MATERNAL HEALTH IS THE KEY

AT 13 years of age, Sana was engaged to a cousin 10 years older than her. Marriage followed soon after. Naturally, the process of her physical and cognitive development was still in a crucial stage. Her father’s only source of income was small-scale farming, and she grew up stunted and undernourished. Poverty and uncertainty due to escalating climate events forced him to marry off his first daughter at an early age. Sana looked smaller, leaner and paler than standard at her age. Healthy eating and nutrition were unaffordable and often overlooked due to meagre resources, ignorance, or lack of education. At this undernourished stage before reaching adulthood, she was preparing to give birth to another life. With short stature and lean bodyweight, she and her child had to bear the consequences of early-marriage tradition. With rural maternal healthcare not available, she needed to travel a long, difficult journey to reach a hospital. This is the stark reality prevailing in rural Pakistan even though access to health services and adequate nutrition prevent complications and deficiencies, resulting in good cognitive development and strong immunity, which can help later in bearing a healthy new generation. The consequences of malnutrition among women of childbearing age are a significant challenge since Pakistan is facing an intergenerational cycle of malnutrition where malnourished mothers transfer severe deficiencies to their children. The triple burden of malnutrition includes underweight, obesity and micronutrient deficiencies, which are a threat to foetal stunting, low birthweight and chronic childhood anaemia. The consequences of teenage pregnancies with poor dietary habits include lower haemoglobin and calcium levels, causing iron deficiency anaemia or pre-eclampsia. Mothers receiving timely antenatal services in urban areas have more survival chances compared to mothers in rural or remote areas. Urban medical services facilitate vaccination, iron and folic acid supplementation, counselling for a balanced diet, and trained medical assistance during childbirth. These are all absent in rural areas. Sana’s vaccination and antenatal check-ups were delayed due to the long distance to the medical facility. Her financial and social constraints became a barrier to accessing timely antenatal medical care. Having healthy mothers in Pakistan today is the only way to ensure a healthy next generation, but the urban-rural disparity is making it just about impossible to meet the relevant targets. The World Health Organisation (WHO) in 2023 reported that the risk of maternal death in low-income countries was one in 66 compared to one in 8, 000 in high-income countries. It is estimated that every dollar spent on maternal and infant health is an investment in human capital, helping build healthier communities and fostering economic growth, which is expected to generate $9 to $20 in return. The United Nations emphasised the need to address maternal and neonatal mortality as a matter of priority, reducing maternal mortality ratio (MMR) to 70 deaths per 100, 000 live births, and neonatal mortality ratio (NMR) to 12 deaths per 1, 000 live births to achieve Sustainable Development Goal (SDG) 2030. About 20 per cent of preventable women’s death of child-bearing age occur due to maternal complications. In rural Pakistan, the MMR is 26pc higher than in urban areas due to distant medical health services. The gross domestic product (GDP) for healthcare in Pakistan is 0. 8pc, and lacking health facilities near rural settings increases the risk for both the mother and the child. The barriers Sana faced were not only related to the absence of medical facilities alone; economic and social determinants were equally evident. After immense difficulty finding a sufficient form of public transport to the nearest health facility late in the night amid a heavy monsoon downpour, she was fortunate to reach the hospital, although complications due to her young age, under-nutritional status and nutritional deficiencies had already put her in the danger zone. She needed an urgent blood transfusion, while the newborn with low birthweight required close and additional monitoring for several days in an incubator. The lady doctor counselled Sana’s father, explaining to him the downside of early marriages. The pain and stress his daughter had suffered made the father vow that he would give his younger daughters enough time to grow healthy, learn and live a normal life. Sana also realised the relationship between a mother’s poor nutritional status and the fate of her child, and wished someone had told her earlier. The mother-baby dyad is a bond immensely intertwined even after the postpartum period. The umbilical cord is a connection that transfers not only nutrients during the pregnancy, but a connection that remains invisibly attached even after the pregnancy and throughout the phase of growth. As stunting starts long before a child is born, during pregnancy, an undernourished mother experiences maternal wasting, which causes babies to be born at a low gestational age, pointing towards early neonatal mortality and childhood wasting. Also, teenage pregnancies, with poor dietary habits, lower haemoglobin and calcium, can give rise to iron deficiency anaemia or pre-eclampsia. Investing in women’s health, nutrition and education is a strategic human capital investment, ensuring the sustainability and prosperity of the new generations. However, women in rural areas face inequality in accessing healthcare, wholesome or nourishing food, and education for healthier growth and survival. According to WHO 2025 data, Pakistan has made significant progress in alleviating this issue over the years. The MMR has declined from 276 deaths per 100, 000 live births in 2006 to 155 in 2024. Likewise, the NMR has declined from 52 deaths per 1, 000 live births to 37. 6, and stillbirths from 39. 8 per 1, 000 births in 2000 to 27. 5 in 2024. But the job is far from done. Micronutrient deficiencies are significantly associated with maternal health status and food insecurity. High inflation rates, poverty and lack of education compel rural girls/women to consume less nutritious, refined, and calorie-dense food to fill their stomachs, with no dietary diversity, causing deficiencies in iron, zinc, calcium and vitamins A, D and B12. The National Nutrition Survey (NNS) 2018 showed that one in seven women of reproductive age is undernourished. The urban and rural divide is clear; 15. 8pc and 12pc, respectively. The same trend was seen in terms of iron and zinc insufficiency, leading to 8. 4pc more cases of child stunting and 2. 2pc more cases of child wasting than urban areas. This urban-rural disparity needs to be addressed on an urgent basis by focusing on medical care interventions alongside reforms related to girls’ education, awareness regarding health, balanced diet, sanitation and hygiene, and distribution of supplements like folic acid, iron and vitamin D in hard-to-reach areas. There should be equitable access to primary services. Lastly, government policies on early marriages and maternal health must be enforced, especially in rural areas, to ensure the welfare and prosperity of generations to come. The writer is Editor, Scientific Investigation and Global Network of Scientists (SIGNS).

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