Cultural Barriers in Accessing Maternal Health Care Service in Malakand Pakistan

Abstract

Accessibility to maternal health care does not only reduce maternal mortality and complications among women rather it is one of the basic reproductive human rights of women which should be ensured to women all over the world. The present research mainly focuses to identify all those gender-based cultural perceptions and prevailing unwritten customary laws which not only restrict women from accessing maternal health care services but contribute to high maternal mortality in Malakand Pakistan (PDHS, 2012) which is one of the areas in Pakistan with high MMRs. In this study maternal health care as dependent variable is categorized as ANC services, institutional delivery and postpartum services while the independent variables are categorized as sociodemographic characteristics, subordinate position of women in Pakhtun families, Pakhtun family’s perception toward maternal health care of women and decision making at household level. The data was collected by using mix method. A questionnaire was designed following the Pakistan Demographic and Health Survey questionnaire with to include the cultural aspect while WHO verbal autopsy instrument was adopted for studying maternal death cases. Through quantitative data 503 respondents were interviewed while in qualitative data two FGD one each with men and women was conducted. Family members of four maternal death cases were interviewed in the research area. The researcher used bivariate and multivariate logistic regression test in order to assess the association between outcome (maternal health) and independent variables. Both bivariate and multivariate analysis shows that prevalence and practice of un-written customary laws and practices among Pakhtun had a significant relationship with access to maternal health care among women in the study area. In both bivariate and multivariate analysis it is found that socio-cultural as well as some of the basic socio-demographic factors were strongly associated with maternal health care access. Among the major findings it was statistically drawn that the women have subordinate position in the family and men are the key decision makers regarding women’s access to maternal health care and they restrict women within the domestic sphere utilize maternal health care services from unskilled persons. The situation is not only statistically significant rather FGD also supports the statistical results. Key recommendation of the study is to include detailed cultural and gender based questions in studies conducted by different agencies on maternal health, as well as mainstreaming of men in all kinds of programmes and awareness campaigns designed for improving maternal health as they are the key decision makers regarding women’s access to and utilization of maternal health care services.