Maternal Mortality: A 5-year analysis at a District Headquarter Hospital in Pakistan


  • Saiqa Ikram District Headquarter Hospital, Timergara
  • Nazia Wahid District Headquarter Hospital, Timergara
  • Sobia Ali Ayub Medical College, Abbottabad
  • Sofia Ali Ayub Medical College, Abbottabad


Background: Maternal mortality ratio is an important figure reflecting the strength of a healthcare system. Traditionally the causes of maternal death are described by the three-delay model. This study was conducted to evaluate the causes and determinants of maternal mortality at a secondary level hospital in a rural area of northern Pakistan over a period of 5 years (2013-17). Methods: This cross-sectional study was conducted in 2018 on hospital data for the previous 5 years (2013-17) regarding mortality in the Gynaecology department of District Headquarter hospital, Timergara. Cases of maternal death were identified and secondary data was retrieved from the hospital records and patient case sheets. Results: Forty-seven cases of maternal death were identified over a period of 5 years and the average maternal mortality ratio calculated to be 110/100,000 live births. Haemorrhage was the commonest cause (36%) followed by uterine rupture (34%) and hypertensive disorders (21%). Most of the cases seen were in uneducated women belonging to the poor socioeconomic stratum (85%) aged 20 to 35 years (55%). 51% of the women were multigravidae coming from within a distance of 25–50 km from the hospital (53%) Majority of the dying mothers (57%) had no antenatal care and were seen arriving at the hospital in the evening shifts (48%). Conclusions: Causes and determinants of maternal death are complex and inter sectorial. Poverty, lack of education, antenatal care, family spacing and prompt access to emergency care contribute to maternal death. Keywords: Maternal death; Maternal mortality; Causes; Determinants; Rural area; Pakistan

Author Biographies

Saiqa Ikram, District Headquarter Hospital, Timergara

Department of Obstetrics & Gynaecology

Nazia Wahid, District Headquarter Hospital, Timergara

Department of Obstetrics & Gynaecology

Sobia Ali, Ayub Medical College, Abbottabad

Lecturer, Department of Community Medicine


Alkema L, Chou D, Hogan D, Zhang S, Moller AB, Gemmill A, et al. Global, regional, and national levels and trends in maternal mortality between 1990 and 2015, with scenario-based projections to 2030: a systematic analysis by the UN Maternal Mortality Estimation Inter-Agency Group. The Lancet 2016; 387(10017):462-74.

International statistical classification of diseases and related health problems. Geneva: World Health Organization; 2010.

Majrooh MA, Hasnain S, Akram J, Siddiqui A, Memon ZA. Coverage and Quality of Antenatal Care Provided at Primary Health Care Facilities in the ‘Punjab’ Province of ‘Pakistan’. PLoS ONE 2014; 9(11): e113390.

Khan KS, Wojdyla D, Say L, Gulmezoglu AM, Look PFV. WHO analysis of causes of maternal death: a systematic review. The Lancet 2006; 367(9516):1066-74.

AbouZahr C. Global burden of maternal death and disability. British Medical Bulletin 2003; 67(1): 1-11.

Pasha O, Saleem S, Ali S, Goudar SS, Garces A, Esamai F et al. Maternal and newborn outcomes in Pakistan compared to other low and middle income countries in the Global Network’s Maternal Newborn Health Registry: an active, community-based, pregnancy surveillance mechanism. Reprod Health 2015; 12(suppl 2):s15.

Thaddeus S, Maine D. To



Most read articles by the same author(s)