scholarly journals Birthing Between the “Traditional” and the “Modern”: DāĪ Practices and Childbearing Women’s Choices During COVID-19 in Pakistan

2021 ◽  
Vol 6 ◽  
Author(s):  
Inayat Ali ◽  
Salma Sadique ◽  
Shahbaz Ali ◽  
Robbie Davis-Floyd

Pregnancy and birth are biological phenomena that carry heavy cultural overlays, and pregnant and birthing women need care and attention during both ordinary and extraordinary times. Most Pakistani pregnant women now go to doctors and hospitals for their perinatal care. Yet traditional community midwives, called DāĪ in the singular and Dāyūn in the plural, still attend 24% of all Pakistani births, primarily in rural areas. In this article, via data collected from 16 interviews—5 with Dāyūn and 11 with mothers, we explore a maternity care system in tension between the past and the present, the DāĪ and the doctor. We ask, what does the maternity care provided by the Dāyūn look like during times of normalcy, and how does it differ during COVID-19? We look at the roles the DāĪ has traditionally performed and how these roles have been changing, both in ordinary and in Covidian circumstances. Presenting the words of the Dāyūn we interviewed, all from Pakistan’s Sindh Province, we demonstrate their practices and show that these have not changed during this present pandemic, as these Dāyūn, like many others in Sindh Province, do not believe that COVID-19 is real—or are at least suspect that it is not. To contextualize the Dāyūn, we also briefly present local mother’s perceptions of the Dāyūn in their regions, which vary between extremely positive and extremely negative. Employing the theoretical frameworks of “authoritative knowledge” and of critical medical anthropology, we highlight the dominance of “modern” biomedicine over “traditional” healthcare systems and its effects on the Dāyūn and their roles within their communities. Positioning this article within Pakistan’s national profile, we propose formally training and institutionalizing the Dāyūn in order to alleviate the overwhelming burdens that pandemics—present and future—place on this country’s fragile maternity care system, to give mothers more—and more viable—options at all times, and to counterbalance the rising tide of biomedical hegemony over pregnancy and birth.

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
M Shah ◽  
Q Jamali ◽  
F Aisha

Abstract Background Unsafe practices such as cutting umbilical cord with unsterilized instruments and application of harmful substances, are in practice in many rural areas of Pakistan, and associated with high risk of neonatal sepsis and mortality. Methods We conducted an implementation research in 2015 in Tharparkar district, in Sindh province of Pakistan to understand the feasibility and acceptability of community-based distribution of chlorhexidine (CHX) in rural Pakistan. For this cohort group-only study, 225 lady health workers (LHWs) enrolled 495 pregnant women. Enrolled women received 4% CHX gel and user’s instructions for newborn cord care. The LHWs also counseled women on the benefits and correct use of CHX. Study enumerators collected data from CHX receiving women 3 times: at around 2 weeks before delivery, within 24 hours after delivery, and on the 8th day after delivery. We implemented this study jointly in collaboration with Ministry of Health in Sindh province, Pakistan. Results Among enrolled participants, 399 women (81%) received only the first visit, 295 women (60%) received first two visits and 261 women (53%) received all three visits by enumerators. Among 399 women, who received CHX gel, counseling on its use and were respondent to the first round data collection, 78% remembered that the CHX gel to be applied to cord stump and surrounding areas immediately after birth; but less than a third (29%) forgot the need to keep the cord clean and dry. Among 295 respondents in the first two rounds of data collection, who delivered at home, 97% applied CHX to cord stump on the first day. Conclusions Community-based CHX distribution by LHWs, along with counseling to recipient women, resulted in a high rate of cord care with CHX among newborn delivered at home. Results from this study may help program implementers to consider expanding this intervention for improving newborn cord care on the first day of life in Pakistan. Key messages Community-based distribution of chlorhexidine for newborn cord care appears as highly acceptable and feasible in rural communities in Pakistan. Relevant program policy supporting community-based CHX distribution along with counseling by LHW may help expanding coverage of newborn cord care in rural communities in Pakistan.


2021 ◽  
Author(s):  
◽  
Claire Sweetman

<p>Although birth is a fundamental part of the life process, competing factions within the health profession struggle to agree on the best way to deliver maternity services. Despite this long-standing tension, the midwifery-led model has dominated New Zealand’s maternity system for more than two decades with the majority of consumers expressing satisfaction with the care provided. Unfortunately for a small number of mothers and babies the pregnancy and birth experience is not a positive one and families are left suffering life-long, and often tragic, consequences. As one of the main consumer watchdogs in New Zealand, the Health and Disability Commissioner is charged with investigating claims of poor quality healthcare. This paper examines the central themes in the Commissioner’s reports on substandard midwifery practice and proposes a number of regulatory solutions to the issues involved. Working in unison, these amendments have the potential to ease the pressure placed on midwives; enhance interprofessional relationships; improve practitioner competence; and increase overall compliance with the Code of Health and Disability Services Consumers’ Rights. By implementing these changes, the New Zealand Government could safeguard valuable midwifery-based principles whilst still ensuring that high quality maternity care is provided to all of the country’s mothers and babies.</p>


2021 ◽  
Vol 71 (11) ◽  
pp. 2694-2694
Author(s):  
Nitik Sharma ◽  
Arsalan Hyder ◽  
Sikander Ali

The district Larkana has faced multiple outbreaks in the past decade. AIDS-related deaths of children in the Larkana district since the 2019 outbreak of HIV has increased with the potential to rise even more in the future. This article discusses the stigma associated with HIV in rural areas of Sindh Province and emphasizes ways to promptly deal with these situation. Continuous...


2021 ◽  
Vol 30 (3) ◽  
pp. 159-167
Author(s):  
Katherine Hinic

This article reports original research that describes new mothers' experiences of birth and maternity care. Qualitative data were collected through a survey on birth satisfaction, which included space for women to provide comments about their birth and experience of care. Thirty-nine women provided comments that were analyzed using the thematic analysis method. Two themes emerged from the women's experiences: “Unexpected birth processes: expectations and reality” and “Coping with birth: the role of health-care staff.” Participants described unexpected birthing processes, their experiences of care, and maternity care staff's contributions to coping with birth. Implications for practice for childbirth professionals include promotion of physiologic birth, respectful person-centered care during all phases of perinatal care, and the value of childbirth preparation.


Author(s):  
Sadia Jamil

Through examining use of mobile in Pakistan's Sindh province, the current chapter presents a unique and interesting case of the socio-economic impacts of mobile use on users' lifestyles. Although there exists an obvious divide between urban and rural areas in terms of impacts of mobile use, the case of Pakistan could serve as an alert to scholars that why mobile use remains limited in narrowing the gap between urban and rural areas against a backdrop of mobile being widely believed to be able to play a big role in narrowing the social and economic gap between urban and rural areas. The author of this chapter found that mobile use was also gender-biased in rural areas, resulting in a gap between males and females as far as social and economic impacts of mobile use on their lifestyles.


2016 ◽  
Vol 6 (2) ◽  
pp. 56-62
Author(s):  
Ashok Kumar Biswas ◽  
Edward Gebuis ◽  
Petrica Irimia

The health care system of WB needs a massive change from every aspect. However, changing a system which is running for years is in itself a challenge. Therefore, change in the health policy needs to begin either from the foundation up or according to the importance of proposed legislation. Rural health care system without specialty care has always been the underdog of WB health system. However, most improvement can be made there. This policy document proposes a basic specialty care in rural areas of WB, intended to improve health care for a maximum possible population.


1973 ◽  
Vol 2 (2) ◽  
pp. 153-161
Author(s):  
Sam Cordes

Students of our nation's medical care system generally express particular concern over the availability or lack of availability of physician services in rural areas. This concern is not without statistical foundation. In 1969 the nation's most urbanized counties (5,000,000 inhabitants or more) had approximately five times as many actively-practicing private physicians per 100,000 population as did the most rural counties (less than 10,000 inhabitants) [1]. In view of this situation a number of measures designed to increase the rural supply of physician services are being proposed. In general, these measures can be categorized into (1) those designed to increase the size of the resource base used in producing physician services and (2) those designed to reorganize the existant resource base in hopes of increasing resource productivity.


2017 ◽  
Vol 08 (04) ◽  
pp. 556-561 ◽  
Author(s):  
Vaios Peritogiannis ◽  
Thiresia Manthopoulou ◽  
Afroditi Gogou ◽  
Venetsanos Mavreas

ABSTRACTIntroduction: Patients living in rural and remote areas may have limited access to mental healthcare due to lack of facilities and socioeconomic reasons, and this is the case of rural areas in Eastern Europe countries. In Greece, community mental health service delivery in rural areas has been implemented through the development of the Mobile Mental Health Units (MMHUs). Methods: We present a 10-year account of the operation of the MMHU of the prefectures of Ioannina and Thesprotia (MMHU I-T) and report on the impact of the service on mental health delivery in the catchment area. The MMHU I-T is a multidisciplinary community mental health team which delivers services in rural and mountainous areas of Northwest Greece. Results: The MMHU I-T has become an integral part of the local primary care system and is well known to the population of the catchment area. By the end of 2016, the majority of patients (60%) were self-referred or family-referred, compared to 24% in the first 2 years. Currently, the number of active patients is 293 (mean age 63 years, 49.5% are older adults), and the mean caseload for each member of the team is 36.6. A significant proportion of patients (28%) receive care with regular domiciliary visits, and the provision of home-based care was correlated with the age of the patients. Within the first 2 years of operation of the MMHU I-T hospitalizations of treatment, engaged patients were reduced significantly by 30.4%, whereas the treatment engagement rates of patients with psychotic disorders were 67.2% in 5 years. Conclusions: The MMHU I-T and other similar units in Greece are a successful paradigm of a low-cost service which promotes mental health in rural, remote, and deprived areas. This model of care may be informative for clinical practice and health policy given the ongoing recession and health budget cuts. It suggests that rural mental healthcare may be effectively delivered by integrating generic community mental health mobile teams into the primary care system.


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