Impact of place of delivery on neonatal mortality in Pakistan: Challenges and pathways toward achieving the sustainable development goals

The United Nations present the Sustainable Development Goals (SDGs) with the “leave no one behind” principle, with SDG 3 focusing on improving maternal and child health outcomes to reduce neonatal mortality (NM). Although global NM rates have declined significantly, NM persists as a pressing public health challenge across developing regions. This ongoing burden necessitates intensified, multifaceted interventions to accelerate progress toward SDG targets and enhance child survival worldwide. This study provides evidence on the impact of place of delivery on NM, an area that has received limited attention in existing research. The study utilized data from the Pakistan Demographic and Health Survey 2017 – 2018. A logistic regression model was employed to analyze the association between NM and place of delivery. The primary variable of interest was the place of delivery, whereas sociodemographic factors served as control variables. These factors included the mother’s employment status, child sex, birth order, maternal age, maternal education, residence, region, and size of the child. The analysis revealed that the place of delivery is a significant predictor of NM, with deliveries within facilities substantially reducing the odds of NM. Moreover, the study also found that the sex of a child, birth order, working status, and region are highly significant indicators for predicting NM. These findings indicate that most neonatal deaths occur during deliveries outside health facilities in Pakistan. It is recommended that the government emphasize accessible healthcare services and develop educational programs that focus on facility-based deliveries, prenatal care, and postnatal care for expectant mothers.