Influence of Social and Cultural Practices on Maternal Mortality: A Qualitative Study from South Punjab, Pakistan

Abstract

Background: A disproportionate high rate of maternal deaths are reported in developing and underdeveloped regions of the world. Much is associated with social and cultural factors which are barriers for women to utilise appropriate maternal health care. A huge body of research is available on maternal mortality in developing countries. Nevertheless, there is paucity of literature on socio-cultural factors leading to maternal mortality within the context of the Three Delay 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: i) 60 key informative interviews with gynaecologists, ii) four focus group discussions with Lady Health Workers (LHWs), and iii) ten case studies among family members of deceased mothers. The study was conducted in Dear Ghazi Khan, situated at South Punjab, Pakistan. Data was analysed with the help of thematic analysis.Results: The study identified that delay in seeking care – and its potentially following maternal mortality – is more likely to occur due to certain social and cultural factors in Pakistan. Poor socioeconomic status, limited knowledge on maternal care, and financial constraints of rural people were the main barriers in seeking care. Low status of women and male domination keeps women less empowered. The preference of traditional birth attendants results into maternal deaths. In addition to that, early marriages and lack of family planning as deeply entrenched in cultural values, religion and traditions – e.g. the influence of spiritual healers – prevented young girls to obtain maternal health care.Conclusion: The situation of maternal mortality is highly alarming in Pakistan. The uphill task of reducing deaths among pregnant women is deeply rooted in addressing certain socio-cultural practices, which are constraints for women seeking maternal care. The focus on reduction of poverty and enhancement of decision-making power is essential for approaching the right of medical care.

“Can’t live willingly”: A thematic synthesis of qualitative evidence exploring how early marriage and early pregnancy affect experiences of pregnancy in South Asia

“…Across South Asia, younger girls were thought to have an increased risk of experiencing complications during pregnancy and delivery due to their physical immaturity [21, 48-50, 54, 59, 60, 65, 68, 71, 74, 85, 88, 95, 98, 100, 102, 105, 109, 116, 119, 121]. This was attributed to early marriage [47,51,55,66,77,88,110].…”

“…1988/89 [44] Impact on care-seeking. Women and girls often delayed care seeking as a result of this normalisation of risk, as they considered pregnancy to be a condition needing care only in complicated cases [46,47,49,56,58,62,71,74,77,80,85], as explained by this young married woman:…”

“…early. Families considered younger girls less mature and those married early less knowledgeable[46,49,51,52,59,77,112,113], justifying their increased control over decision-making, as expressed by this 26-year-old aunt:…”