Aim
This paper investigates the effect of a religious holiday (
Eid-ul-Fitr
in Pakistan) on compliance behaviour instituted during the COVID-19 pandemic. Longstanding religion-based norms of behaviour during the Eid holidays (traveling to meet family members, praying in large gatherings, hugging) may counteract newly established (and weaker) norms of health-preserving behaviours.
Method
We study the impact of
Eid-ul-Fitr
on compliance with COVID guidelines for a sample of university students. Our effects are identified by unprompted delays in fielding a survey measuring compliance with prescribed behaviours.
Results
We find that compliance with guidelines declines immediately after the religious holiday in our sample of students, with no observable decline in other well documented predictors of compliance behaviour (risk perceptions, trust in the authorities). We find that this decline in compliance is largely attributable to male participants, with one important exception. We further confirm our results by conducting robustness checks incorporating matching techniques and a smaller follow-up study where we randomize invitations to the survey.
Conclusion
We conclude that amid the pandemic, newly formed norms pertaining to healthcare guidelines (focusing on social-distancing) emerged, and were subsequently undercut by longstanding norms of behaviour following a religious celebration:
Eid-ul-Fitr
. This paper underscores the fragility of these newly emerged norms, especially when challenged by a more well-entrenched, traditional norm.
Background: The majority of poor, illiterate women of reproductive years in Pakistan are living in underdeveloped regions and are solely dependent on free primary health services provided by the state. This project aims 1) to collect baseline health and social data, 2) to deliver a health and social literacy intervention, 3) to deliver a team-building intervention for primary-level healthcare providers, and 4) to conduct a community needs assessment.
Methods: Electronic health and social data will be collected at baseline, which will be used to develop a comprehensive database and develop an index for Maternal Health and Wellbeing. A 24-month intervention will be delivered which will have 6 modules related to health and social literacy. The principal investigators will train the data collectors and intervention facilitators. Lady Health Workers will collect the electronic data and pre-post test data, and Community Social Workers will deliver the health and social literacy intervention. Cluster randomized sampling will be used to sample 6 BHUs across 6 different cities of Punjab, Pakistan. A total of 360 women will be sampled and assigned randomly to the experiment and control groups. The principal investigators will deliver the team-building intervention and conduct the community needs assessment. The participants for the latter will include doctors, nurses and community health workers; and for the former will include women from the community, women community health providers, community elders and religious leaders, and local government officials.
Discussion: Pakistan is falling behind on its sustainable development goals for maternal health, mainly due to the limitations of the existing services and literacy of women. There is critical need to support understaffing of current providers by partnering them with community social workers and training them for better care delivery. Similarly, women need support for gaps in both health and social literacy. Development of an index and community needs assessment report can support better identification of environmental and socio-cultural needs in the community and to advise policy makers and stakeholders about issues wider which directly and indirectly impact women’s health.
Trial registration: This study has been registered with ClinicalTrials.gov. The identification number is: NCT05389501.
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