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4.6.3 Delivery Location and Type of Assistances

Overall 16 percent of births in 2024-25 took place at home as compared to 30 percent in 2018 - 19. (Table 1 9a).The percentage is almost twice in rural areas with 20 percent as compared to urban areas with 8 percent . It is encouraging to note that home deliveries have declined significantly across both urban and rural areas. This trend indicates a gradual shift towards institutional deliveries, reflecting improved access to healthcare facilities and a growing preference for safer childbirth practices.
Sustaining this progress wi ll be vital for further reducing maternal and neonatal risks. The reliability on Govt. hospitals has increased to 41 percent in 2024 -25 as compared to 29 percent in 2018-19 on the same side the trend of private hospitals/clinic for child delivery has also been increased to 42 percent in 2024-25 as compared to 40 percent in 2018-19.(Figure 4.17)
Childbirth assisted by a skilled birth attendant plays a vital role in reducing both maternal and neonatal mortality. The coverage of deliveries assisted by Skilled Birth Attendants in Pakistan has shown steady improvement over the years, reaching 84 percent in 2024-25,(Figure 4.18) which show 8 out of 10 women have their delivery through skilled birth attendant. Among these, doctors account for the largest share at 71 percent. A bit more comprehensive efforts are required to cover remaining 16 percent birth under umbrella of skilled birth attendant. (Table 19b)
Home , 16 G.hospital /RHC/BH U, 41 Private hosp/clinic , 42 Other, 1 Figure 4.17:Delivery Location Skilled Birth Attendants: Skilled Birth Attendants includes Doctors, Nurses, midwives and Lady Health Visitors (LHV). In Pakistan, 84% of births take place with the assistance of skilled birth attendants.

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Table 19b present percentage of delivery by type of assistance which indicates the increase in deliveries assisted by doctors with 71 percent in 2024-25 as compared to 58 percent in 2018-19. This trend highlights a positive shift toward pr ofessional medical assistance during childbirth,
reflecting improved access to healthcare facilities and greater trust in skilled providers. The percentage of child deliveries assisted by Trained Dai and TBA decreased to 11 in 2024–25 from 22 in 2018–19, reflecting a positive shift toward skilled birth attendance and improved maternal and neonatal health outcomes.
4.6.4 Post-Natal Consultation Post-natal consultation is supposed to be provided to the mother and her infant within six week of child’s birth, overall 4 4 percent of mothers reported to have post - natal check-up within six weeks after delivery as compared to 33 percent in 2018-19. (Figure 4.1 9) This means from every 4 women in Pakistan around one or two is going for post Natal consultation. However, the overall provincial situation shows an increasing trend in 2024-25 as compared to 2018 -19, highest trend is observed in Sindh with 50 percent. This percentage is higher in urban area with 56 percent and rural with 45 percent. Followed by Punjab with 49 percent, KP with 27 percent and Balochista n with 26 percent. Although KP and Balochistan show lower trend of post-natal care compared to 78 51 58 90 75 79 92 80 84 0 50 100 150 200 250 300 Urban Rural Total2013-14 2018-19 2024-25 Figure 4.18:Skilled Birth Attendant

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other provinces, both provinces have still demonstrated a gradual upward trend since 2018-19. This increase, though modest, indicates improving access and awareness, but also highlights the need for enhanced outreach and service availability in remote and underserved areas. (Table 20a). Table 20b shows the facility consulted for post-natal consultation, Private hospital/clinic with 58 percent and government hospital/BHU/RHC with 38 percent are the topmost facilities visited for post-natal consultation. The same pattern for consultation is observed both in urban and rural area.

4.6.5 Breastfeeding Practices in Pakistan Breastfeeding remains a foundational practice for child health, providing essential nutrients and protection against common childhood illnesses. Continued emphasis on breastfeeding support and awareness is vital for promoting healthy growth and improving early-life outcomes nationwide. Breastfeeding remains widely practiced across the country with 95 percent of women in Pakistan breastfeeding their last child. However, provincial differences are minimal, as Sindh, KP, and Balochistan showed higher rates with 97 percent comparative to Punjab with 94 percent. Overall, the trend reflects strong and consistent adherence to breastfeeding practices nationwide.(Table 21, Figure 4.20).

Figure 4.19: Post Natal Consultation Within Six Weeks After Delivery 0 10 20 30 40 50 Pakistan Punjab Sindh KP Balochistan 44 49 50 27 26 33 34 41 24 19 2024-25 2018-19 Figure 4.20: Percentage of Women That Breast Fed Their Last Child 91 92 93 94 95 96 97 98 96 94 98 97 97 95 93 97 97 97 95 94 97 97 97 Urban Rural Total

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List of Statistical Tables Table 1a Percentage of children aged 12-23 months that have been immunized
Table 1b Percentage of children aged 12-23 months that have been immunized on record
Table 1c Percentage of children aged 12-23 months that have been immunized on record and recall Table 2 Percentage of Children Aged 12-23 Months That Have Been Fully Immunized Based On Record- By Quintiles Table 3 Percentage of Children 12-23 Months That Have Been Immunized by Type of Antigen-Based On Record Table 4 Percentage of Children Aged 12-23 Months That Have Been Immunized by Type of Antigen-Based On Record and Recall Table 5a Children under 5 suffering from diarrhoea in past 15 days by Region and Province
Table 5b Treatment of Diarrhoea cases where practitioner was consulted in children under 5 years and under –By Region and Province Table 5c Treatment of Diarrhoea cases where ORS was given to child under 5 years and under – By Region and Province
Table 6 Diarrhoea Cases in Children Under 5 Years Duration of Episodes Table 7 Diarrhoea Cases Where Govt. Health Practitioner Was Consulted First by Region and Province Table 8 Type of Practitioner Consulted for Diarrhoea Treatment-By Region and Practitioner Table 9 Reason for Not Visiting Govt. Facility First for Diarrhoea Treatment- By Region and Province Table 10 Diarrhoea Cases in Past 15 Days- By Province and Quintiles
Table 11 Reasons for Visiting Private Practitioner First for Diarrhoea Treatment–By Region and Province Table 12 Percentage of Population with Malaria/Dengue, Hepatitis B & C and Tuberculosis
Table 13 Neo Natal Mortality with Respect to Period of Birth
Table 14 Infant Mortality Rate- By Gender and Region Table 15 Infant Mortality and Mother’s Education Table 16a Pre-Natal consultation-by Region and Province Table 16b Pregnant Women that have received Tetanus Toxoid Injection Table 16c Protected During Last Pregnancy Table 17 At least Four Pre-Natal consultation-By Region Table 18 Person/ Facility Consulted for Pre-Natal consultation Table 19a Child Deliveries- Location where Child was Delivered Table 19b Child Deliveries- By Type of Assistance Table 20a Post-Natal Consultation-By Province and Region Table 20b Post-Natal Consultation-By Person/Facility Consulted Table 21: Breast Feeding and Weaning Practice- By Province and Months

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Table 1 Percentage of children ages 12-23 months that have been immunized Province\Region\Gender a) Based on Recall At Least One Immunization b) Based on Record Fully Immunized c) Based on Recall and Record Fully Immunized Province\Region\Gender 2024-25 2018-19 2024-25 2018-19 2024-25 2018-19 Pakistan 96 99 73 68 78 76 Male 97 99 73 68 79 77 Female 96 99 73 67 77 76 Urban 97 100 75 76 80 83 Male 98 100 77 76 83 83 Female 96 100 74 76 77 83 Rural 96 99 72 63 77 73 Male 96 98 71 64 77 74 Female 96 99 72 63 77 72 Punjab 97 99 79 81 82 84 Male 97 98 80 81 82 84 Female 97 99 79 81 81 85 Urban 98 100 80 85 81 88 Male 100 100 82 85 84 87 Female 97 100 77 86 79 88 Rural 97 98 79 78 82 83 Male 96 98 79 79 82 83 Female 97 99 80 78 83 83 Sindh 96 100 66 50 75 73 Male 96 100 66 51 76 74 Female 97 100 66 48 73 72 Urban 98 100 73 64 81 80 Male 98 100 75 67 85 81 Female 98 100 70 62 76 78 Rural 95 99 60 36 69 67 Male 95 100 58 37 69 66 Female 96 99 62 35 70 67 Khyber Pakhtunkhwa
97 99 69 62 78 68 Male 98 99 69 63 77 71 Female 97 99 70 61 79 65 Balochistan 85 97 54 33 55 42 Male 85 98 56 32 58 44 Female 85 97 52 34 53 41 Urban 83 98 58 54 62 62 Male 83 98 62 50 68 58 Female 82 97 54 59 56 66 Rural 86 97 51 26 52 35 Male 87 46 52 37 52 56 Female 87 18 51 13 52 71 Notes:- Based on recall: Children reported as having received at least one immunization expressed as a percentage of all children aged 12-23 months. Based on record: Children who reported having received full immunization who also have an immunization card, expressed as a percentage of all children aged 12-23 months.

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NOTES: 1. Quintiles: Income groups made on the basis of per capita household consumption. 2. The 1st Quintile contains individuals with the lowest consumption level, whereas the 5th quintile contains individuals with the highest consumption level. 3. Children who reported having received full immunization who also have an immunization card, expressed as a percentage of all children aged 12-23 months. 4. Immunizations: To be classed as fully immunized a child must have received: ‘BCG’, ‘PENTA1’, ‘PENTA2’, ‘PENTA3’, ‘PNEUMOCOCCAL1’, ‘PNEUMOCOCCAL2’ , ‘PNEUMOCOCCAL3’, ‘Polio1’, ‘Polio2’, ‘Polio3’ and ‘Measles1,Measles 2 ’‘Hepatitis B1’, ‘Hepatitis B2’ and ‘Hepatitis B3’. Table 2:-Percentage of children age 12-23 months that have been fully Immunized Based on Record–by Quintiles Urban
Rural
Total

Male Female Both Male Female Both Male Female Both Pakistan

1st Quintile 64 64 64 61 67 64 62 66 64 2nd Quintile 77 72 74 71 66 69 73 68 70 3rd Quintile 89 73 81 78 77 78 82 76 79 4th Quintile 73 74 74 77 77 77 75 76 75 5th Quintile 80 79 79 76 86 81 78 82 80

Punjab

1st Quintile 85 83 84 73 76 74 75 77 76 2nd Quintile 85 82 83 81 80 81 83 80 82 3rd Quintile 89 82 86 80 80 80 83 81 82 4th Quintile 79 75 77 82 79 81 81 77 79 5th Quintile 75 73 74 80 90 85 78 81 79

Sindh

1st Quintile 58 54 56 52 61 56 53 60 56 2nd Quintile 69 59 64 57 51 54 61 55 58 3rd Quintile 94 67 79 64 75 69 80 70 75 4th Quintile 65 70 67 69 67 68 66 69 67 5th Quintile 87 91 89 83 69 75 87 86 87

Khyber Pakhtunkhwa

1st Quintile 34 40 37 58 67 63 57 65 61 2nd Quintile 59 68 64 68 61 64 67 61 64 3rd Quintile 81 75 78 84 76 80 83 76 80 4th Quintile 64 81 72 73 76 74 71 77 74 5th Quintile 71 92 81 64 85 74 66 87 75

Balochistan

1st Quintile 18 38 28 31 37 34 27 37 33 2nd Quintile 63 46 53 63 55 58 63 53 57 3rd Quintile 82 33 59 66 53 59 73 46 59 4th Quintile 43 93 74 62 68 65 56 80 68 5th Quintile 92 100 93 50 69 62 81 75 79