An Analysis of How Marginalisation Exacerbates Maternal Mortality Rate: The Case of Balochistan and Gilgit Baltistan
Maternal mortality remains a global concern, with 287,000 maternal deaths globally in 2020. While this is a global issue, maternal mortality rate (MMR) is more prevalent in the marginalised communities due to lack of access to basic health facilities, high poverty rate, lack of basic awareness and socio-economic disadvantages. Although Pakistan’s situation is quite worse - with a maternal mortality rate of 186 deaths per 100,000 livebirths due to poor health facilities with substandard infrastructure and lack of basic awareness around the health issues. The country has a total number of 1201 public hospitals with poorly managed staff and only 731 Maternity & Child Health Centers. The situation is more concerning in the regions like Gilgit Baltistan (disputed territory governed by Pakistan) and Balochistan (conflict-ridden province of Pakistan) with more frightening numbers. Balochistan with a mere 12 Million population recorded 466 maternal deaths and the numbers in Gilgit Baltistan with even lesser population of 1.5 Million, maternal death numbers even go higher with around 261 recorded. Meanwhile Punjab with 110 Millions as per 2017 census, the MMR was 235.
Maternal mortality is a serious public health challenge worldwide, particularly in low- and middle-income countries, with sub-Saharan Africa and Southern Asia contributing to 87% of global cases. While significant reductions in maternal mortality have been made in recent years, the situation remains critical in vulnerable and conflict-ridden settings, where women face a significantly higher risk of maternal death. Our geographic focus of this article is Gilgit-Baltistan and Balochistan, provinces in Pakistan, that have experienced systemic injustice for decades. This has caused massive disparities in access to quality healthcare that exponentially increases the risk for women during pregnancy. The complex context of geographical and socio-economic barriers in Gilgit-Baltistan and Balochistan further hinders progress in reducing maternal mortality. This highlights the need for targeted interventions to ensure that every woman receives adequate care during the critical stages of pregnancy, birth and after-birth.
Maternal mortality remains a global concern, with 287,000 maternal deaths globally in 2020. While this is a global issue, maternal mortality rate (MMR) is more prevalent in the marginalised communities due to lack of access to basic health facilities, high poverty rate, lack of basic awareness and socio-economic disadvantages. Although Pakistan’s situation is quite worse - with a maternal mortality rate of 186 deaths per 100,000 livebirths due to poor health facilities with substandard infrastructure and lack of basic awareness around the health issues. The country has a total number of 1201 public hospitals with poorly managed staff and only 731 Maternity & Child Health Centers. The situation is more concerning in the regions like Gilgit Baltistan (disputed territory governed by Pakistan) and Balochistan (conflict-ridden province of Pakistan) with more frightening numbers. Balochistan with a mere 12 Million population recorded 466 maternal deaths and the numbers in Gilgit Baltistan with even lesser population of 1.5 Million, maternal death numbers even go higher with around 261 recorded. Meanwhile Punjab with 110 Millions as per 2017 census, the MMR was 235.This is not a coincidence but it says a lot about how facilities are poor in these two regions as they have been deprived of basic facilities for over 70 years with lack of quality healthcare, access to educational resources and institutions, poor infrastructure and culturally instilled taboos. The state of health facilities is daunting in these regions with around 50% of people in Balochistan not even having access to health facilities, and 6 districts being without any presence of hospitals. Balochistan has also the highest percentage of home birth ratio with 74 percent and Dera Bugti district of the province with 97 percent.
While in Gilgit Baltistan the situation is even more worse with a 1:4100 ratio of doctor to population. As per a report, when the Basic Health Units in GB were assessed, they were not able to provide preventive Maternal, Neonatal and Child Health (MNCH) services for a standard workweek of six days, each with an 8-hour workday because one or more components of preventive MNCH services package would be missing. Not only that, the taboos that are innate in the society further restricts women to express themselves in a way that helps in equating health facilities. These are not only factors that leads to marginalisation but also affect the women in Gilgit Baltistan and Balochistan leading to higher rate of MMR.
But the question is whether they are systematically marginalised or the other provinces like Punjab and Khyber Pakhtunkhwa are systematically privileged? The answer is most probably ‘yes’. As in regions like Gilgit Baltistan and Balochistan the focus has always been more on militarisation, keeping the people in disarray about their basic rights and making it unclear to form an informed practice and policy around other areas that affects individuals and population at large. While there has been a history of insurgency, false flag operations and provocations in Balochistan and Gilgit Baltistan leading to political unrest impacting lives of millions of people. These regions have poor infrastructure, quality of life, resource management and education quality that further adds to disproportionating standards of health care facilities and increasing maternal deaths, as all areas are interconnected.
These regions need to be freed from systemic cycles of inequity, and there is a need for addressing all the relevant disparities that lead to maternal mortality including the socio-economic and political factors. It is also imperative for the state to justify its actions and further improve the standard of life in the regions that’s in accordance with global quality of lifestyle and health standards. At the same time, increasing access to pre-natal care and MNCH services are vital in providing the women in these areas with better maternal health facilities. Need for improving infrastructure, health and education are key factors that would not only play a role in uplifting lives of the people in the GB and Balochistan but would also help the state in creating a more positive image in regions holding so many grievances.
Under Sihaat Mand Khaandaan (SMK) Project by UNFPA during 2020-2024, provided the community midwives with an opportunity to get mentorship and supervisory support with clinical attachment. This project has been transformative particularly in the GB region where midwives are often not well trained or equipped with technology. As the region lacks health centres, these interventions play a vital role. Aga Khan Development Network (AKDN) also ran a Maternal Care and Child Survival project which was about building the capacity of these midwives. A beneficiary of this project was Noor Khatoon who went on to become the best community midwife in Gilgit region while also supporting her family. These stories emphasise the need to design the interventions aligned with local systems. However, it’s also important for more engagement from different individuals and organisations to support the health infrastructure, nutrition programmes and awareness campaigns.
In conclusion, addressing the marginalization and inequalities that weigh on women is a collective responsibility that requires concerted and determined action. Despite significant progress in many regions, disparities in access to skilled care and systemic and social barriers continue to undermine women's health, especially in conflict-ridden areas of Balochistan and Gilgit Baltistan. Only by restoring equitable access to health services and ensuring policies that uplift society as a whole, can we ensure that every woman has the opportunity to experience a safe and healthy pregnancy.