Addressing disparities in maternal health care in Pakistan: gender, class and exclusion
详细信息 查看全文
- 作者：Zubia Mumtaz (1)
Sarah Salway (2)
Laura Shanner (3)
Shakila Zaman (4)
Lory Laing (3) - 关键词：Social exclusion ; Maternal health ; Gender ; Caste system ; Pakistan ; Health care system ; Class ; Health policy ; Pregnancy and childbirth ; Antenatal care
- 刊名：BMC Pregnancy and Childbirth
- 出版年：2012
- 出版时间：December 2012
- 年：2012
- 卷：12
- 期：1
- 全文大小：284KB
- 参考文献：1. World Health Organization: / Maternal mortality in 2000: estimates developed. WHO UNICEF and UNFPA, Geneva, Switzerland; 2004.
2. National Institute of Population (NIPS) [Pakistan] Studies Macro International Inc: / Pakistan demographic and health survey 2006-7. National Institute of Population Studies and Macro International Inc, Islamabad, Pakistan; 2008.
3. Shah I, Say L: Maternal mortality and maternity care from 1990-005: uneven but important gains. / Reprod health matter 2007, 15:17-7. CrossRef
4. Islam M: The safe motherhood initiative and beyond. / B World Health Organ 2007, 85:735. CrossRef
5. Jafarey SN: Maternal mortality in Pakistan–compilation of available data. / J Pak Med Assoc 2002, 52:539-44.
6. Koblinsky M, Matthews Z, Hussein J, Mavalankar D, Mridha MK, Anwar I, Achadi E, Adjei S: Going to scale with professional skilled care. / Lancet 2006, 368:1377-386. CrossRef
7. Freedman L, Waldman R, di Pinho H, Chowdhury M, Rosenfield A: Transforming health systems to improve the lives of women and children. / Lancet 2005, 365:997-000. CrossRef
8. Freedman LP, Waldman RJ, de Pinho H, Wirth ME, Chowdhury AMR, Rosenfield A: / Who’s got the power? Transforming health systems for women and children. United Nations Development Programme, London; 2005.
9. Wirth ME, Balk D, Delamonica E, Storeygard A, Sacks E, Minujin A: Setting the stage for equity-sensitive monitoring of the maternal and child health Millennium Development Goals. / B World Health Organ 2006, 84:519-27. CrossRef
10. Kabeer N: Gender aware policy and planning: a social relations perspective. In / Gender Planning and Development Agencies. Edited by: MacDonald M. Oxfam, Oxford; 1994.
11. Razavi S, Miller C: / From WID to GAD: Conceptual shits in the women and development discourse. United Nations Research Institute for Social Development, Geneva; 1995.
12. Pearson R, Whitehead A, Young K: / Introduction: the continuing subordination of women in the development process. Edited by: Young K, Wolkovitz C, McCullagh R. Of Marriage and the Market, Routledge and Kegan Paul, London; 1984.
13. Pathmanathan I, Liljestrand J, Martins JM, Rajapaksa LC, Lissner C, de Silva A, Selvaraju S, Singh PJ: / Investing in maternal health: learning from Malaysia and Sri Lanka. The World Bank, Washington, D.C; 2003.
14. Gwatkin DR, Rutstein S, Johnson L, Suliman E, Wagstaff A: / Initial Country-Level Information about Socio-Economic Differences in Health, Nutrition and Population. 2nd edition. World Bank and UNFPA, Washington, DC; 2003.
15. Houweling T, Ronsman C, Campbell C, Kunst A: Huge poor-rich inequalities in maternity care: an international comparative study of maternity and child care in developing countries. / B World Health Organ 2007, 85:745-54.
16. Shiffman J: Can poor countries surmount high maternal mortality? / Stud Family Plann 2002, 31:274-89. CrossRef
17. Narayan D: / Voices of the Poor: Can Anyone Hear Us?. Oxford University Press, New York; 2000. CrossRef
18. World Health Organization, World Bank: / Dying for change: Poor people’s experience of health and ill-health. World Health Organization, Geneva; 2002.
19. Silver H: Social exclusion and social solidarity. In / Marginalnosc i marginalizacja spoteczna. Edited by: Kowalak T. Dom Wydawniczy Elipsa, Warsaw; 1998.
20. Lepianka D: What is social exclusion-a brief introduction to the concept. / Polish Foreign Affairs Digest 2003, 1:85-09.
21. Sayed Y, Soudin C: (Re) framing education exclusion and inclusion discourse: limits and possibilities. / IDS Bull 2003, 34:9-9. CrossRef
22. Silver H: Social exclusion and social solidarity: three paradigms. / Int Labour Rev 1994, 133:531-78.
23. Kipling W: Ostracism. / Annu Rev Psychol 2007, 58:425-52. CrossRef
24. De Haan A: “Social exclusion- an alternative concept for the study of deprivation? / IDS Bull 1998, 29:10-9. CrossRef
25. Atkinson R, Davoudi S: The concept of social exclusion in the European Union: context, development and possibilities. / J Common Mark Stud 2000, 38:427-28. CrossRef
26. Kabeer N: Poverty, social exclusion and the MDGs: the challengs of “durable inequalities-in the Asian context. / IDS Bull 2006, 37:64-8. CrossRef
27. Wood G: / Adverse incorporation: Another dark side of social capital. Working Paper 2. Institute for International Policy Analysis (IFIPA), University of Bath; 1999.
28. Labonte R: Social inclusion/exclusion: dancing the dialectic. / Health Promot Int 2004, 19:115-21. CrossRef
29. Kantor P: Women’s exclusion and unfavourable inclusion in informal employment in Lucknow, India: barriers to voice and livelihood security. / World Dev 2009, 37:194-07. CrossRef
30. Loudon I: / Death in Childbirth. An International Study of Maternal Care and Maternal Mortality 1800-905. Oxford University Press, Oxford; 1992.
31. Freedman L: Achieving the MDGs: health systems as core social institutions. / Development 2005, 48:19-4. CrossRef
32. Gilson L: Trust and development of health care as a social institution. / Soc Sci Med 2003, 56:1453-468. CrossRef
33. Jewkes R, Abrahams N, Mvo Z: Why do nurses abuse patients? Reflections from South African obstetric services. / Soc Sci Med 1998, 47:1781-795. CrossRef
34. Miller S, Tejada A, Murgueytio P: / Strategic assessment of reproductive health in the Dominican Republic. Population Council, New York; 2002.
35. Sherwin S: / The Politics of Women’s Health: Exploring Agency and Autonomy. Temple University Press, Philadelphia; 1998.
36. Mahowald MB: / Women and Children in Health Care: An Unequal Majority. Oxford University Press, London & New York; 1993.
37. Baird K: / Gender Justice and the Health Care System. Garland, New York; 1998.
38. Dula A, Goering S: / “It Just Ain’t Fair!-The Ethics of Health Care for African Americans. Greenwood, Connecticut; 1994.
39. Tong R, Santos A, Anderson G: / Globalizing Feminist Bioethics: Women’s Health Concerns Worldwide. Westview Press, Boulder, Colorado; 2000.
40. Thaddeus S, Maine D: Too far to walk: Maternal mortality in context. / Soc Sci Med 1994, 38:1091-110. CrossRef
41. Afsana K: The Tremendous Cost of Seeking Hospital Obstetric Care in Bangladesh. / Reprod Health Matters 2004, 12:171-80. CrossRef
42. Mumtaz Z: / Gender and reproductive health: a need for reconceptualization. PhD thesis. London School of Hygiene and Tropical Medicine; 2002.
43. Gazadar H: / A qualitative study of politics in Pakistan. Background paper for the World Bank’s Pakistan poverty assessment 2001. mimeo, Poverty Reduction and Economic Management Unit and the World Bank, Karachi & Washington, D.C.; 2002.
44. Hooper E, Hamid A: / Scoping study on social exclusion in Pakistan: A summary of findings. Department for International Development, United Kingdom; 2003.
45. Easterly W: / The political economy of growth without development: A case study of Pakistan. Development Research Group, World Bank; 2001.
46. Hafeez S: / Sociology of Power Dynamics in Pakistan. Book City, Islamabad; 1998.
47. York S: Beyond the household: an exploration of private and public spheres in the Yasin Valley. In / Family and gender in Pakistan: domestic organization in a Muslim society. Edited by: Donnan H, Selier F. Hindustan Publishing Corporation, New Delhi; 1997.
48. Khan A: / Rhetoric and reform: Feminism among Indian Muslims 1900-940. ASR Publications, Lahore; 2000.
49. Winkvist A, Akhtar HZ: Images of Health and Health care options among low income women in Punjab, Pakistan. / Soc Sci Med 1997, 45:1483-491. CrossRef
50. Donnan H: Family and household in Pakistan. In / Family and Gender in Pakistan: Domestic Organization in a Muslim Society. Edited by: Donnan H, Selier F. Hindustan Publishing Corporation, New Delhi; 1997.
51. Mumtaz Z, Salway S: Gender, pregnancy and uptake of antenatal care services in Pakistan. / Sociol Health Ill 2007, 29:1-6. CrossRef
52. Mumtaz Z, Salway S: “I never go anywhere- extricating the links between women’s mobility and uptake of reproductive health services in Pakistan. / Soc Sci Med 2005, 60:1767-779. CrossRef
53. Sathar ZA, Kazi S: / Women’s Autonomy, livelihood and fertility: A study of rural Punjab. Pakistan Institute of Development Economics, Islamabad; 1997.
54. Siddiqui S, Haq IU, Mahaini R: Pakistan’s maternal and child health policy: Analysis, lessons and the way forward. / Health Policy 2004, 69:117-30. CrossRef
55. Jafarey SN, Kamal I, Qureshi AH, Fikree F: Safe motherhood in Pakistan. / Int J Gynaecol Obstet 2008, 102:179-85. CrossRef
56. Government of Pakistan, Ministry of Health: / Pakistan: National maternal and child health policy and strategic framework (2005-015). 2005.
57. Fikree F, Mir A, Haq I: She may reach a facility but she will still die! An analysis of quality of public sector maternal health services, district Multan, Pakistan. / J Pak Med Assoc 2006, 56:156-63.
58. Ali M, Hotta M, Kuroiwa C, Ushijima H: Emergency obstetric care in Pakistan: potential for reduced maternal mortality through improved basic EmOC facilities, services, and access. / Int J Gynaecol Obstet 2005, 91:105-12. CrossRef
59. Ali M, Ahmed M, Kuroiwa C: Emergency obstetric care in Punjab, Pakistan: improvement needed. / Eur J Contracep Repr 2008, 13:201-07. CrossRef
60. Bhutta Z: Why has so little changed in maternal and child health in South Asia? / Brit Med J 2000, 321:809-12. CrossRef
61. Rizvi N, Nishtar S: Pakistan’s health policy: appropriateness and relevance to women’s health needs. / Health Policy 2008, 88:269-81. CrossRef
62. Mumtaz Z, Salway S, Waseem M: Gender-based barriers to provision of primary health care in rural areas of Pakistan. / Health Policy Plann 2003, 18:261-69. CrossRef
63. Golbart J, Hustler D: Ethnography. In / Research Methods in Social Sciences. Edited by: Someke B, Lewis C. Sage Publications, London; 2005.
64. Ulin P, Robinson E, Tolley E: / Qualitative Methods in Public Health: A Field Guide for Applied Research. Jossey-Bass, San Francisco; 2005.
65. Geertz C: / Available Light. Anthropological Reflections on Philosophical Topics. Princeton University Press, Princeton; 2000.
66. Wainwright D: Can sociological research be qualitative, critical and valid? / The Qualitative Report [On-line serial] 3(2): http://www.nova.edu/ssss/QR/QR3-/wain.html
67. Bernard H: / Research Methods in Anthropology. Altamira Press, London; 1995.
68. Atkinson P, Coffey A, Delamont S, Lofland J, Lofland L: / Handbook of Ethnography. Sage Publications, London; 2001.
69. Barbour R, Schostak S: Interviewing and focus groups. In / Research Methods in Social Sciences. Edited by: Someke B, Lewis C. Sage Publications, London; 2005.
70. Greenhalgh S: / Anthropological contributions to fertility theory. Working paper No: 64. Population Council Research Division, New York; 1994.
71. Rubin H, Rubin I: / Qualitative Interviewing: the Art of Hearing Data. Sage Publications, London; 1995.
72. Mason J: / Qualitative researching. Sage Publications, London; 2005.
73. Guest G, Bunce A, Johnson L: How many interviews are enough? An experiment with data saturation and variability. / Field Method 2006, 18:59-2. CrossRef
74. Fern E: / Advanced Focus Group Research. Sage Publications, Thousand Oaks & London; 2001.
75. Stark S, Torrance H: Case Study. In / Research Methods in Social Sciences. Edited by: Someke B, Lewis C. Sage Publications, London; 2005.
76. ATLAS.ti Qualitative Analyse und Datenauswertung -ATLAS.ti Software;
77. Hulton L, Matthews Z, Stones R: Applying a framework for assessing the quality of maternal health services in urban India. / Soc Sci Med 2007, 64:2083-095. CrossRef
78. Hammersley M: / Reading Ethnographic Research. Longman, London & New York; 1998.
79. Hulton L, Matthews Z, Stones R: / A framework for the evaluation of quality of care maternity services. University of Southampton, Southampton; 2000.
80. Higginbottom G: Sampling issues in qualitative research. / Nurse Res 2004, 12:7-9.
81. Abbott S, Shaw S, Elston J: Comparative analysis of health policy and implementation: the use of documentary analysis. / Policy Stud J 2004, 25:259-66. CrossRef
82. Afsana K, Rashid S: The challenges of meeting rural Bangladeshi women’s needs in delivery care. / Reprod health matter 2001, 9:79-9. CrossRef
83. Key Development Challenges - Canadian International Development Agency (CIDA)http://www.acdi-cida.gc.ca/acdi-cida/ACDI-CIDA.nsf/eng/NIC-53131840-NB8
84. The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2393/12/80/prepub - 作者单位：Zubia Mumtaz (1)
Sarah Salway (2)
Laura Shanner (3)
Shakila Zaman (4)
Lory Laing (3)
1. School of Public Health, University of Alberta, 3-309 Edmonton Clinic Health Academy, 11405 -87 Ave, Edmonton, AB, T6G 1C9, Canada
2. Centre for Health and Social Care Research, Sheffield Hallam University, Montgomery House, 32 Collegiate Crescent Collegiate Campus, Sheffield, S10 2BP, UK
3. 3-309 Edmonton Clinic Health Academy, 11405 -87 Ave, Edmonton, AB, T6G 1C9, Canada
4. 85-K Str 77 Defence Housing Authority Lahore Cantt, Lahore, Pakistan
文摘
Background After more than two decades of the Safe Motherhood Initiative and Millennium Development Goals aimed at reducing maternal mortality, women continue to die in childbirth at unacceptably high rates in Pakistan. While an extensive literature describes various programmatic strategies, it neglects the rigorous analysis of the reasons these strategies have been unsuccessful, especially for women living at the economic and social margins of society. A critical gap in current knowledge is a detailed understanding of the root causes of disparities in maternal health care, and in particular, how gender and class influence policy formulation and the design and delivery of maternal health care services. Taking Pakistan as a case study, this research builds upon two distinct yet interlinked conceptual approaches to understanding the phenomenon of inequity in access to maternal health care: social exclusion and health systems as social institutions. Methods/Design This four year project consists of two interrelated modules that focus on two distinct groups of participants: (1) poor, disadvantaged women and men and (2) policy makers, program managers and health service providers. Module one will employ critical ethnography to understand the key axes of social exclusion as related to gender, class and zaat and how they affect women’s experiences of using maternal health care. Through health care setting observations, interviews and document review, Module two will assess policy design and delivery of maternal health services. Discussion This research will provide theoretical advances to enhance understanding of the power dynamics of gender and class that may underlie poor women’s marginalization from health care systems in Pakistan. It will also provide empirical evidence to support formulation of maternal health care policies and health care system practices aimed at reducing disparities in maternal health care in Pakistan. Lastly, it will enhance inter-disciplinary research capacity in the emerging field of social exclusion and maternal health and help reduce social inequities and achieve the Millennium Development Goal No. 5.