Intended for healthcare professionals

Analysis Health in South Asia

Progress in maternal and child health: how has South Asia fared?

BMJ 2017; 357 doi: (Published 11 April 2017) Cite this as: BMJ 2017;357:j1608
  1. Nadia Akseer, statistician1 2,
  2. Mahdis Kamali, research assistant1,
  3. Shams E Arifeen, senior scientist3,
  4. Ashar Malik, senior instructor4,
  5. Zaid Bhatti, statistician4,
  6. Naveen Thacker, consultant, paediatrician5 ,
  7. Mahesh Maksey, head of foundation6,
  8. Harendra D’Silva, professor7,
  9. Inacio CM da Silva, epidemiologist,8 ,
  10. Zulfiqar A Bhutta, professor1 2 4
  1. 1Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada
  2. 2Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
  3. 3Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b)
  4. 4Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
  5. 5Deep Children Hospital and Research Centre, Gandhidham, Gujrat, India
  6. 6Nepal Public Health Foundation, Kathmandu, Nepal
  7. 7Faculty of Medicine, University of Colombo, Sri Lanka
  8. 8International Center for Equity in Health, Federal University of Pelotas, Brazil
  1. Correspondence to: Z A Bhutta zulfiqar.bhutta{at}

Although maternal and child health has improved over the past decade, much remains to be done. Nadia Akseer and colleagues highlight the deficiencies and how to ensure progress continues

In our review of the state of maternal and child health in South Asia published in The BMJ 12 years ago,1 we highlighted rampant poverty, malnutrition, and lack of female empowerment as key barriers to change. Since then, the region has seen much focus on the millennium development goals related to maternal and child health as well as economic development. This article explores the progress and current state of reproductive, maternal, newborn and child health throughout South Asia, and presents a snapshot of the region’s preparedness for the sustainable development goals.2

Methods and data sources

Our analysis focuses on countries that are active members of the South Asian Association for Regional Cooperation: Afghanistan, Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan, and Sri Lanka. We used national and global data sources to assess maternal mortality,3 child mortality,4 and stillbirths5 as well as causes of death.678

We calculated coverage rates for interventions and health indicators for mothers, infants, and children in South Asia from UN, World Bank, and WHO sources.8910111213 Full definitions of the variables and details of the methods are provided in the appendix on

Mortality trends and causes of death

Globally, maternal mortality ratio dropped from 385 to 216 deaths per 100 000 live births between 1990 and 2015, a 44% reduction.3 Nevertheless, around 303 000 mothers die every year, about 22% of whom are in South Asia, with India accounting for the bulk of these deaths. Maternal mortality fell substantially in all South Asian countries during this period (ranging from a 59% reduction in Pakistan and Sri Lanka to 90% in the Maldives), with an overall reduction …

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