RafPakistan Australian Government - ausAID Department for International Development
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MNH Themes

These themes provide an overarching framework for grantees, and are to be used as the basis for further analysis and prioritisation of the key issues that RAF will consider for funding. It should be noted that RAF has already funded research on some of these areas and encourages grantees to build on that research, in terms of investigating further critical gaps identified, or developing an advocacy initiatives where strong evidence has been generated and opportunities exist.

Please refer to the RAF's Approach to Advocacy - Guidance for Applicants & Grantees for further details on the MNH issues the fund has chosen to prioritise.


A large number of maternal and newborn deaths could be avoided if women had access to timely, appropriate, affordable and adequate care in Pakistan. Efforts to improve MNH outcomes in Pakistan have thus far focussed on increasing the availability of basic health services, trained staff, adequate medical supplies and equipment. Recent studies have highlighted the ‘futility’ of strengthening the supply side of a health system without addressing the major demand side barriers that currently prevent many of the poorest women from accessing health services.
However, poor women’s access to, and utilisation of, health care services is limited by economic, social and cultural barriers. Financial barriers and costs for MNH care can exclude poor women from accessing critical health services, leaving them to rely on self-treatment, traditional healers, and delivery at home without skilled birth attendance.  Women are often not able to demand better access to healthcare services due to their lower socio-cultural and economic status, lack of education, constraints on mobility and their ability to appear in public spaces. Long distance travel to healthcare facilities is a major barrier to accessing healthcare services, particularly for women who may have restrictions placed on their mobility or who may not be able to afford the transportation costs or the time needed for travel.
Quality of care refers to the reliability, reach, responsiveness and effectiveness of the healthcare system. Efforts to improve the quality of care and services must address clinical factors - such as safe procedures, accurate information and reliable products - as well as healthcare providers’ awareness and sensitivity to their patients’ cultural values, social concerns and individual needs.
The further extension and consolidation of health services and infrastructure in Pakistan must be accompanied by a corresponding improvement in the quality of those services and systems. The improved quality of Emergency Obstetric and Neonatal Care (EmONC) for example, should contribute to a significant reduction in maternal and newborn mortality and morbidity rates. A clear advocacy agenda exists in scaling up of evidence based minimum packages of care and enhancing capacity of existing human resources for health.
Particular areas of focus include: Continuum of Care; Emergency Obstetric and Neonatal care; Technologies and Drugs; and Human Resources for Health.
Promotion of family planning is a priority focus area for RAF. Unintended pregnancies may result in unsafe abortions, and the lack of availability of contraception may lead to multiple pregnancies, which can have a detrimental effect on the health of mothers. In 2000, approximately 90% of global abortion-related and 20% of obstetric-related mortality and morbidity could have been averted by the use of effective contraception by women wishing to postpone or cease further childbearing. Birth spacing is one of the most cost effective ways of reducing maternal and newborn mortality. Unsafe abortions remain a major cause of both maternal mortality and morbidity.
High-level political commitment is therefore needed alongside a broad coalition of support from elite groups and religious leaders, adequate funding, the use of mass media and access to contraceptives through medical facilities, social marketing, and outreach services. RAF has an important opportunity to support grantee advocacy that looks to promote political commitment and effective implementation of family planning at a Provincial level.
There is strong evidence and broad consensus about the influence of education on maternal health outcomes. Education gives women the knowledge to understand their health needs, and to demand and seek healthcare. Education therefore has the double effect of improving access to information as well as empowering women to make choices. A low level of education is also an important factor in determining whether a woman bears children at a young age, which may result in unfavourable health outcomes for both maternal and child health, particularly if the girl is young and physically and psychologically underdeveloped. In Pakistan, women with more than secondary education get married at a median age of 24.5 years, nearly six years later than women with no education (18.2 years).
Gender inequality in access to education and health is a strong determinant of maternal and infant mortality rates. Levels of women’s education are positively associated with low rates of use of contraceptives and antenatal care. Infant and child mortality rates are also lower among children whose parents are more highly educated. Improved access of education for women is therefore critical to the success of interventions targeted at reducing maternal and infant mortality. It is also necessary to increase general understanding amongst men, women, boys and girls about basic health concepts and key MNH issues e.g. timely access to skilled birth attendants.
Whilst there is recognition of malnutrition as a problem in Pakistan, little progress made over the last 20 years. Under-nutrition amongst women can lead to pregnancy complications and low immunity in mothers and newborns. Poor maternal nutritional status is often the result of inadequate food intake due to limited access to food within the household and poor dietary habits. Focusing on improving nutrition for adolescent girls in the pre-conception period is an important priority as undernourished girls often grow up to become undernourished women who give birth to a new generation of undernourished children. Child malnutrition is a major problem in Pakistan and results from maternal malnutrition, inappropriate infant and child feeding and caring practices, frequent episodes of diarrhoea, infectious diseases and lack of safe drinking water and household sanitation.

However, a lack of political commitment, combined with minimal investments in nutrition interventions have hindered progress. There is also currently no national nutrition policy or national strategic plan for addressing malnutrition in Pakistan. Key challenges in addressing under-nutrition include building commitment, building capacity and scaling up proven interventions that focus on those most in need.


Last modified: 28/04/2011   |  Print Page
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