Pakistan's Historic Floods Threaten Progress in Maternal and Child Health

(September 2010) At least 16 million Pakistanis have had to leave their homes because of historic monsoon rains that flooded a large swath of the country.1 The UN estimates the flooding has caused the deaths of 1,600 people, but the worst health effects are still ahead. There are reports of an upsurge of gastroenteritis, diarrhea, and skin-related diseases, and health experts worry about increases in malaria and water-borne diseases like typhoid and cholera.2


The millions of people who lost homes, livestock, and livelihoods will be vulnerable to malnutrition and health problems for some time. UNICEF and other relief organizations are working “with the government to ensure that basic water, sanitation, and hygiene services are repaired to prevent major disease outbreaks.”3 The situation threatens to reverse recent gains in infant and maternal health and undercut efforts to reduce poverty and to achieve the Millennium Development Goals (MDGs) by 2015.


Population and Key Indicators: Pakistan


2010 Total Population (millions) 184.8
2050 Total Population (millions) 335.2
Population Under Age 15 (%) 38
Population Age 65+ (%) 4
Average Number of Births per Woman 4.0
Life Expectancy at Birth (years) 66
Infant Mortality Rate (deaths under age 1 per 1,000 births) 64

Source: Carl Haub, 2010 World Population Data Sheet (Washington, DC: Population Reference Bureau, 2010).

Progress Undermined by Flood Devastation

The recent devastation is a setback to efforts to improve health, especially of mothers and children.4 Pakistan’s nearly 185 million people had seen improvement in many indicators of health and socioeconomic well-being in recent years. Income per capita has more than doubled since 1990, in constant dollars, reaching US$2,700 in 2008. Income is close to the average for India, and well above that for neighboring Afghanistan and Nepal.5 Pakistan is still classified as a low-income country by the World Bank—more than one-half of the residents survive on less than $2 per day, yet it is better off now than in previous decades.

Child and maternal health had also been improving. In 2010, an estimated 64 of every 1,000 babies born will not survive their first year, down from about 90 deaths per 1,000 in 1990. But this rate is still more than 10 times the rate in more developed countries and well above the level needed to achieve the 2015 MDG for improving child health. Over the short-term, child health is likely to worsen. Diarrhea—a leading cause of death among infants and young children—has increased in flooded areas, threatening the lives of many more young Pakistanis. Even before the flooding, a majority of Pakistanis did not have access to safe water and sanitation, which are essential for maintaining good health. The situation has deteriorated.

Maternal mortality is still high in Pakistan: In 2008, an estimated 376 women died for every 100,000 live births. While an improvement over 1990 when the maternal mortality ratio was estimated at 541, this most recent estimate is still more than twice Pakistan’s MDG target.6

The percentage of pregnant women receiving prenatal care and skilled medical care had been increasing, a positive indicator for mother’s health. The percentage of women receiving prenatal care from a skilled health provider (nurse, doctor, midwife, or “Lady Health Visitor”) rose from just 33 percent in 1996 to 61 percent in 2006-07.7 Yet less than two-fifths (39 percent) of babies are born with the assistance of a skilled medical provider. The MDGs’ call for nearly all (at least 90 percent) of births attended by skilled health personnel by 2015 seems unlikely in Pakistan. Skilled medical care during childbirth is crucial for avoiding maternal deaths and injuries.

The flooding has left many expectant mothers without access to medical care. The UN Population Fund estimates that nearly 500,000 women affected by the floods are pregnant, and that 1,700 women will go into labor each day. More than 250 of them will experience complications requiring medical care. Most flood victims do not have access to proper health services including skilled delivery assistance.8

“This is a tragic situation that will affect the lives of thousands of Pakistani families and place additional pressure on an already burdened health system,” says Marya Khan, PRB senior policy analyst, who works on PRB’s ENGAGE Project to help reduce maternal deaths in Pakistan.9

Population Growth Hampers Progress

Improving health, education, and economic status have been challenged by rapid population growth fueled by high birth rates. About 5.6 millions babies are born each year in Pakistan, yielding a net population increase of 4 million after accounting for annual deaths. Pakistani women have about four births each during their childbearing years—a rate that has changed little since 2001. Yet about one-fourth of women of childbearing age would like to delay or prevent another pregnancy, but are not using family planning. If these women had access to effective contraceptives, they could avoid unwanted pregnancies, which would help slow population growth and promote maternal and child health. Numerous studies show that both mothers and babies benefit when women wait at least two years between pregnancies.

Use of family planning remains low—although it is more than twice the rate in the early 1990s. The 2006/07 DHS recorded just less than 30 percent of women using a contraceptive, with just 22 percent using an efficient modern method. With the current devastation and disruption of transportation, providing women with the family planning services they want and need will be a greater challenge than ever.

Mary Mederios Kent is senior demographic writer at the Population Reference Bureau.



  1. Goddard Earth Sciences Data and Information Services Center, “Flooding in Pakistan Caused by Higher-Than-Normal Monsoon Rainfall,” accessed at, on Aug. 31, 2010.
  2. Priyanka Pruthi, “In Flood-Devastated Pakistan, 3.5 Million Children Are at Risk of Disease,” accessed at, on Aug. 31, 2010.
  3. UNHCR Pakistan, “Flood Update No 11, 27 August 2010,” accessed at, on Aug. 31, 2010.
  4. United Nations Development Programme, “MDG Goals,” accessed at, on Sept. 1, 2010.
  5. United Nations, “Millennium Development Goals Indicators,” accessed at, on Sept. 2, 2010.
  6. Margaret C. Hogan et al., “Maternal Mortality for 181 Countries, 1980-2008: A Systematic Analysis of Progress Towards Millennium Development Goal 5,” The Lancet 375, no. 9726 (2010): 1609-23; and Pakistan Planning Commission, Pakistan Millennium Development Goals Report 2004 (2005), accessed at, on Sept. 2, 2010.
  7. Lady Health Visitors (LHV) are female health professionals who serve populations in remote mountainous areas and rural villages and are often the first contact women have with the health system. See Jocelyn Hezekiah, “The Pioneers of Rural Pakistan: The Lady Health Visitors,” Health Care for Women International 14, no. 6 (1993): 493–502; and Pakistan National Institute of Population Studies (NIPS) and Macro International Inc., Pakistan Demographic and Health Survey 2006-07 (Islamabad, Pakistan: NIPS and Macro International Inc., 2008).
  8. “Lives of Thousands of Pregnant Women at Risk: UN,” The Express Tribune, Sept. 8, 2010, accessed at, on Sept. 8, 2010.
  9. PRB’s ENGAGE Project, conducted in partnership with the Gapminder Foundation and in-country partners, is a global initiative that aims to help reduce maternal morbidity and mortality. The project team works closely with local partners to reach out to high-level government policymakers, civic and religious leaders, program officials, journalists, and other influential leaders. In Pakistan, ENGAGE staff work with the Rahnuma Family Planning Association of Pakistan and the National Committee for Maternal and Neonatal Health.