Pakistan has been ranked highest and appears worst in stillbirths’ rate according to the recent global estimates. Reasons could be manifold; socio-cultural, health system related country specific, and some of these of course déjà vu, i.e., the biomedical causes. Yet, a fresh stocktaking is necessary to understand the complex phenomenon in a country, awfully affected by this menace. Maternal, neonatal and child health program needs to be informed and geared up toward addressing the actual reasons behind this heavy toll of stillbirths inPakistan. Maternal health indicators would never be improved, if the issue of stillbirths is not stalled at the earliest. Besides known medical reasons, this account attempts to document the health systems related factors, and more so the social determinants behind the whole scenario, so that appropriate and customized interventions could be suggested, developed and implemented. This paper will be a piece of evidence for policy corridors, program managers, development partners, non-governmental organizations, public health institutions, students, and researchers to enhance their understanding of a major public health problem, and to recognize the strengths and opportunities in the health system of Pakistan to cope with this challenge.Keywords: Stillbirths; Health system; Social determinants; MNCH; Pakistan


WHO. Making pregnancy safer. Executive Board meeting 107th Session. Geneva: 2000.

World Health Organization. Stillbirths: Maternal, newborn, child and adolescent health. [Internet]. [cited 2016 April 22]. Available from:

Blencowe H, Cousens S, Jassir FB, Say L, Chou D, Mathers C, et al. National, regional, and worldwide estimates of stillbirth rates in 2015, with trends from 2000: a systematic analysis. Lancet Glob Health 2016;4(2):e98–108.

WHO. Global reference list of 100 core health indicators. Geneva; 2015.

Aminu M, Unkels R, Mdegela M, Utz B, Adaji S, van den Broek N. Causes of and factors associated with stillbirth in low- and middle-income countries: a systematic literature review. BJOG 2014;121(Suppl 4):141–53.

Murphy S. Reclaiming a moral identity: stillbirth, stigma and ‘moral mothers’. Midwifery 2012;28(4):476–80.

United Nations. Transforming our world: The 2030 agenda for sustainable development. New York: 2015.

Cousens S, Blencowe H, Stanton C, Chou D, Ahmed S, Steinhardt L, et al. National, regional, and worldwide estimates of stillbirth rates in 2009 with trends since 1995: a systematic analysis. Lancet 2011;377(9774):1319–30.

Planning Commission. Pakistan 2025-One nation-One vision. Ministry of Planning, Development & Reform, Government of Pakistan. Islamabad: 2015.

Nasrullah M, Bhatti JA. Gender inequalities and poor health outcomes in Pakistan: A need of priority for the national health research agenda. J Coll Physicians Surg Pak 2012;22(5):273–4.

Shaikh BT, Haran D, Hatcher J. Women's social position and health-seeking behaviors: is the health care system accessible and responsive in Pakistan? Health Care Women Int 2008;29(8):945–59.

Khan A, Kinney MV, Hazir T, Hafeez A, Wall SN, Ali N, et al. Newborn survival in Pakistan: a decade of change and future implications. Health Policy Plan 2012;27(Suppl 3):iii72–87. Ref no 12&35 are same

WHO. ICD-10: International statistical classification of diseases and related health problems-Instruction manual. Geneva: 2004.

Lawn JE, Blencowe H, Pattinson R, Cousens S, Kumar R, Ibiebele I, et al. Stillbirths: Where? When? Why? How to make the data count? Lancet 2011;377(9775):1448–63.

Frøen JF, Cacciatore J, McClure EM, Kuti O, Jokhio AH, Islam M, et al. Stillbirths: why they matter. Lancet 2011;377(9774):1353–66.

National Institute of Population Studies & Macro International. Pakistan Demographic and Health Survey 2006-07. Islamabad: 2008.

National Institute of Population Studies & Macro International. Pakistan Demographic and Health Survey 2012-13. Islamabad: 2014.

Goldenberg RL, McClure EM, Bhutta ZA, Belizán JM, Reddy UM, Rubens CE, et al. Stillbirths: the vision for 2020. Lancet 2011;377(9779):1798–805.

Flenady V, Koopmans L, Middleton P, Frøen JF, Smith GC, Gibbons K, et al. Major risk factors for stillbirth in high-income countries: a systematic review and meta-analysis. Lancet 2011;377(9774):1331–40.

Lawn JE, Blencowe H, Waiswa P, Amouzou A, Mathers C, Hogan D, et al. Stillbirths: rates, risk factors, and acceleration towards 2030. Lancet 2016;387(10018):587–603.

Tinker A. Improving women's health in Pakistan. World Bank, Islamabad: 1998.

Aga Khan University, Pakistan Medical Research Council, Nutrition Wing, Cabinet Division, Government of Pakistan. National Nutrition Survey Pakistan. Islamabad: 2011.

Bhutta ZA, Yakoob MY, Lawn JE, Rizvi A, Friberg IK, Weissman E, et al. Stillbirths: what difference can we make and at what cost? Lancet 2011;377(9776):1523–38.

Pattinson R, Kerber K, Buchmann E, Friberg IK, Belizan M, Lansky S, et al. Stillbirths: how can health systems deliver for mothers and babies? Lancet 2011;377(9777):1610–23.

Abrejo FG, Shaikh BT, Rizvi N. And they kill me, only because I am a girl…a review of sex selective abortions in South Asia. Eur J Contracept Reprod Health Care 2009;14(1):10–6.

Heazell AE, Siassakos D, Blencowe H, Burden C, Bhutta ZA, Cacciatore J, et al. Stillbirths: economic and psychosocial consequences. Lancet 2016;387(10018):604–16.

Chou D, Daelmans B, Jolivet RR, Kinney M, Say L. Ending preventable maternal and newborn mortality and stillbirths. BMJ 2015;351:h4255.

WHO. Every newborn: An action plan to end preventable deaths. Geneva: 2014.

Lassi ZS, Bhutta ZA. Community-based intervention packages for reducing maternal and neonatal morbidity and mortality and improving neonatal outcomes. Cochrane Database Syst Rev 2015;3:CD007754.

Sibley LM, Sipe TA, Barry D. Traditional birth attendant training for improving health behaviors and pregnancy outcomes. Cochrane Database Syst Rev 2012;8:CD005460.

Akhtar N. Factors affecting utilization of antenatal and postnatal services in Punjab, Pakistan (Doctoral dissertation, University Of Agriculture, Faisalabad). 2014.

Noorani QA, Azam I, Shaikh BT, Ranasinghe T, Abbas S, Wali S, et al. Role of community based savings groups (CBSGs) enhancing the utilization of community midwives in Chitral district of Pakistan. BMC Pregnancy Childbirth 2013;13:185.

Save the Children. Stillbirths – the global picture and evidence-based solutions. An executive summary for the BMC Pregnancy and Childbirth Supplement. 2009.

Goldenberg RL, Saleem S, Pasha O, Harrison MS, Mcclure EM. Reducing stillbirths in low-income countries. Acta Obstet Gynecol Scand 2016;95(2):135–43.

Shaikh BT. Private sector in health care delivery: a reality and a challenge in Pakistan. J Ayub Med Coll Abbottabad 2015;27(2):496–8.

Michalow J, Chola L, McGee S, Tugendhaft A, Pattinson R, Kerber K, et al. Triple return on investment: the cost and impact of 13 interventions that could prevent stillbirths and save the lives of mothers and babies in South Africa. BMC Pregnancy Childbirth 2015;15:39.

Dawson AJ, Buchan J, Duffield C, Homer CS, Wijewardena K. Task shifting and sharing in maternal and reproductive health in low-income countries: a narrative synthesis of current evidence. Health Policy Plan 2014;29(3):396–408.

Black RE, Levin C, Walker N, Chou D, Liu L, Temmerman M, et al. Reproductive, maternal, newborn, and child health: key messages from Disease Control Priorities 3rd Edition. Lancet 2016;388(10061):2811–24.

Frøen JF, Friberg IK, Lawn JE, Bhutta ZA, Pattinson RC, Allanson ER, et al. Stillbirths: progress and unfinished business. Lancet 2016;387(10018):574–86.

Hamid S, Malik AU, Richard F. Stillbirth--a neglected priority: understanding its social meaning in Pakistan. J Pak Med Assoc 2014;64(3):331–3.

Mustufa MA, Kulsoom S, Sameen I, Moorani KN, Memon AA, Korejo R. Frequency of stillbirths in a tertiary care hospital, Karachi. Pak J Med Sci 2016;32(1):91–4.

Negandhi PH, Neogi SB, Chopra S, Phogat A, Sahota R, Gupta R, et al. Improving reporting of infant deaths, maternal deaths and stillbirths in Haryana, India. Bull World Health Organ 2016;94(5):370–5.

Kerber K. Counting every stillbirth and neonatal death: Perinatal audit tools and implementation for improving quality of care linked to maternal death surveillance and response. Saving Newborn Lives, Save the Children. 2015

WHO. Stillbirths: The Invisible Public Health Problem. Geneva: 2011.

Allahdadian M, Irajpour A, Kazemi A, Kheirabadi G. Strategy for Mental Health Improvement of Iranian Stillborn Mothers From Their Perspective: A Qualitative Study. Iran Red Crescent Med J 2016;18(1):e21081.

Ejaz I, Shaikh BT. Social marketing for early neonatal care: Saving newborn lives in Pakistan. World Health Popul 2010;11(3):17–23.

Jahan S, Jespersen E, Mukherjee S, Kovacevic M, Bonini A, Calderon C, et al. Human development report 2015: Work for human development. UNDP N Y NY USA; 2015.

Auger N, Delézire P, Harper S, Platt RW. Maternal education and stillbirth: estimating gestational-age-specific and cause-specific associations. Epidemiol 2012;23(2):247–54.

Ma N, Hou X. Empowering women: The effect of women’s decision making power on reproductive health services uptake: Evidence from Pakistan. World Bank: 2011.

Bhutta ZA, Hafeez A. What can Pakistan do to address maternal and child health over the next decade? Health Res Policy Syst 2015;13(Suppl 1):49.

Government of Pakistan. National vision for coordinated priority actions to address challenges of reproductive, maternal, newborn, child and adolescent health, and nutrition 2016-20125. Ministry of National Health Services, Regulation and Coordination, Islamabad: 2015.



Most read articles by the same author(s)

1 2 3 > >>