Trends in the Levels, Causes, and Risk Factors of Maternal Mortality in Pakistan: A Comparative Analysis of National Surveys of 2007 and 2019.

PONE-D-24-01507

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Reviewer #1: Yes

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Reviewer #1: Yes

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Reviewer #1: Yes

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Reviewer #1: This study has looked in depth at the into the trends and risk factors associated with maternal mortality in Pakistan from 2007 to 2019, against the backdrop of global efforts to achieve Sustainable Development Goal targets for maternal health. Employing secondary data analysis, the study compares results from the Pakistan Maternal Mortality Survey 2019 with the Pakistan Demographic and Health Survey 2007, employing a nested case-control design. Logistic regression, adjusting for crucial factors, is utilized to estimate odds ratios for major risk factors of maternal mortality. The findings reveal a 33% reduction in Pakistan's Maternal Mortality Ratio (MMR) to 186 per 100,000 live births in 2019, with notable rural-urban disparities. Leading causes of maternal mortality include postpartum hemorrhage, hypertensive disease of pregnancy, postpartum infection, and post-abortion complications. Advanced maternal age (>35 years) and primiparity emerge as risk factors, while family planning appears protective. Access to quality emergency obstetric care remains pivotal, evidenced by deaths occurring despite antenatal care. The study underscores the persistent influence of limited family planning on maternal mortality and emphasizes the need for targeted interventions to address access barriers and ensure comprehensive maternal health care in Pakistan.

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Reviewer #1: Yes: Mariyam Sarfraz

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