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This brief focuses on the policy options available to the Sindh government to affect the province’s population growth by 2050 and its potential to achieve MDGs 4 and 5. Maternal mortality is a leading cause of death among women of reproductive age in Sindh—about 24 percent of the deaths in this age group are pregnancy-related. Approximately 2,800 women die each year in Sindh due to pregnancy-related causes despite some recent improvement in reproductive health indicators. Pregnancies that occur too early, too late, or too frequently increase the risk of maternal death. Lowering fertility rates by increasing the use of family planning can help reduce pregnancy-related deaths. The good news is that there has been a decrease in maternal mortality in Sindh. The maternal mortality ratio was estimated at 334 in 2001; in 2006, it was measured at 314; and by 2012 it had fallen to 214 per 100,000 live births. This brief combines data sources to make the case for prioritizing family planning to meet MDGs 4 and 5. Although fertility rates have declined in Sindh, the pace of decline is uneven. Greater efforts are required to establish parity in the fertility decline province-wide.