Autonomous decision-making for antenatal screening in Pakistan: views held by women, men and health professionals in a low–middle income country

Abstract

Prenatal genetic technologies now are being implemented in LMICs and while there is much research on the ethical, legal and social implications of such technologies in Western countries, there is a paucity of such research in LMICs, which have diverse cultural, religious, political, financial and health service contexts. This study aimed to explore views about women's autonomous decision-making for antenatal screening held by women, men and healthcare professionals (HCPs) in Pakistan. A Q-methodology study was conducted during June 2016 to January 2018 in Lahore, Pakistan. A total of 137 participants (60 women, 57 men, 20 HCPs) rank ordered 41 statements. Following by-person factor analysis, four distinct viewpoints were identified. Three of these represent views held by women and men only: autonomous decision-making requires directive advice from doctors; autonomous decision-making requires the husband's involvement, where independent decision-making by the woman is considered culturally inappropriate; and opting for antenatal screening is a foregone decision. One contrasting viewpoint represents predominantly HCPs: autonomous decision-making is the couple's responsibility. These findings highlight that Western approaches to facilitating women's autonomy for antenatal screening are unlikely to be suitable for use in Pakistan. Instead, culturally appropriate practice guidelines are needed in LMICs to enable HCPs to adopt shared decision-making approaches in a way that enables them to facilitate active and joint decision-making by couples, while ensuring women exercise their autonomy.

Regional Disparities of Antenatal Care Utilization in Indonesia

“…This is in line with the conclusions in several studies that show the role of husband/partner in providing support for a woman's health behavior [30--33]. Some other studies actually involve a husband to be able to improve a woman's health status through actively better health behaviors [34][35].…”

Regional disparities in antenatal care utilization in Indonesia

“…This is in line with the findings of several studies that have shown the role of a husband/partner in providing support for a woman's healthy lifestyle [32][33][34][35]. Some other studies actually encourage a husband to help improve a woman's health status by actively encouraging a healthier lifestyle [36,37].…”

Decision making on antenatal screening results: A comparative Q‐method study of women from two Chinese cities

“…The purpose of this study is to explore women's understandings of informed choice concerning antenatal screening tests in two different societal contexts in China. The findings show that women interpret informed choice in different ways, supporting the results of past studies 5,23,27 . We found five viewpoints in our study.…”

“…People may not recognize them as independent decision makers 26 . For example, women from South Asia may prefer to follow the doctor's or husband's advice 5,27 and not make decisions themselves 21,22 . Previous research has also shown that Chinese women prefer to make an informed choice with their husband and family and want doctors to provide directive advice 23,28 .…”