RESUMO
BACKGROUND: A disproportionately high rate of maternal deaths is reported in developing and underdeveloped regions of the world. Much of this is associated with social and cultural factors, which form barriers to women utilizing appropriate maternal healthcare. A huge body of research is available on maternal mortality in developing countries. Nevertheless, there is a lack of literature on the socio-cultural factors leading to maternal mortality within the context of the Three Delays Model. The current study aims to explore socio-cultural factors leading to a delay in seeking care in maternal healthcare in South Punjab, Pakistan. METHODS: We used a qualitative method and performed three types of data collection with different target groups: (1) 60 key informant interviews with gynaecologists, (2) four focus group discussions with Lady Health Workers (LHWs), and (3) ten case studies among family members of deceased mothers. The study was conducted in Dera Ghazi Khan, situated in South Punjab, Pakistan. The data was analysed with the help of thematic analysis. RESULTS: The study identified that delay in seeking care-and the potentially resulting maternal mortality-is more likely to occur in Pakistan due to certain social and cultural factors. Poor socioeconomic status, limited knowledge about maternal care, and financial constraints among rural people were the main barriers to seeking care. The low status of women and male domination keeps women less empowered. The preference for traditional birth attendants results in maternal deaths. In addition, early marriages and lack of family planning, which are deeply entrenched in cultural values, religion and traditions-e.g., the influence of traditional or spiritual healers-prevented young girls from obtaining maternal healthcare. CONCLUSION: The prevalence of high maternal mortality is deeply alarming in Pakistan. The uphill struggle to reduce deaths among pregnant women is firmly rooted in addressing certain socio-cultural practices, which create constraints for women seeking maternal care. The focus on poverty reduction and enhancing decision-making power is essential for supporting women's right to medical care.
Round the world, many women are dying because of complications during pregnancy or in childbirth. These deaths are more frequent in developing and underdeveloped countries. Some reasons for this are related to social and cultural factors, which form barriers to women using appropriate maternal healthcare. Therefore, this study aims to explore socio-cultural factors leading to a delay in seeking maternal healthcare in South Punjab, Pakistan. We interviewed a variety of people to get an overview of this topic: (1) 60 interviews were conducted with gynaecologists, (2) we performed four focus group discussions with eight to ten Lady Health Workers providing maternal healthcare, and (3) we talked with family members of mothers who had died.The study shows that delays in seeking care are related to poor socioeconomic status, limited knowledge about maternal care, and low incomes of rural people. The low status of women and male domination keeps women less empowered. In addition, early marriages and lack of family planning due to cultural values, religion and traditions stopped young girls from getting maternal healthcare.The number of new mothers who die is very worrying in Pakistan. One of the important tasks for reducing deaths among pregnant women is to address certain socio-cultural practices. It is very important to reduce poverty and improve decision-making power to make sure women can use their right to medical care.
Assuntos
Acessibilidade aos Serviços de Saúde , Serviços de Saúde Materna/estatística & dados numéricos , Mortalidade Materna/etnologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Complicações na Gravidez/mortalidade , Criança , Características Culturais , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Entrevistas como Assunto , Masculino , Serviços de Saúde Materna/organização & administração , Paquistão/epidemiologia , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Gravidez , Complicações na Gravidez/etiologia , Cuidado Pré-Natal , Pesquisa Qualitativa , População Rural/estatística & dados numéricos , Fatores SocioeconômicosRESUMO
In Pakistan, 96% of the children under the age of two years do not receive an adequate diet. The main aim of this paper is to identify the sociodemographic, nutritional, and health-related factors associated with stunting, wasting, and underweight in children under the age of two years in Pakistan. Secondary data analysis was performed based on the Pakistan Demographic and Health Survey, 2012â»2013. The analysis was limited to children under the age of two years (n = 984). Analysis was done using bivariate and multivariable binary logistic regression. The incidence of stunting, wasting, and underweight in children was 28.3%, 12.1%, and 27.9%, respectively. The odds of stunting, wasting, and underweight increased with the child's age. The odds of stunting and underweight increased with the mother's low body mass index, low access to information, high birth order of child, consanguineous marriages, father's low education, rural settlement, poor toilet facilities, and low vitamin A consumption. The odds of wasting increased in children who were not being breastfed, but no significant relation was seen with stunting and underweight. There is a need to improve child nutritional status in Pakistan by addressing issues such as poverty, low parental education, low micronutrient intake, and targeting provinces where undernutrition was found to be higher.
Assuntos
Dieta/efeitos adversos , Fenômenos Fisiológicos da Nutrição do Lactente , Desnutrição/etiologia , Estado Nutricional , Desenvolvimento Infantil , Consanguinidade , Dieta/etnologia , Escolaridade , Feminino , Transtornos do Crescimento/etiologia , Humanos , Incidência , Lactente , Fenômenos Fisiológicos da Nutrição do Lactente/etnologia , Masculino , Desnutrição/epidemiologia , Desnutrição/etnologia , Desnutrição/fisiopatologia , Inquéritos Nutricionais , Estado Nutricional/etnologia , Paquistão , Pais/educação , Prevalência , Saúde da População Rural/etnologia , Fatores Socioeconômicos , Síndrome de Emaciação/etiologiaRESUMO
Evidence shows that Pakistan has an increasing rate of children with low birth weight (LBW). Employed mothers in paid work (EMPW) in the country have predominantly been disadvantaged in terms of access to education and low-income employment; with negative consequences on maternal and child health. The objective of this study was to determine socio-demographic characteristics of EMPW and identify the association between maternal employment and child birth weight in Pakistan. Secondary data from the Pakistan Demographic Health Survey (PDHS) conducted for the year 2006-2007 was used. PDHS is a nationally representative household survey. Relevant data needed from the PDHS data file were coded and filtered. The sample size of EMPW with at least one child born in the last 5 years was 2,515. Data was analyzed by using SPSS. Descriptive and inferential statistics were used to see the association between EMPW characteristics and LBW. Findings confirm that the majority of EMPW in Pakistan are illiterate, poor, employed in unskilled work, and belonging to rural regions. Multivariate regression analysis revealed statistical association between EMPW and LBW among mothers who did not receive prenatal care from unskilled healthcare provider (AOR 1.92; 95% CI 1.12-3.30), had lack of access to information such as radio (AOR 1.88; 95% CI 1.28-2.77), during pregnancy did not receive calcium (AOR 1.19; 95% CI 1.05-1.34), and iron (AOR 1.33; 95% CI 1.05-1.69), had experienced headaches during pregnancy (AOR 1.41; 95% CI 1.12-1.76), and were not paid in cash for their work (AOR 1.41; 95% CI 1.04-1.90). EMPW in Pakistan, especially in low-income jobs and rural regions, need urgent support for healthcare awareness, free supplementation of micronutrients and frequent consultation with trained practitioner during the prenatal period. Long-term mobilization of social structure and governance is needed to encourage maternal health awareness, hospital deliveries, and formal sector employment for EMPW.
Assuntos
Emprego/estatística & dados numéricos , Recém-Nascido de Baixo Peso , Mães , Fatores Socioeconômicos , Adolescente , Adulto , Feminino , Humanos , Alfabetização/estatística & dados numéricos , Pessoa de Meia-Idade , Paquistão/epidemiologia , Gravidez , População Rural/estatística & dados numéricos , Inquéritos e QuestionáriosRESUMO
This article documents the coping strategies adopted by women victims of spousal violence in Pakistan. By drawing on 21 in-depth interviews conducted in Lahore and Sialkot (Pakistan), we found that the women tried to cope with violence by using various strategies, both emotion focused (e.g., use of religion, placating the husband, etc.) and problem focused (e.g., seeking support from formal institutions, etc.). The data showed that a majority of the women used emotion-focused strategies, especially spiritual therapies, which somehow reduced the violence and provided them with psychosocial solace. Nonetheless, these strategies incurred some costs, such as the consumption of scarce resources, time, and emotional energy. Our data also showed that few women opted for problem-focused strategies, such as seeking help from formal institutions, as these strategies could lead to overt confrontation with their husbands and may result in divorce, the outcome least desired by most of the Pakistani women. We noted that the coping behavior of Pakistani women was complex, subjective, and nonlinear and that the boundaries between emotion-focused and problem-focused strategies were diffuse and blurred. Although the women never surrendered to violence, they were fully aware of their structural limitations and vulnerabilities. Being mindful of the consequences of their actions, women carefully tailored a combination of strategies which could be helpful in resisting or reducing violence but, at the same time, should not be counterproductive. This article argues that Pakistani women alone cannot effectively resist violence while living under a harshly patriarchal regime, where violence against women is embedded in the social, political, and legal structures of society. There are no quick fixes to change the status quo. The Pakistani government, civil society, and formal institutions must proactively support women in reducing their vulnerabilities and facilitate them in expanding their capabilities to address the real causes of violence against them.