Improving Maternal Health in Pakistan: Toward a Deeper Understanding of the Social Determinants of Poor Women’s Access to Maternal Health Services

Abstract

Evidence suggests national- and community-level interventions are not reaching women living at the economic and social margins of society in Pakistan. We conducted a 10-month qualitative study (May 2010-February 2011) in a village in Punjab, Pakistan. Data were collected using 94 in-depth interviews, 11 focus group discussions, 134 observational sessions, and 5 maternal death case studies. Despite awareness of birth complications and treatment options, poverty and dependence on richer, higher-caste people for cash transfers or loans prevented women from accessing required care. There is a need to end the invisibility of low-caste groups in Pakistani health care policy. Technical improvements in maternal health care services should be supported to counter social and economic marginalization so progress can be made toward Millennium Development Goal 5 in Pakistan.

The Utilization of Quality Antenatal Care in Pakistan: Analyzing Health Inequity in Various Periods

“…The results of the decomposition of socioeconomic inequality show that the woman's age, place of residence, and husband's education widened socioeconomic inequalities, which precipitated the failure to use quality antenatal care. The result is consistent with previous studies, which have established the appreciable role of the husband in the decision-making of the household, and in particular, related to reproductive care of women in Pakistan (Mumtaz et al, 2014;Sathar & Kazi, 2000). Another set of studies suggest that when the economic and social dimensions of the distribution of power between partners increases, the reproductive health care of women in developing countries improves (Mumtaz & Salway, 2007;Simkhada, Van Teijlingen, Porter & Simkhada, 2008;Andrade et al, 2012).…”

“…But, the mechanized structure of programs, and the disregard of socioeconomic stratification, embedded in the society, made these attempts less successful than what they would be otherwise (Agha, 2011b;Mumtaz, O'Brien, Bhatti & Jhangri, 2012). The existing literature suggests that, in developing countries in particular, the level of education, stratification of the region of residence, occupation, socioeconomic mobility, and religious beliefs of the population are all factors that have some bearing on reproductive healthcare (Afzal & Yusuf, 2013;Arif & Ibrahim, 1998;Dhak, 2013;Midhet & Becker, 2010;Mumtaz et al, 2014;.…”

“…It is because of the prevailing cultural norms, higher expenses for quality antenatal care, the typically long commutes to and from the nearest medical facility, and lack of knowledge about the benefits of the utilization of services of qualified birth attendants that rural women forego having these skilled attendants assist them. (Mahmud et al, 2011;Majrooh, Hasnain, Akram, Siddiqui & Memon, 2014;Mumtaz et al, 2014;Mumtaz & Salway, 2007;Sathar & Kazi, 2000). The limited use of skilled birth attendants increases the likelihood of obstetric complications for women, such as still-births, and deaths of newborn babies, i Lady Health Worker program (in continuation since 1994), Pakistan Initiative for Mothers andNewborn (2004-2010), and Maternal and Child Health (in progress since 2007).…”

The Global and Local Factors Influencing Maternal Mortality Ratios: Barriers and Recommendations for Success

“…Results showed that despite the availability and awareness of treatment services, lowincome women did not utilize the services due to poverty and the reliance on individuals from higher castes for loans or cash transfers. Researchers concluded that socioeconomic status was a significant barrier for Pakistan to achieve Millennium Development Goal 5 (Mumtaz, Salway, Bhatti, Shanner, Zaman, Laing & Ellison, 2014).…”

“…Not only are females at risk for direct health complications that affect their health, but women who are exposed to poverty and gender violence and who lack education and access to care experience a more compromised level of maternal health (Mumtaz, Salway, Bhatti, Shanner, Zaman, Laing & Ellison, 2014;Vallieres, Hansen, McAuliffe, Cassidy, Owora, Kappler & Gathuru, 2013;Reid & Shams, 2013).…”