The influence of social and cultural practices on maternal mortality: a qualitative study from South Punjab, Pakistan

Abstract

Background A disproportionately high rate of maternal deaths is reported in developing and underdeveloped regions of the world. Much of this is associated with social and cultural factors, which form barriers to women utilizing appropriate maternal healthcare. A huge body of research is available on maternal mortality in developing countries. Nevertheless, there is a lack of literature on the socio-cultural factors leading to maternal mortality within the context of the Three Delays 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: (1) 60 key informant interviews with gynaecologists, (2) four focus group discussions with Lady Health Workers (LHWs), and (3) ten case studies among family members of deceased mothers. The study was conducted in Dera Ghazi Khan, situated in South Punjab, Pakistan. The data was analysed with the help of thematic analysis. Results The study identified that delay in seeking care—and the potentially resulting maternal mortality—is more likely to occur in Pakistan due to certain social and cultural factors. Poor socioeconomic status, limited knowledge about maternal care, and financial constraints among rural people were the main barriers to seeking care. The low status of women and male domination keeps women less empowered. The preference for traditional birth attendants results in maternal deaths. In addition, early marriages and lack of family planning, which are deeply entrenched in cultural values, religion and traditions—e.g., the influence of traditional or spiritual healers—prevented young girls from obtaining maternal healthcare. Conclusion The prevalence of high maternal mortality is deeply alarming in Pakistan. The uphill struggle to reduce deaths among pregnant women is firmly rooted in addressing certain socio-cultural practices, which create constraints for women seeking maternal care. The focus on poverty reduction and enhancing decision-making power is essential for supporting women’s right to medical care.

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“…Studies from Pakistan corroborate this and highlight that home births are highly prevalent because of difficulties in obtaining permission to visit a health facilities, financial dependency, distance to health facilities, and costly transportation [37]. Moreover, the subservient status of women keeps them disempowered and adds further constraints for timely maternal care [38].…”

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“…Apart from these biological determinants, maternal death is also a product of complex interactions between economic and socio-cultural factors ( Omer et al, 2021 ). In Pakistan, pregnant women in rural areas continually exhibit delayed treatment seeking behaviour due to correlations between their poor socioeconomic status, early marriages and lack of maternal care knowledge ( Omer et al, 2021 ).…”

“…Apart from these biological determinants, maternal death is also a product of complex interactions between economic and socio-cultural factors ( Omer et al, 2021 ). In Pakistan, pregnant women in rural areas continually exhibit delayed treatment seeking behaviour due to correlations between their poor socioeconomic status, early marriages and lack of maternal care knowledge ( Omer et al, 2021 ). Pregnant women who live in poverty also suffer from poor nutrition, are generally less educated and also lack funds for transportation to far-away healthcare facilities and their services ( Omer et al, 2021 ).…”

“…In Pakistan, pregnant women in rural areas continually exhibit delayed treatment seeking behaviour due to correlations between their poor socioeconomic status, early marriages and lack of maternal care knowledge ( Omer et al, 2021 ). Pregnant women who live in poverty also suffer from poor nutrition, are generally less educated and also lack funds for transportation to far-away healthcare facilities and their services ( Omer et al, 2021 ). This causes them to consult cheap and unskilled services from Traditional Birth Attendants (TBAs) and community healers ( Omer et al, 2021 ).…”

“…Pregnant women who live in poverty also suffer from poor nutrition, are generally less educated and also lack funds for transportation to far-away healthcare facilities and their services ( Omer et al, 2021 ). This causes them to consult cheap and unskilled services from Traditional Birth Attendants (TBAs) and community healers ( Omer et al, 2021 ). Consulting TBAs and healers encourages delayed treatment seeking behaviour as they associate pregnancy complications with evil forces and advise pregnant women to stay indoors ( Omer et al, 2021 ).…”