• Abdul Mateen
  • Babar Tasneem Shaikh
  • Ramesh Kumar


Background: Globally 529,000 women die annually due to pregnancy related problems and in Pakistan alone this toll is about 35,000 deaths per annum. This situation is even more critical in the rural remote areas of Azad Jammu & Kashmir (AJK). The whole phenomenon needs a contextual assessment to ascertain the geographical, financial and socio cultural accessibility, and availability of EmOC services in order to generate fresh evidence for the decision makers and concerned stakeholders for improving these services. Methods: A cross-sectional study was conducted using a structured questionnaire with the women delivered in the last 15 days, whereas the geographical accessibility and availability of EmOC services were assessed by visiting EmOC facilities in the district Neelum of AJK. Results: Over a hundred women delivered in the last 15 days, participated in the study. Geographically, a central EmOC facility is far away and the terrain is hilly and dangerous. Women’s social status, education, husband’s employment and household income were found to have a significant association with the use of EmOC services.  The health facilities audit showed that around 90% centres do not have a female medical officer appointed. Moreover, the state of the equipment, medicines and the basic utilities such as water, sanitation, and electricity are not satisfactory. Conclusion: Accessibility of EmOC services is poor in the district Neelum. Evidence on ground calls for organisational reforms at EmOC service delivery level as well as for long term planning in other sectors for improving socio-economic and education status of the women in Azad Jammu & Kashmir.Keywords:  Emergency obstetrics care, reproductive health, health care


Peters DH, Garg A, Bloom G, Walker DG, Brieger WR, Rahman MH. Poverty and access to health care in developing countries. Ann NY Acad Sci 2008;1136:161–71.

Mcintyre D, Thiede M, Birch S. Access as a policy relevant concept in low and middle income countries. J Health Econ Policy Law 2009;4(part 2):179–93.

Gulliford M, Figueroa-Munoz J, Morgan M, Hughes D, Gibson B, Beech R, et al. What does ‘access to health care’ mean? J Health Serv Res Policy 2002;7(3):186–8.

Jeny S. A case study for the evaluation of access to PHC across different population groups. Yogyakarta, Indonesia. Thesis 2010.

World Health Organization: Maternal & Reproductive Health. Global Health Observatory. http://www.who.int/gho/maternal_ health/en/index.html [accessed on 1st April, 2012]

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

Shaikh BT, Haran D, Hatcher J. Women’s social position and health seeking behaviours: Is healthcare system accessible and responsive in Pakistan? Healthcare Women Int 2008;29(8):945–59.

Nishtar S. The Gateway Paper-financing health in Pakistan and its linkage with health reforms. J Pak Med Assoc 2006;56(12 Suppl 4):S25–42.

World Bank. Pakistan Poverty Assessment. Poverty in Pakistan: Vulnerabilities, Social Gaps, and Rural Dynamics. Poverty Reduction and Economic Management Sector Unit South Asia Region, 2002.

UNICEF: Leading and underlying causes of maternal mortality. http://www.unicef.org/wcaro/overview_2642.html [accessed on 1st April, 2012]

Shaikh BT, Hatcher J. Health seeking behavior and health services utilization in Pakistan: challenging the policy makers. J Public Health (Oxford) 2005;27(1):49–54.

Fikree FF, Mir AM, Haq IU. She may reach a facility but will still die! An analysis of quality of public sector maternal health services, District Multan, Pakistan. J Pak Med Assoc 2006;56(4):156–63.

Bhutta ZA, Ahmed T, Black RE, Cousens S, Dewey K, Giugliani E, et al. What Works? Interventions for maternal and child under nutrition and survival. Lancet 2008;371(9610):417–40.

UNFPA: Emergency obstetric care: Checklist for planners. Available at: http://www.unfpa.org/upload/lib_pub_file/ 150_ filename_checklist_MMU.pdf [accessed on 14th March 2012]

Pearson L, Shoo R. Availability and use of emergency obstetric services: Kenya, Rwanda, Southern Sudan and Uganda. Int J Gynecol Obstet 2005;88:208–15.

Gunasekera PC, Wijesinghe PS, Goonewardene IMR. Emergency obstetric care: the key to further reducing maternal mortality in Sri Lanka. Geneva: World Health Organization; 2002.

Noorali R, Stephen L, Rahber MH. Does use of government service depend on distance from the health facility? Health Policy Plan 1999;14:191–7.

Kijugu DO. Analysis of factors that contribute to high number of maternal deaths in Singida Region, Tanzania. Royal Tropical Institute (KIT), Amsterdam: 2009.

Ali M, Bhatti M, Kuroiwa C. Challenges in access to and utilization of reproductive health care services in Pakistan. J Ayub Med Coll Abbottabad 2008;(20)4:3–7.

Fotso JC, Ezeh A, Madise N, Ziraba A, Ogollah R. What does access to maternal care mean among urban poor? Factors associated with use of appropriate maternal health services in slum settlements of Nairobi, Kenya. Matern Child Health J 2003;13:130–7.

Integrated Regional Information Network. Bangladesh: Educating girls lowers maternal death rate. Available at: http://www.irinnews.org/Report/89451/BANGLADESH-Educating-girls-lowers-maternal-death-rate [accessed 20th May 2012]

World Health Organization: Women and health: today's evidence tomorrow's agenda. Geneva: 2009.

World Health Organization: Cross-cutting gender issues in women’s health in the Eastern Mediterranean Region. Cairo: 2007.

Qureshi N, Shaikh BT. Women empowerment and health: analyzing the role of institutions of power in Pakistan. East Mediterr Health J 2007;13(6):1459–65.

Titaley CR, Hunter CL, Dibley MJ, Heywood P. Why do some women still prefer traditional birth attendants and home delivery? A qualitative study on delivery care services in West Java Province, Indonesia. BMC Preg Childbirth 2010;10:43.

Ali M, Ahmed KM, Kuroiwa C. Emergency obstetric care in Punjab, Pakistan: improvement needed. Eur J Contracept Reprod Health Care 2008;13(2):201–7.

Siddiqi S, Haq IU, Ghaffar A, Akhtar T, Mahaini R. Pakistan’s maternal and child health policy: analysis, lessons and the way forward. Health Polcy 2004;69(1):117–30.

Pasha O, Goldenberg RL, McClure EM, Saleem S, Goudar SS, Althabe F, et al. Communities, birth attendants and health facilities: A continuum of emergency maternal and newborn care (the Global Network’s EmONC trial). BMC Pregnancy Childbirth 2010;10:82



Most read articles by the same author(s)

1 2 3 4 > >>