Why & Where Perinatal Deaths: Trends and Determinants in Pakistan

Background: The perinatal mortality rate is a proxy indicator of healthcare quality for mothers and newborns. Unfortunately, Pakistan faces poor pregnancy outcomes, which are significantly worse than those of many other low-resource countries worldwide. Realizing the set of targets under Sustainable Development Goal 3 demands a substantial reduction in perinatal mortality in Pakistan. Methods: SPSS data files from the Pakistan Maternal Mortality Survey (PMMS) 2019, with a sample of 136,226 households, were used. The PNMR was computed by urban and rural areas for the regions and provinces of Pakistan and for each category of the common risk factors (independent variables). We applied the chi-square test to determine whether the correlations between the PNMR and the independent variables were statistically significant. Finally, binary logistic regression analysis was conducted via SPSS version 19.0 to compute the adjusted odds ratio (AOR). Results: The PNMR for the entire sample was 70.1 per 1000 live births. The geographical differences were not statistically significant, with the exception of the Gilgit-Baltistan (GB) region, which had a lower PNMR. We found the lowest PNMR among the highest quintile, primigravida, having 3–5 pregnancies, mothers aged 24–35 years, with education 10 years or higher, who had adequate antenatal care and those who delivered at home without skilled birth attendants. Binary logistic regression analysis revealed a twofold greater risk among the lowest wealth quintile: 1.37 times greater among women aged >35 years and 1.5 times greater among women who had skilled birth attendance. After adjusting for socioeconomic and demographic variables, parity and antenatal care were found to have no association with perinatal deaths. Discussion & Conclusion: We found no increase in the risk of PNMR among women younger than 25 years and using antenatal care, whereas other studies reported a greater risk of PNMR among younger and adolescent mothers. Therefore, more robust primary studies are needed to determine the associations of the key variables with perinatal mortality in Pakistan.