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Assessing Neo-natal mortality trends in Pakistan: An insight using Equity Lens

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Abstract

Statement of the Problem: Of the estimated 130 million infants born each year worldwide, 4 million die in the first 28 days of life. Two-thirds of the world's neonatal deaths occur in just 10 countries, mostly in Asia. Pakistan is number three among these countries. With an estimated 298,000 neonatal deaths annually and a reported neonatal mortality rate of 49 per 1000 live births, Pakistan accounts for 7% of global neonatal deaths. Inequities exist in access to and utilization of many preventative and curative health services, and are particularly exacerbated between the richest and poorest, and across geographical regions in Pakistan. Despite various initiatives taken to improve maternal health indicators, the progress has been slow with wide disparities based on income level, class and social status. Methodology & Theoretical Orientation: The study was done using raw data from the last two Pakistan Demographic & Health Surveys (2012-13 and 2006-7). Inequities were observed in neonatal mortalities in different wealth quintiles by geography (Provinces) and type of residence (Rural/Urban population). Inequities are represented by concentration curves which plots the cumulative proportion of the individuals under consideration ranked by wealth against the cumulative proportion of the health/healthcare variable (e.g. antenatal care visits, skilled birth attendant etc.) being measured. Findings: When we compare the concentration index for neo-natal deaths by wealth quintile for Pakistan, there was an overall decrease, reflecting an improvement in terms of equity as the gap between the number of deaths among the richest and poorest quintiles narrowed down. PDHS for Pakistan shows that the gap between the richest and poor wealth quintiles has reduced; although the overall neonatal mortality has increased from 55 to 58 live births nationally. This could be an alarming indicator for quality of services being provided even in the urban areas.