Challenges in access to and utilization of reproductive health care in Pakistan.

BACKGROUND: Pakistan's maternal mortality rate is high, and adequate and timely emergency services could prevent most maternal deaths. A woman's right to life-saving services of skilled health care providers in childbirth is undeniable. This paper examines factors restricting women's access to emergency obstetric care services in Pakistan. METHOD: This cross-sectional survey on emergency obstetric care services collected information at the health facility level using UN process indicators. The study enrolled 170 health facilities from nineteen randomly selected districts in Punjab and NWFP. RESULTS: Diverse factors limit women's access to Emergency Obstetric Care (EmOC) services. EmOC services were unavailable in most health facilities surveyed. Staff absenteeism, geographic remoteness, delayed access, and ambulance shortages jeopardize the transferral of seriously ill patients to higher level care facilities. Cultural norms dictate that women should be examined by women doctors, whose dearth makes these services inaccessible. CONCLUSION: Many maternal deaths would be avoidable if EmOC health services were accessible. The geographic obstacles to timely access, poor hospital infrastructure, and high staff absenteeism rates require immediate attention. Health facilities' working hours were inconsistent with the provision of around-the-clock essential services, depriving and endangering the lives of many in need. It is imperative to increase skilled female workers capable of managing EmOC problems through proper incentives. A focused approach at local levels through proper supervision, motivation, and management would unquestionably save women's lives.

Assessment of prevalence and determinants of posttraumatic stress disorder in survivors of earthquake in Pakistan using Davidson Trauma Scale.

INTRODUCTION: Pakistan's 2005 earthquake claimed almost 87,000 lives and displaced millions. The present study sought to assess PTSD prevalence among earthquake survivors, to evaluate its determinants, and to identify protective factors that suggest future interventions in the aftermath of disasters. METHODS: In a cross-sectional survey, three districts were selected based on their proximity to the epicenter and the presence, accessibility, and security of refugees, 300 earthquake survivors were enrolled. RESULTS: Analysis revealed that after 30months, PTSD prevalence was high. Being female, older, unmarried, head of the family, and currently unemployed and having low income and living in temporary housing confer higher risks of PTSD. Having a high social capital and religious inclination seem to have protective, buffer effect and increase resilience against PTSD. CONCLUSION: This is the first post-quake study in Pakistan that has utilized, adapted and validated Davidson Trauma Scale in the local context. Results imply the significance of continued psychological support, of drawing on resilience factors in PTSD management. Implications and directions for future research are discussed.

Reproductive health needs of adolescent males in rural Pakistan: an exploratory study.

This is the first study done to explore reproductive health needs of adolescent males in Pakistan. The purpose of this exploratory study was to obtain qualitative information on existing knowledge and perceptions on puberty and reproductive health needs and to identify effective communication channels for imparting reproductive health education to adolescent males. Seventy-eight unmarried adolescent males participated in the survey, conducted through in-depth interviews by a semi-structured questionnaire using purposive sampling, in eight rural districts in Pakistan. The study pointed out that there existed misconceptions and gaps in knowledge regarding puberty and reproductive health. These young men also have poor knowledge about sexually transmitted diseases dynamics. The communication between parents or siblings on the said issues was found to be poor and they mainly get information from friends followed by the media. The majority showed interest in getting quality information. Multiple entry points and settings can be used to enhance access to information and services. In-school adolescents could be effectively approached through teachers and peer group. Out-of-school adolescents could be reached via media and local health care providers. The results imply that there is a dire need for reproductive health education for adolescent males and suggestions from this study might be utilized when initiating any reproductive health educational service for male adolescents in rural areas in Pakistan. Future efforts should thus focus on assuring access to timely, comprehensive and high-quality reproductive health education for all teenagers and reducing gaps in access related to gender and school attendance.