From policy to practice: a desk review of constraints to maternal immunization in Pakistan
1
Aga Khan University, Karachi, Pakistan
2
Vital Pakistan Trust, Karachi, Pakistan
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
BACKGROUND:
Pakistan experiences high maternal and neonatal mortality, estimated at 155 per 100000 live births and 37.6 per 1000 live births, respectively. Maternal immunization is an evidence based strategy to reduce this burden. New maternal vaccines for respiratory syncytial virus and group b streptococcus are in advanced stages of development. This study aimed to examine policy and system level gaps and challenges shaping maternal immunization in Pakistan to inform the introduction of new maternal vaccines.
METHODS:
A desk review was conducted using WHO workbook for situation analysis of immunization programme performance. Key sources included the national immunization policy 2022, relevant programmatic and policy documents, published literature, and media reports. The review was conducted between November 2024 and February 2025. Findings were synthesized across three analytical levels: policy, health system, and implementation.
RESULTS:
At the health system level, barriers included inequitable distribution of healthcare workers, operational inefficiencies in supply chain and limited availability of trained staff. Weak integration between the immunization programme and reproductive, maternal, newborn and child health services. At the policy level, reliance on tetanus diphtheria as the sole maternal vaccine reflected limited prioritization of maternal immunization, alongside fragmented national provincial coordination and regional disparities, with the lowest coverage observed in Baluchistan. Sustainability of immunization programmes remained a concern due to heavy dependence on external donor financing. At the implementation level, low awareness, vaccine hesitancy driven by misinformation and cultural barriers, limited counselling by health workers, and minimal engagement of traditional birth attendants further constrained uptake.
CONCLUSIONS:
Expanding maternal immunization in Pakistan beyond tetanus diphtheria requires strengthened governance, sustainable financing, improved integration between immunization and maternal health services, and targeted strategies in low performing areas. Addressing workforce and operational gaps alongside strategic community engagement to counter misinformation will be critical to support the introduction of new maternal vaccines.
Pakistan experiences high maternal and neonatal mortality, estimated at 155 per 100000 live births and 37.6 per 1000 live births, respectively. Maternal immunization is an evidence based strategy to reduce this burden. New maternal vaccines for respiratory syncytial virus and group b streptococcus are in advanced stages of development. This study aimed to examine policy and system level gaps and challenges shaping maternal immunization in Pakistan to inform the introduction of new maternal vaccines.
METHODS:
A desk review was conducted using WHO workbook for situation analysis of immunization programme performance. Key sources included the national immunization policy 2022, relevant programmatic and policy documents, published literature, and media reports. The review was conducted between November 2024 and February 2025. Findings were synthesized across three analytical levels: policy, health system, and implementation.
RESULTS:
At the health system level, barriers included inequitable distribution of healthcare workers, operational inefficiencies in supply chain and limited availability of trained staff. Weak integration between the immunization programme and reproductive, maternal, newborn and child health services. At the policy level, reliance on tetanus diphtheria as the sole maternal vaccine reflected limited prioritization of maternal immunization, alongside fragmented national provincial coordination and regional disparities, with the lowest coverage observed in Baluchistan. Sustainability of immunization programmes remained a concern due to heavy dependence on external donor financing. At the implementation level, low awareness, vaccine hesitancy driven by misinformation and cultural barriers, limited counselling by health workers, and minimal engagement of traditional birth attendants further constrained uptake.
CONCLUSIONS:
Expanding maternal immunization in Pakistan beyond tetanus diphtheria requires strengthened governance, sustainable financing, improved integration between immunization and maternal health services, and targeted strategies in low performing areas. Addressing workforce and operational gaps alongside strategic community engagement to counter misinformation will be critical to support the introduction of new maternal vaccines.
| eISSN: | 2654-1459 |
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