Maternal Mortality Ratio (MMR) in Balochistan is deemed to be much more than reported since many maternal deaths remain unrecorded due to occurrence in far flung areas and absence of vital statistics system. Due to fragmented healthcare systems, especially in remote regions, data collection often remains incomplete and inconsistent. Surveys are time-consuming and expensive, with many maternal and child deaths going unrecorded, particularly in rural areas where infrastructure and reporting systems are weak. According to health department data, the estimates of current maternal mortality ratio in Balochistan indicate around 298 deaths per 100,000 live births, although specific provincial data might vary. Similarly, infant mortality rate is approximately 60-70 deaths per 1,000 live births. As the officials of population welfare and health departments acknowledge unreported deaths of women and infants, they also mention to absence of vital statistics system at district and union council level and validity of such data. “Implementing a vital statistics systems at district and even union council levels is indispensable to ensure accurate data recording for effective implementation of policies about family planning and reproductive health services,” stated Abdullah Khan, Secretary Balochistan Population Welfare Department. “Limited healthcare services, shortage of medical practitioners including gynecologists, medical officers, lady health workers, cultural and social barriers, inadequate family planning services, low literacy, mal-nutrition and poor infrastructure are the major causes of the high MMR in Balochistan,” he said. There are common complaints by residents about insufficient facilities at health centers especially in remote areas resulting in frequent deaths. Aminullah, 34, a resident of union council Malikyar in Pishin district is one of instances whose wife died on way to District Headquarters Hospital as no doctor was available at BHU and DHQ was on an hour travelling distance from his area. “I could not save her life and lost my wife and child,” he said and mentioned that one lady health worker used to work in BHU Malikyar sometime back and after her retirement, no LHV was appointed. Umar Khan Nasar, 33, resident of Kili Nasarabad in Loralai district depicted same story of healthcare for women in his district as Loralai Teaching Hospital is the sole facility for a population of 272,432 people also with skeletal staff. “On account of insufficient Emergency Obstetrics and Newborn Care Facility, the serious patients are referred to Quetta on emergency basis,” Umar said, mentioning that 265 kilometer travelling between Loralai and provincial capital result in many deaths. This is the picture of a district comparatively somehow equipped with EONC facilities from where one can easily gauge the situation in far-flung and remote districts when it comes to better healthcare facilities for pregnant women. Situation is also not encouraging in other districts like Kohlu, Awaran, Dera Bugti, Musakhail, Kharan and Barkhan etc. According to Health Department out of 35 districts in Balochistan, 15 have comprehensive Emergency Obstetric and Newborn Care (EMONC) services at Teaching and DHQ hospitals. As a whole, there are 1500 health facilities with nine teaching hospitals, two divisional, 28 district and five tahsil headquarter hospitals, 108 rural health centers, 784 BHUs and 91 mother and infant centers across the province. Latest census data for Balochistan reveals provincial population reaching 19.26 million in 2023 from 12.34 million in 2017 at a growth rate of 3.2%, significantly higher than the national average that needs an urgent focus to improve healthcare. Dr Ali Mir of Population Council, Islamabad states that unmet need of married couples in Balochistan is high as compared to other provinces as 33% of married women want to space or limit the number of children but they rarely mange to use contraceptive methods. “By reducing the number of unplanned pregnancies and voluntary family planning, the government could decrease the burden of ante-natal, peri-natal and post-natal health services for each pregnancy and lower the risks of MMR, saving the lives of thousands,” he pleaded. On this issue, Secretary Population Welfare Department, Abdullah Khan reiterated to minimize the number of MMR. “We have to focus other options as we prefer the term ‘balance’ rather than ‘control’ when addressing population growth and MMR.” He said the government has limited resources to expand family planning services to rural areas, “but we are closely working with Balochistan Human Capital Investment Program (BHCIP), WHO and UNFPA to provide services.” The Secretary mentioned to recruiting family welfare workers and engaging religious leaders to create awareness and deliver FP services at union councils in every district. “Our department has committed in FP 2030 to increasing Contraceptive Prevalence Rate (CPR) to 36% by 2025 and 46% by 2030,” he said. “Service integration with the health department is another strategy to manage population growth by engaging health professionals and healthcare providers.” Meanwhile, Amin Mandokhail, DG Health has informed that health department was striving hard to ensure best health facilities in every district. “But we need a holistic approach to achieve this goal with improved inter-district road connectivity and basic amenities at each district to save our mothers and infants.” Therefore, the government departments and allied organizations need to evolve a multifaceted strategy for improving infrastructure, healthcare, family planning and education system to address this problem.