In a statement marking the “International Day of the Midwife,” United Nations Population Fund (UNFPA) lamented that Pakistan had only 2.2 midwives per 10,000 people, nearly half the global average, and faces a shortage of almost 82,000. It also accounts for about four per cent of global maternal deaths, pointing to a basic service gap in a country where pregnancy and childbirth remain among the most dangerous experiences for poor and rural women.
The 2019 Pakistan Maternal Mortality Survey placed the maternal mortality ratio at 186 deaths per 100,000 live births. The same survey showed wide provincial variation, emphasising rural women were at higher risk than urban women.
The infant and newborn figures are equally stark. Pakistan’s infant mortality rate stood at 56 deaths per 1,000 live births, while neonatal mortality was 42 per 1,000. Neonatal deaths account for a large share of under-five mortality, and many occur around labour, delivery and the first days of life. Skilled midwives can help detect danger signs, support safe delivery, manage early newborn care and refer complicated cases before delays become fatal.
Those delays remain a central weakness. In many districts, families first turn to untrained birth attendants because they are nearby, socially accepted and cheaper than formal care.
The 2022 floods exposed the same vulnerability on a national scale. UNFPA estimated that almost 650,000 pregnant women needed maternal health services, while up to 73,000 were expected to deliver within a month. Floods damage roads, displace families, interrupt nutrition and cut off health facilities. For Pakistan, maternal care can no longer be treated as a routine health-sector issue. It must be built into disaster planning, mobile clinics, relief camps and ambulance networks.
There is no shortage of local experience to learn from. Sindh’s PPHI network has expanded primary-level services in many districts while other midwife-led initiatives show that women are more likely to use maternity services when care is local, affordable, respectful and linked to referral hospitals. The problem is that such models remain uneven, and too many basic health units still lack the staff, supplies and transport needed for safe delivery.
The policy response should, henceforth, be measurable. Training new midwives will achieve little if graduates remain unemployed, underpaid or forced into private work without support.
Pakistan cannot lower maternal mortality through speeches on motherhood. It needs a regulated maternity system with trained midwives at the first point of care and functioning referral links behind them. The numbers tell a revealing story about where things have gone wrong. Now, the real test is whether the state is ready to step up and invest in making things right. *