Are community midwives addressing the inequities in access to skilled birth attendance in Punjab, Pakistan? Gender, class and social exclusion
详细信息 查看全文
- 作者：Zubia Mumtaz (1)
Beverley O’Brien (2)
Afshan Bhatti (3)
Gian S Jhangri (4) - 关键词：Pregnancy and childbirth ; Pakistan ; Maternal health care ; Skilled birth attendance ; Community ; based Midwives ; Social exclusion ; Inequity ; Poverty ; Gender ; Class
- 刊名：BMC Health Services Research
- 出版年：2012
- 出版时间：December 2012
- 年：2012
- 卷：12
- 期：1
- 全文大小：225KB
- 参考文献：1. National Institute of Population (NIPS) [Pakistan] Studies, Macro International Inc: / Pakistan Demographic and Health Survey 2006-7. Pakistan: National Institute of Population Studies and Macro International Inc, Islamabad; 2008.
2. World Health Organization: / Maternal mortality in 2000: estimates developed by WHO UNICEF and UNFPA. Geneva, Switzerland: World Health Organization; 2004.
3. National MNCH program, government of Pakistan http://dynasoft.org/mnch/index.php
4. Shiffman J: Can poor countries surmount high maternal mortality? / Stud Family Plann 2000, 31:274-89. CrossRef
5. Chowdhury ME, Ronsmans C, Killewo J, Anwar I, Gausia K, Das-Gupta S, Blum LS, Dieltiens G, Marshall T, Sasha S, Borghi J: Equity in use of home-based or facility-based skilled obstetric care in rural Bangladesh: an observational study. / Lancet 2006, 367:327-32. CrossRef
6. Narayan D: / Voices of the Poor: Can Anyone Hear Us?. New York: Oxford University Press; 2000. CrossRef
7. World Health Organization, World Bank: / Dying for change: poor people’s experience of health and ill-health. Geneva: World Health Organization; 2002.
8. Mohmand S, Ghazdar H: / Social structures in rural Pakistan. Islamabad: Asian Development Bank,Pakistan Resident Mission; 2007.
9. Kabeer N: Poverty, social exclusion and the MDGs: the challenges of “durable inequalities-in the Asian context. / IDS Bull 2006, 37:64-8. CrossRef
10. Kristof N, WuDunn S: / In Half the Sky: Turning Oppression into Opportunity for Women Worldwide. New York & Toronto: Alfred A. Knopf & Random House Canada Limited; 2009:185-91.
11. Silver H: Social exclusion and social solidarity. In / Marginalnosc i marginalizacja spoteczna. Edited by: Kowalak T. Warsaw: Dom Wydawniczy Elipsa; 1998.
12. Lepianka D: What is social exclusion-a brief introduction to the concept. / Polish Foreign Affairs Digest 2003, 1:85-09.
13. Sayed Y, Soudin C: (Re) framing education exclusion and inclusion discourse: limits and possibilities. / IDS Bull 2003, 34:9-9. CrossRef
14. Silver H: Social exclusion and social solidarity: three paradigms. / Int Labour Rev 1994, 133:531-78.
15. Kipling W: Ostracism. / Annu Rev Psychol 2007, 58:425-52. CrossRef
16. De Haan A: “Social exclusion- an alternative concept for the study of deprivation? / IDS Bull 1998, 29:10-9. CrossRef
17. 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
18. Gilson L: Trust and development of health care as a social institution. / Soc Sci Med 2003, 56:1453-468. CrossRef
19. Freedman L: Achieving the MDGs: health systems as core social institutions. / Development 2005, 48:19-4. CrossRef
20. 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
21. Miller S, Tejada A, Murgueytio P: / Strategic assessment of reproductive health in the Dominican Republic. New York: Population Council; 2002.
22. Thaddeus S, Maine D: Too far to walk: maternal mortality in context. / Soc Sci Med 1994, 38:1091-110. CrossRef
23. Varley E: Targeted doctors, missing patients: obstetric health services and sectarian conflict in Northern Pakistan. / Soc Sci Med 2010, 70:61-0. CrossRef
24. Hooper E, Hamid A: / Scoping study on social exclusion in Pakistan: a summary of findings. United Kingdon: Department for International Development; 2003.
25. Popay J, Escorel S, Hernandez M, Johnston H, Mathieson J, Rispel L: / Understanding and tackling social exclusion. World Health Organization: Final report to the WHO commission on social determinants of health from the Social Exclusion Knowledge Network; 2008.
26. A quantitative assessment of social exclusion in Pakistan: quantifying social exclusion in Pakistan http://www.eldis.org/assets/Docs/19405.html
27. Mumtaz Z, Salway S, Shanner L, Laing L, Zaman S, Hamid S: / Addressing disparities in access to maternal health care in Pakistan: gender, class and exclusion. Edmonton, Alberta: Canadian Institutes of Health Research; 2009. Ongoing study funded by Canadian Institutes of Health Research. Project operating grant no. MOP-97949
28. PASS: Power analysis and sample size software for windows. http://www.ncss.com/pass.html
29. Aliaga A, Ren R: / Optimal sample sizes for two-stage cluster sampling in Demographic and Health Surveys. United States Agency for International Development; 2006.
30. Stata: Data analysis and statistical software. http://www.stata.com
31. Campbell M, Gregor F: / A Primer for Doing Insitutional Ethnography. Aurora, ON: Garamond Press; 2002.
32. 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
33. Mason J: / Qualitative researching. London: Sage Publications; 2005.
34. Mumtaz Z, Salway S: Gender, pregnancy and uptake of antenatal care services in Pakistan. / Sociol Health Ill 2007, 29:1-6. CrossRef
35. Fern E: / Advanced Focus Group Research. Thousand Oaks & London: Sage Publications; 2001.
36. Nonprobability sampling http://www.socialresearchmethods.net/kb/sampnon.php
37. ATLAS.ti: Qualitative analyse und datenauswertung -Atlas.ti software. http://www.atlasti.com/de/index.htmlindex.html
38. Hammersley M: / Reading Ethnographic Research. London & New York: Longman; 1998.
39. Tuckett A: Part II: rigour in qualitative research: complexities and solutions. / Nurse Researcher 2005, 13:29-2.
40. Ryan-Nicolls K, Will C: Rigour in qualitative research: mechanisms for control. / Nurse Researcher 2009, 16:70-5.
41. Ells C, Gutfreund S: Myths about qualitative research and the tri-council policy statement. / Can J Sociol 2006, 31:361-73.
42. University of Alberta: / Section 66, “University of Alberta standards for the protection of human research participants. 2010.
43. Horton R: The continuing invisibility of women. / Lancet 2010, 375:1941-943. CrossRef
44. Mumtaz Z: / Gender and reproductive health: a need for reconceptualization. London School of Hygiene and Tropical Medicine; 2002. PhD thesis
45. The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1472-6963/12/326/prepub - 作者单位：Zubia Mumtaz (1)
Beverley O’Brien (2)
Afshan Bhatti (3)
Gian S Jhangri (4)
1. School of Public Health, University of Alberta, 3-309 Edmonton Clinic Health Academy, 11405 -87 Ave, Edmonton, AB, T6G 1C9S, Canada
2. Nursing Faculty, 5-76 Edmonton Clinic Health Academy, Edmonton, AB, Canada
3. Real Medicine Foundation Pakistan, # 70, Nazimuddin Road, F-7/4, Islamabad, Pakistan
4. 3-19 Edm Clinic Health Academy, Edmonton, AB, Canada
文摘
Background Pakistan is one of the six countries estimated to contribute to over half of all maternal deaths worldwide. To address its high maternal mortality rate, in particular the inequities in access to maternal health care services, the government of Pakistan created a new cadre of community-based midwives (CMW). A key expectation is that the CMWs will improve access to skilled antenatal and intra-partum care for the poor and disadvantaged women. A critical gap in our knowledge is whether this cadre of workers, operating in the private health care context, will meet the expectation to provide care to the poorest and most marginalized women. There is an inherent paradox between the notions of fee-for-service and increasing access to health care for the poorest who, by definition, are unable to pay. Methods/Design Data will be collected in three interlinked modules. Module 1 will consist of a population-based survey in the catchment areas of the CMW’s in districts Jhelum and Layyah in Punjab. Proportions of socially excluded women who are served by CMWs and their satisfaction levels with their maternity care provider will be assessed. Module 2 will explore, using an institutional ethnographic approach, the challenges (organizational, social, financial) that CMWs face in providing care to the poor and socially marginalized women. Module 3 will identify the social, financial, geographical and other barriers to uncover the hidden forces and power relations that shape the choices and opportunities of poor and marginalized women in accessing CMW services. An extensive knowledge dissemination plan will facilitate uptake of research findings to inform positive developments in maternal health policy, service design and care delivery in Pakistan. Discussion The findings of this study will enhance understanding of the power dynamics of gender and class that may underlie poor women’s marginalization from health care systems, including community midwifery care. One key outcome will be an increased sensitization of the special needs of socially excluded women, an otherwise invisible group. Another expectation is that the poor, socially excluded women will be targeted for provision of maternity care. The research will support the achievement of the 5th Millennium Development Goal in Pakistan.