A low birth weight baby, defined by the World Health Organisation as weighing less than 2,500 grams (5.5 pounds) at birth, faces an increased risk of neonatal mortality, stunted growth, cognitive delays, and chronic health conditions in later life.

By Salman Yousafzai

A disturbing rise in the number of underweight newborns across Pakistan’s Khyber Pakhtunkhwa province has put health officials on high alert, particularly in the province’s remote and underserved districts. The latest data released by the Khyber Pakhtunkhwa Health Department reveals that districts like Upper Kohistan, Kolai Palas, and Upper Chitral are recording disproportionately high rates of low birth weight (LBW) infants, raising red flags about maternal health, nutrition, and access to care.

In Upper Kohistan, 98 out of 718 babies – roughly 13.65 per cent – were born underweight, making it the most affected district in the province. Kolai Palas followed with a 9.04 per cent rate (34 out of 376), while Upper Chitral recorded 76 such cases out of 1,212 births, translating to 6.27 per cent.

By contrast, better-resourced districts such as Mardan, Swat, Peshawar, and Haripur reported significantly lower figures. Mardan had just 0.13 per cent of newborns with low birth weight – only 27 out of more than 20,000 births – while Swat reported 0.55 per cent, Peshawar 0.85 per cent, and Haripur 2.79 per cent. Across all districts surveyed, 820 of 76,972 babies were born underweight, reflecting an overall LBW prevalence of 1.06 per cent in these areas.

A Provincial Crisis Rooted in Inequality

Health experts warn that this spike is not just a medical anomaly but a symptom of deeper systemic issues. “Low birth weight isn’t simply a neonatal issue; it’s a direct mirror of the mother’s health, the household’s socioeconomic status, and the health infrastructure in the area,” said Dr. Amina Khan, a senior gynaecologist based in Peshawar.

She attributes the alarming rates to several converging factors: “Malnutrition, lack of antenatal check-ups, early-age pregnancies, anaemia, and even maternal stress all play a role. And in many cases, it’s a combination of all of these.”

A low birth weight baby, defined by the World Health Organization as weighing less than 2,500 grams (5.5 pounds) at birth, faces an increased risk of neonatal mortality, stunted growth, cognitive delays, and chronic health conditions in later life. Globally, the LBW prevalence stands at 16 per cent, climbing to 19 per cent in developing countries and soaring to 32 per cent in rural areas – similar to Khyber Pakhtunkhwa’s most affected zones.

Maternal Nutrition: The Missing Link

In the impoverished and mountainous regions of Upper Kohistan and Kolai Palas, where health infrastructure is sparse and basic amenities are lacking, maternal malnutrition is rampant. According to studies published in the LNH Journals, anaemic mothers are significantly more likely to deliver low birth weight infants.

“In these districts, many women survive on little more than bread and tea during pregnancy,” said Dr. Shahid Rehman, a maternal health specialist working in the Hazara region. “The nutritional deficiencies are severe, and iron or folic acid supplements are either unavailable or not administered due to lack of awareness.”

Micronutrient deficiencies, particularly iron, calcium, and vitamin A, contribute to complications like preeclampsia and intrauterine growth restriction, both of which are associated with LBW.

Antenatal Care Gaps, Early Marriages, Tobacco

Beyond nutrition, a critical gap in antenatal care also drives the problem. Many women in remote areas do not see a doctor or trained health worker throughout their pregnancy. Even when medical facilities exist, cultural taboos, distance, and lack of female staff discourage women from seeking care.

“The culture of early marriages adds another layer of complexity,” explained Dr. Rehman. “Teenage girls who become pregnant are still growing themselves. Their bodies are not physically prepared to support the healthy development of a foetus.”

Medical professionals are now calling for legislation that enforces the legal age of marriage, alongside awareness campaigns to delay childbearing until the mother is physically and emotionally mature.

Research has also drawn a link between maternal tobacco use and low birth weight. Studies on ResearchGate note that women who smoke or use chewing tobacco during pregnancy are more likely to give birth to underweight babies. In certain tribal areas of Khyber Pakhtunkhwa, the use of snuff or naswar among women remains a concerning trend that has not been effectively addressed by public health campaigns.

Provincial Response: Will It Be Enough?

In response to the data, public health experts are urging swift and targeted interventions. Among their key recommendations:

Nutritional Support Programs: Introducing and scaling up food supplementation initiatives for pregnant women, especially in high-risk districts.

Mandatory Antenatal Care: Making early and regular prenatal check-ups a provincial mandate, with penalties or incentives to encourage compliance.

Healthcare Access in Rural Areas: Expanding the Lady Health Worker program and establishing mobile clinics in hard-to-reach areas.

Combating Early Marriages: Enforcing existing laws and conducting grassroots education to highlight the health risks of underage pregnancy.

Awareness Campaigns: Promoting the dangers of maternal tobacco use and the benefits of a balanced diet and medical care during pregnancy.

Dr. Amina Khan emphasized the importance of a long-term vision: “Reducing low birth weight is not just about preventing neonatal deaths. It’s about ensuring a healthy population, capable of learning, working, and contributing to society. It starts with the health of mothers.”

The Khyber Pakhtunkhwa Health Department is reportedly under pressure to act. Sources within the department suggest that a maternal and child health task force is being assembled to draft an emergency action plan, although no official statement has been released.

Still, scepticism remains among frontline health workers. “We’ve seen many plans come and go,” said one nurse in Swat on condition of anonymity. “Unless there’s political will and adequate funding, it’s hard to bring real change.”

The disparity between districts like Mardan and Upper Kohistan illustrates that solutions do exist – but only where governance, resources, and public health education converge. Without addressing the deep-seated inequities, experts fear that the crisis may worsen, leaving another generation born into a cycle of poor health and lost potential.

As Khyber Pakhtunkhwa grapples with this emerging maternal health crisis, the province stands at a crossroads. The choices made today will determine not only the survival of newborns but the strength of communities for decades to come.