Globally, Pakistan has the third highest burden of maternal, fetal, and child mortality. It has made slow progress in
achieving the Millennium Development Goals (MDGs) 4 and 5 and in addressing common social determinants of
health. The country also has huge challenges of political fragility, complex security issues, and natural disasters. We
undertook an in-depth analysis of Pakistan’s progress towards MDGs 4 and 5 and the principal determinants of
health in relation to reproductive, maternal, newborn, and child health and nutrition. We reviewed progress in
relation to new and existing public sector programmes and the challenges posed by devolution in Pakistan.
Notwithstanding the urgent need to tackle social determinants such as girls’ education, empowerment, and nutrition
in Pakistan, we assessed the eff ect of systematically increasing coverage of various evidence-based interventions on
populations at risk (by residence or poverty indices). We specifi cally focused on scaling up interventions using delivery
platforms to reach poor and rural populations through community-based strategies. Our model indicates that with
successful implementation of these strategies, 58% of an estimated 367 900 deaths (15 900 maternal, 169 000 newborn,
183 000 child deaths) and 49% of an estimated 180 000 stillbirths could be prevented in 2015.