Islamabad (AsiaNews) – According to a recently released UN report, prenatal and maternal mortality rates remained high in 2003 despite declining infant mortality. The Pakistan Population Assessment 2003, a report by United Nations Population Fund (UNFPA), presents three main trends. If Pakistan's population growth is still significant, its fertility rates are in fact dropping with three important variations: decline in urban centres is greater than in rural areas, fertility remains high among the poor and is greater in Baluchistan and the North-West province than in the rest of the country.

The report shows that almost a quarter of the population (23.4 per cent) is aged 10 to 19, a situation that represents a major challenge to the country. It also confirms that a higher mortality rate among women is a clear indicator of their continuing lower social status and greater vulnerability compared to men.

Overall, some 33 million women in Pakistan have reached reproductive age. Every year about 5.4 million get pregnant or give birth to 4.5 million live births.

Most of them face complications during pregnancy; many become sick or die. About two in three get no prenatal care and more than four in five give birth at home, often with the assistance of untrained mid-wives. Estimates of maternal mortality ranges between 300 and 700 per 100,000.

Research confirms that the main causes of death are similar to those in other developing countries: postpartum haemorrhage, toxaemia of pregnancy, obstructed labour and puerperal sepsis. A small but significant number is attributable to unsafe abortions.

For every ten pregnancies, six have complications with about one woman in ten requiring medical intervention. Small-scale studies and hospital-based information point to high prevalence of anemia, prolapsed uterus, genital fistula, rupture of the uterus and puerperal psychosis.

Other areas of concern in women's health are the relatively less explored and neglected areas of reproductive tract infections, cancers, sexually transmitted infections, domestic violence and mental illnesses.

As visible as the shortcomings of the overall health system may be, they are even more glaring in rural areas and urban slums where the poor can hardly afford private health care.

Delivering health care to women is further complicated by social and cultural factors. Despite greater spending and investment, women still face restrictions and prejudices when it comes to access to health services.