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

2020 ◽  
Author(s):  
Sonia Omer ◽  
Rubeena Zakar ◽  
Muhammad Zakria Zakar ◽  
Florian Fischer
Keyword(s):  
Health Care ◽  
Maternal Health ◽  
Maternal Mortality ◽  
Maternal Care ◽  
Cultural Practices ◽  
Cultural Factors ◽  
Maternal Health Care ◽  
High Rate ◽  
Maternal Deaths ◽  
Social And Cultural Factors

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.

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

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Sonia Omer ◽  
Rubeena Zakar ◽  
Muhammad Zakria Zakar ◽  
Florian Fischer
Keyword(s):  
Maternal Mortality ◽  
Cultural Values ◽  
Maternal Care ◽  
Cultural Practices ◽  
Health Workers ◽  
Cultural Factors ◽  
High Rate ◽  
Maternal Healthcare ◽  
Maternal Deaths ◽  
Social And Cultural Factors

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.

scholarly journals Utilization of maternal health care services in Belbari VDC of Eastern Region of Nepal

2012 ◽  
Vol 1 (1) ◽  
pp. 53-58
Author(s):  
Buna Bhandari ◽  
Baburam Pokhrel ◽  
Bimala Bhatta ◽  
Rajib Karn ◽  
Ava Pokhrel ◽  
...  
Keyword(s):  
Health Care ◽  
Maternal Health ◽  
Health Care Services ◽  
Cultural Practices ◽  
Maternal Health Care ◽  
Eastern Region ◽  
Cross Sectional ◽  
Care Services ◽  
Maternal Health Care Services ◽  
One Year

Background: Appropriate utilization of maternal health care services is very important to reduce the maternal morbidity and mortality rate in the country and healthful practices while caring mother is needed to improve the health condition of both mother and child. Objectives: Main objectives of this study is to assess the utilization of Maternal health care services and know the cultural practices about care of mother and children of under one year of children. Methodology: Descriptive cross sectional study was conducted among 248 mothers of less than one year children on Belbari VDC of Morang district. Data was collected by using quantitative (house hold survey) and qualitative (focus group discussions and key informant interview) methods. Results: Among 248 mothers, 84% utilized the antenatal care services, 91% received TT vaccine during pregnancy. Most of them 80% had done delivery in health institutions. Conclusion: Based on proposed objectives of study, Utilization of maternal health care services should be encouraged in Belbari VDC of Morang District and healthful practices should be reinforced in areas where corrections are needed.DOI: http://dx.doi.org/10.3126/jonmc.v1i1.7288 Journal of Nobel Medical College Vol.1(1) 2011 53-58

scholarly journals Utilization of maternal health care services in slum areas of Dhaka city, Bangladesh

1970 ◽  
Vol 4 (2) ◽  
pp. 44-48
Author(s):  
Housne Ara Begum ◽  
Nilufar Yeasmin Nili ◽  
Amir Mohammad Sayem
Keyword(s):  
Health Care ◽  
Maternal Health ◽  
Maternal Mortality ◽  
Health Care Services ◽  
Maternal Health Care ◽  
Dhaka City ◽  
Care Services ◽  
Maternal Health Care Services ◽  
Socio Economic Variables ◽  
Slum Areas

Bangladesh has one of the highest maternal mortality rates (MMR) in the world. The estimated lifetime risk of dying from pregnancy and childbirth related causes in Bangladesh is about 100 times higher compare to developed countries. However, utilization of maternal health care services (MHCS) is notably low. This study examines the socio-economic determinants of utilization of MHCS in some slum areas of Dhaka city. The overall utilization was 86.3% of women; however, utilization of different sorts of MHCS was very low, i.e., the mean utilization was found to be 2.25 out of 5 MHCS. Indicator wise, ANC, TT, institutional delivery, delivery assistance by health professional and PNC were received by 61.3%, 80.4%, 12.6%, 33.2% and 55.4% of women respectively. Variation was observed with different socio-economic variables. Multiple regression model could explain 38% of variance (P<0.001). Among the significant determinants, order of last birth negatively explained the most variance (15.2%). Similarly, distance between home and clinic was found to affect the utilization negatively. Besides, some respondents’ socio economic variables had a significant positive effect on MHCS utilization. To reduce maternal mortality in disadvantaged women in slum areas, this study might suggest a few pointers while considering formulation of policies and planning. Keywords: determinants; utilization; maternal health care; service; slum areas DOI: 10.3329/imcj.v4i2.6495Ibrahim Med. Coll. J. 2010; 4(2): 44-48

scholarly journals Overview of equity in maternal health care coverage by ethnicity

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
N Armenta-Paulino ◽  
M Sandín Vázquez ◽  
F Bolúmar
Keyword(s):  
Health Care ◽  
Maternal Health ◽  
Maternal Mortality ◽  
Skilled Birth Attendant ◽  
Maternal Health Care ◽  
Indigenous Women ◽  
Vulnerable Groups ◽  
Cross Sectional ◽  
Health Care Coverage ◽  
The Continuum

Abstract Background Indigenous women are one of the most vulnerable groups in Latin America. They experience substantially worse maternal health outcomes than most of the population and less likely to benefit from services. Therefore, inequities in maternal health care between different ethnic groups should be monitored to identify critical factors that could limit health care coverage. Methods Cross-sectional analysis of the continuum of maternal health care, the indicators covering the continuum of women's care from pregnancy to the puerperium were estimated. We used nationally representative demographic surveys from Bolivia, Guatemala, Mexico, and Peru (2008-2016) to explore the coverage gaps across maternal health care by ethnicity. Women were classified as indigenous through self-identification, and we measured a relative inequality by ethnicity through the estimation of adjusted coverage ratios (CR), CR = 1 means that the coverage is equal between indigenous and non-indigenous. We estimated the CR with Poisson regression models adjusted for sociodemographic variables. Results Indigenous women in all four countries had less coverage than non-indigenous in the continuum of maternal healthcare. The most relevant inequalities occur in the coverage of skilled-birth-attendant and in the use of contraceptives, mainly for Bolivia [CR = 0.64, p &lt; 0.001; CR = 0.91, p &lt; 0.001] and Guatemala [CR = 0.78, p &lt; 0.001; 0.77 (0.73;0.80), p &lt; 0.001]. Peru and Mexico are the countries with the smallest gaps throughout the continuum care and Guatemala with the largest. Conclusions The differences observed reflect the inequities that indigenous women face in the coverage of maternal health care. Therefore, it is useful and necessary to monitor ethnicity inequalities to identify the factors that limit the coverage of care that indigenous women receive to design culturally appropriate programs and policies to reduce the risks of maternal mortality and the inequities in care that indigenous women face. Key messages As long as the inequalities persist, identifying them will be the first step in their elimination. If not reduce the differences in care, it will be difficult to reduce maternal mortality that indigenous women face.

scholarly journals Maternal Mortality and Maternal Health Care in Nigeria: Implications for Socio-Economic Development

2019 ◽  
Vol 7 (5) ◽  
pp. 849-855 ◽  
Author(s):  
Olawale Olonade ◽  
Tomike I. Olawande ◽  
Oluwatobi Joseph Alabi ◽  
David Imhonopi
Keyword(s):  
Health Care ◽  
Maternal Health ◽  
Maternal Mortality ◽  
Health Care System ◽  
Socioeconomic Development ◽  
Maternal Health Care ◽  
African Countries ◽  
Sub Saharan ◽  
The Government ◽  
Care System

BACKGROUND: Even though maternal mortality, which is a pregnancy-related death is preventable, it has continued to increase in many nations of the world, especially in the African countries of the sub-Saharan regions caused by factors which include a low level of socioeconomic development. AIM: This paper focuses on cogent issues affecting maternal mortality by unpacking its precipitating factors and examining the maternal health care system in Nigeria. METHODS: Contemporary works of literature were reviewed, and the functionalist perspective served as a theoretical guide to examine the interrelated functions of several sectors of the society to the outcome of maternal mortality. RESULTS: It was noted that apart from the medical related causes (direct and indirect) of maternal mortality, certain socio-cultural and socioeconomic factors influence the outcome of pregnancy. Also, a poor health care system, which is a consequent of weak social structure, is a contributing factor. CONCLUSION: As a result, maternal mortality has debilitating effects on the socioeconomic development of any nation. It is therefore pertinent for the government to improve maternal health and eradicate poverty to ensure sustainable development.

scholarly journals Pattern of Severe Acute Maternal Morbidity in a Tertiary Care Institute

2016 ◽  
Vol 3 (2) ◽  
pp. 45
Author(s):  
Narinder Kaur ◽  
Shreyashi Aryal
Keyword(s):  
Health Care ◽  
Maternal Health ◽  
Maternal Mortality ◽  
Maternal Morbidity ◽  
Tertiary Care ◽  
College Teaching ◽  
Maternal Health Care ◽  
Near Miss ◽  
Eligibility Criteria ◽  
Severe Acute Maternal Morbidity

Introduction: Maternal mortality traditionally has been the indicator of maternal health all over the world. More recently review of the cases of severe acute maternal morbidity (SAMM), also termed as "near miss obstetrics events", has been found to be a useful supplementary indicator to investigate maternal health care. Cases of near miss are those in which women present with potentially fatal complication during pregnancy, delivery, or the puerperium and survive merely by chance or by good hospital care. This study was done with the objective to analyze cases of SAMM at Lumbini Medical College Teaching Hospital (LMCTH), Nepal.   Methods:   A retrospective study of all cases meeting the WHO criteria for SAMM,  during May 2015, was done. Cases meeting the WHO eligibility criteria for near miss cases were included in the study. Medical record of such cases in past one year was reviewed. Their socio-demographic variables, parity, gestational age, associated organ dysfunction, ICU and hospital stay, management, and fetal and maternal outcome were noted.   Results: During the study period, there were total of 28 cases of SAMM and two maternal mortality out of 2735 live births. Thus rate of SAMM was 1.02%, and maternal mortality rate was 0.07%. Majority of patients were unbooked (n=18, 64.28%) and 10 (35.71%) were illiterate. Commonest causes for admission to ICU was hemorrhage (n=10, 35.71%) followed by hypertensive disorders (n=9, 32.06%), sepsis (n=2, 7.14%), and obstructed labour (n=2, 7.14%). Laparotomy was performed in six (21.42%) women, obstetric hysterectomy in four (14.28%), and pelvic devascularization in two (10.71%).   Conclusion: SAMM is a useful adjunct to maternal mortality to assess maternal health care. Improving facility based care and prompt referral, education of primary health care (PHC) staff can be a short term measure to quickly reduce the number of maternal deaths. Facility based monitoring and reporting of SAMM outcome is an important step for scaling up such efforts.

scholarly journals Knowledge and practices on maternal health care among mothers: A case study from Sewar Bansbot village of Dang district

2020 ◽  
pp. 13-27
Author(s):  
Ganga KC
Keyword(s):  
Health Care ◽  
Health Status ◽  
Maternal Health ◽  
Maternal Mortality ◽  
Maternal Mortality Ratio ◽  
Maternal Health Care ◽  
Reproductive Age ◽  
Safe Motherhood ◽  
Early Marriage ◽  
Significant Shift

Knowledge and practices regarding maternal health care among women has had a significant shift in Nepali culture. Understanding this ship can help to improve women's overall status. Nepal implemented a safe motherhood program, which slightly improved maternal health. Data, showed the maternal mortality ratio decreased during the period between 1996 and 2016 but still there is high ratio in maternal mortality. Conservative practices of maternal health are prevalent to this date. Health education is one of the crucial factors empowering women to be attentive of their rights and health status to get appropriate health services. Maternal health is a major burning issue in Nepal, which has been affected mainly due to early marriage, teenage pregnancy, superstition, low women literacy rate, and unhygienic behavioural practices. Women go through a rather depressing situation due to workload ignorance, lack of health facilities, economic, and social conditions. Despite the efforts from various types of private, government, and voluntary health agencies, there has not been a satisfactory improvement in maternal health status and safe motherhood. This study focuses on the knowledge and practices of maternal Health care. It also describes antenatal care, delivery care, and postnatal care. The study was conducted in Sewar Basbot village of ward no. 13, Ghorahi Sub-metropolitan city of Dang district that is situated near by district headquarters, Ghorahi. In total, 45 women of reproductive age (15-49 years) who were pregnant and having children below five years of age were purposively interviewed and completed the self-administered interview schedule.

scholarly journals Socio-cultural contextual factors that contribute to the uptake of a mobile health intervention to enhance maternal health care in rural Senegal

2019 ◽  
Vol 16 (1) ◽  
Author(s):  
Margaret E. MacDonald ◽  
Gorgui Sene Diallo
Keyword(s):  
Health Care ◽  
Maternal Health ◽  
Maternal Mortality ◽  
Community Health ◽  
Health Care Providers ◽  
Mobile Health ◽  
Maternal Health Care ◽  
Care Group ◽  
Care Providers ◽  
Mhealth Intervention

Abstract Background Although considerable progress has been made in reducing maternal mortality over the past 25 years in Senegal, the national maternal mortality ratio (MMR), at 315 deaths per 100,000 live births, is still unacceptably high. In recent years a mobile health (mHealth) intervention to enhance maternal health care has been introduced in rural and remote areas of the country. CommCare is an application that runs on cell phones distributed to community health workers known as matrones who enroll and track women throughout pregnancy, birth and the post-partum, offering health information, moral support, appointment reminders, and referrals to formal health care providers. Methods An ethnographic study of the CommCare intervention and the larger maternal health program into which it fits was conducted in order to identify key social and cultural contextual factors that contribute to the uptake and functioning of this mHealth intervention in Senegal. Ethnographic methods and semi-structured interviews were used with participants drawn from four categories: NGO field staff (n = 16), trained health care providers (including physicians, nurses, and midwives) (n = 19), community level health care providers (n = 13); and women belonging to a community intervention known as the Care Group (n = 14). Data were analyzed using interpretive analysis informed by critical medical anthropology theory. Results The study identified five socio-cultural factors that work in concert to encourage the uptake and use of CommCare: convening women in the community Care Group; a cultural mechanism for enabling pregnancy disclosure; constituting authoritative knowledge amongst women; harnessing the roles of older women; and adding value to community health worker roles. We argue that, while CommCare is a powerful tool of information, clinical support, surveillance, and data collection, it is also a social technology that connects and motivates people, transforming relationships in ways that can optimize its potential to improve maternal health care. Conclusions In Senegal, mHealth has the potential not only to bridge the gaps of distance and expertise, but to engage local people productively in the goal of enhancing maternal health care. Successful mHealth interventions do not work as ‘magic bullets’ but are part of ‘assemblages’ – people and things that are brought together to accomplish particular goals. Attention to the social and cultural elements of the global health assemblage within which CommCare functions is critically important to understand and develop this mHealth technology to its full potential.

Men and maternal health care utilization in India and in selected less-developed states: evidence from a large-scale survey 2015–16

2020 ◽  
pp. 1-21
Author(s):  
Aparajita Chattopadhyay ◽  
Dipti Govil
Keyword(s):  
Health Care ◽  
Maternal Health ◽  
Child Health ◽  
Health Care Utilization ◽  
Maternal Care ◽  
Institutional Delivery ◽  
Maternal Health Care ◽  
Care Utilization ◽  
Maternal Health Care Utilization ◽  
And Child Health

Abstract Male involvement in maternal health care utilization is an important contributor to maternal health, especially in male-dominated societies. This study aimed to understand the variations and determinants of women’s antenatal care (ANC) utilization and institutional delivery in India and three socioeconomically less-developed states (Bihar, Madhya Pradesh and Uttar Pradesh) using NFHS-4 data (2015–16). Husband’s knowledge of pregnancy care and delivery, having a non-violent marital relationship and a respectful attitude towards his wife, better education and wealth, higher exposure to mass media and fewer children substantially enhanced the probability of him being present at his wife’s ANC visits. Furthermore, men’s presence at any ANC visit was shown to be an important factor influencing institutional delivery in India as a whole, as well as in the three less-developed states. The two major hurdles in maternal and child health care utilization in India were incorrect perception of ‘unnecessary’ maternal health care by families and high cost as reported by husbands. Furthermore, the proportion of husbands who received knowledge from health workers on maternal and child health was too low to achieve the maternal health SDGs by 2030. The dissemination of knowledge on maternal care among husbands, and encouraging their presence during antenatal care, may help secure better maternal health outcomes in India. It is imperative that the husband-involvement agenda is strengthened in India if the SDGs for maternal care are to be achieved.

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