It was estimated that over 141 million newborns will be added to the world population in the year 2019, the number rising with every year. On the other hand, almost 2.5 million died in the first 28 days of life in the year 2017 . These 2.5 million deaths account for 47% of the total deaths in children under the age of five years, increasing from 40% in 1990 . Although the overall under-5 child mortality has declined over the past decade or so, the decline in the neonatal mortality has not been at the same pace, according to the UNIGME . This rise in the proportion of neonatal deaths was expected, as predicted in earlier studies which mentioned that the infant mortality rates are expected to decline due to widespread implementation of known and cost-effective interventions like vaccines for preventable diseases, and oral rehydration therapy for diarrhea .
Almost 75% of the newborn deaths happen during the first seven days of life, while over 25% happen before completion of the first 24-hours of life, highlighting the fact that the probability of surviving increases with every passing day for the newborn .
There is increasing evidence that significant inequalities in health across a number of dimensions – including wealth, ethnicity, and geography – continue to exist both between and within countries  . Indeed, it has been suggested that inequalities may have widened in recent times  . World Health Organization (WHO) defines health inequities as “Health inequities are differences in health status or in the distribution of health resources between different population groups, arising from the social conditions in which people are born, grow, live, work and age. Health inequities are unfair and could be reduced by the right mix of government policies” .
Over 65% of the total neonatal deaths occurring globally belong to just 10 countries. Most of these countries are from Asia. Pakistan ranks third among these ten. It is estimated that almost 300,000 newborns die annually in the country, the latest reported neonatal mortality rate being 42 per thousand live births, accounting for around 7% of neonatal deaths happening globally . Pakistan is also a signatory to the Alma Ata Agreement , which stipulates that health is affected by social position and the underlying inequality in a society.
Equity in health is a basic and core principle of the “Primary Health Care approach” . It is, henceforth, implicitly or explicitly mentioned in the health policies of a majority of the countries . It is widely recognized that people’s equitable access to health care services is vital to sustaining good health which depends primarily on income levels and the cost and availability of quality health services. There is an established correlation between social and health inequality. While inequalities are ubiquitous and a reality of life, the concept of inequity refers to the degree of unfairness and injustice in societies which often result from pervasive inequalities .
The Sustainable Development Goals (SDGs) make up a set of targets developed in a holistic manner to guide future development projects. Health is at the center of the third SDG, to “Ensure healthy lives and promote well-being for all at all ages” . This goal also focuses on the integration of equity, human rights, gender and social determinants into policies. These programs and institutional mechanisms all over the world that would be vital for empowering women and men, and reducing inequities between and among populations and promoting everyone’s human rights. Goal 10 also calls for a reduction in inequality within and among countries to empower and promote the inclusion of all . New-born health has also been taken seriously in the SDGs as the target for Neonatal Mortality Rate (NMR) for each country has been set at 12 per 1,000 live births .
Human welfare and development is a basic right of each individual as highlighted in the Constitution of Pakistan . Access to majority of the curative and preventive health services, and hence, their utilization are not equitable in Pakistan. These inequities are specifically intensified as we move from the richest towards the poorest wealth quintiles, as well as across various geographical regions of the country, especially highlighting the rural and urban divides. A multitude of initiatives have been taken over time to improve maternal and neonatal health indicators across the country. However, the progress so far is sluggish, and the inequities amongst different wealth and income statuses, social statuses, literacy rates and geographies have remained more or less constant  .
Using national data from Pakistan, this study aimed to:
observe trends in neonatal mortality in Pakistan with an equity lens; using data from the last three Demographic and Health Surveys
quantify the magnitude of inequalities in neonatal mortality trends by wealth quintile and place of residence with province wise segregation.