 74% of women in rural areas give birth at home, compared to 43% of women in urban areas. In case of complications, women are either referred—or in many cases, self-refer—to the nearest healthcare facility. If the problem cannot be managed there, they are transferred to tertiary care hospitals, which may be hours away. Unfortunately, many women do not survive this arduous journey.

Coupled with this, delays in receiving medical care is one of the crucial reasons why women don’t survive childbirth and these delays occur on multiple levels. One of the most significant barriers is the ignorance by families and traditional midwives regarding the warning signs of complications. Many families hesitate to seek medical help, either due to lack of awareness or deep-rooted cultural beliefs that prioritize home births over hospital deliveries.

Reaching a hospital is a battle in itself.

With no ambulances or telephones, rural women are often transported on motorcycles or donkey carts, losing precious time. Even at hospitals, shortages of staff, supplies, and emergency care turn delays into tragedy, making survival a matter of chance.

In Pakistan’s patriarchal society, a woman’s access to maternal healthcare is shaped by social, economic, and cultural barriers. In rural areas, where 62% of women of reproductive age have never received formal education, a lack of awareness about maternal health and reproductive rights puts them at greater risk. Without education, many women do not prioritize prenatal care, often viewing it as either unnecessary or financially out of reach.

Women often have little say in crucial decisions about their own health, including family planning. The size of a family is frequently determined not by the woman herself but by her husband or mother-in-law, reflecting entrenched cultural norms. Many rural families resist contraception due to religious beliefs, with some viewing it as un-Islamic or even as a conspiracy against Muslim population growth. This mindset, combined with the cultural preference for sons, forces many women into back-to-back pregnancies, significantly increasing their health risks.

A woman’s pregnancy is rarely just her own. It is a family affair that is dominated by toxic traditions, cultural norms and apathetic family members, that decide what she will eat, whether she will receive any medical care and how she will deliver.

Nutrition during pregnancy, for instance, is frequently overlooked. Many expecting mothers do not receive the balanced diet they need, not just because resources are scarce, but also because their nutritional needs are simply not prioritized. In some households, pregnant women eat last and least, their meals dictated more by custom than by medical necessity.

The decision to seek medical care is rarely in a woman's hands. Even when she recognizes the danger, she must navigate layers of approval—from her husband, mother-in-law, or extended family. These delays can be life-threatening. Cultural norms like ‘pardah’ impose further restrictions, as many women are not allowed to visit healthcare facilities without a male relative—a limitation that can be fatal in emergencies.

Early marriage compounds these risks. Although the legal marriage age for girls is 16, traditional practices often take precedence, with some marrying as young as 14. These young girls, still in the midst of their own development, are forced into pregnancies their bodies are not yet equipped to endure.

The weight of cultural expectations also plays a devastating role in maternal health. Women who bear daughters often face discrimination, as the birth of a girl is sometimes seen as a burden rather than a blessing. In certain communities, this perception leads to neglect—expecting mothers carrying female fetuses may receive less care, putting both mother and child at risk. Beyond this, family planning remains an underutilized tool in reducing maternal mortality. Despite evidence that contraceptive use lowers pregnancy-related risks, only 30% of married women in Pakistan use modern contraceptives, a statistic that has remained unchanged in recent years. The lack of awareness, coupled with social stigma around birth control, means that women continue to experience multiple, high-risk pregnancies, further fueling maternal deaths.

When a woman’s well-being is dependent on the consent of others, and when her access to care is filtered through layers of tradition, maternal mortality becomes less a medical failure and more a societal one. For too long, preventable deaths have been accepted as inevitable and destined, when they are actually reflections of the fundamental societal failures and how we value a woman’s health and autonomy in this society.

Change must happen at every level.

Hospitals and clinics must ensure a steady supply of essential resources like blood and antibiotics, particularly in rural areas where healthcare access remains severely limited. Maternal mortality rates in rural regions are nearly 26% higher than in urban areas, highlighting the stark disparity in available medical services.

Beyond healthcare facilities, change must also happen within communities by challenging traditions that discourage women from seeking medical care. At the family level, the mindset must shift—maternal health is not a luxury but a necessity, forming the backbone of a healthy and thriving household.

Policies must translate into practice, Pakistan’s federal and provincial governments have set the goal to reduce maternal mortality to goal of reducing the maternal mortality rate to 70 deaths per 1000,000 live births by the year 2030 and that is possible to achieve only if commitments are matched by funding, accountability and implementation.

Lastly, we need to address the societal and cultural obstacles that stop women from accessing healthcare. Providing education, creating economic opportunities, and challenging outdated traditions are key steps toward change. There is reason to be hopeful—where these efforts have been put in place, progress has followed. In recent years, more women have been giving birth in healthcare facilities, and antenatal care has become more widespread, proving that change is not only necessary but achievable.

Every mother lost is not just a statistic; she is a life cut short, a child left motherless, a family shattered. These deaths are preventable, yet they continue. How many more lives must be lost before we act?

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For further reading and references, see the list below:

• Abbasi, S., & Younas, M. (2015). Determinants of Maternal Mortality in Pakistan at a Glance. Journal of Midwifery and Reproductive Health, 3(3), 430–432

• Bano, N., Chaudhri, R., Yasmeen, L., Shafi, F., & Ejaz, L. (2011). A study of maternal mortality in 8 principal hospitals in Pakistan in 2009. International Journal of

  Gynecology & Obstetrics, 114(3), 255–259.

• Jafarey, S., Kamal, I., Qureshi, A. F., & Fikree, F. (2008). Safe motherhood in Pakistan. International Journal of Gynecology & Obstetrics, 102(2), 179–185

• Omer, S., Zakar, R., Zakar, M. Z., & Fischer, F. (2021). The influence of social and cultural practices on maternal mortality: A qualitative study from South Punjab, Pakistan. Reproductive Health, 18, 97.

• Pakistan Maternal Mortality Survey (2019 PMMS)

• Shaeen, S. K., Tharwani, Z. H., Bilal, W., Islam, Z., & Essar, M. Y. (2022). Maternal mortality in Pakistan: Challenges, efforts, and recommendations. Annals of Medicine and Surgery, 81, 104380.

• UNICEF. (n.d.). Maternal and Newborn Health Disparities. UNICEF Data.

• Image by Constance Strickland.