Women's Health Commons^™

Birth Spacing And Family Planning Uptake In Pakistan: Evidence From Falah, Arshad Mahmood

Reproductive Health

The Population Council was the lead implementing agency for the Family Advancement for Life and Health (FALAH) project in Pakistan. The project’s main objectives were to achieve a 10 percent increase in the use of moden contraceptives, to equip 80 service delivery points to provide family planning services, and to ensure birth-spacing understanding and ways to achieve it by three-quarters of the target population. The main conclusion of this research is that a sharp uptake of family planning is possible in a relatively short time, if certain investments are made to ensure better communication and greater access to quality family …

Contraceptive Use Dynamics In Pakistan 2008-09, Arshad Mahmood, Syeda Saman Naz

Reproductive Health

This report looks at contraceptive use dynamics in Pakistan, focusing on contraceptive discontinuation, method failure, and contraceptive switching, as well as the reasons for discontinuation. The study found that almost one-third of discontinuations were due to side effects followed by one-fifth of them by the method failure. Side effects were the most common reason for discontinuing modern methods (IUDs and hormonal methods), while failure was the most common reasons for discontinuing barrier and traditional methods (condom, rhythm, withdrawal). Based on the findings of this study, this report suggests that better training of health providers and better information and counseling of …

Situation Analysis Of Health Facilities With Special Reference To Family Planning Services In Pakistan, Arshad Mahmood, Muhammad Jamil Arshad, Maqsood Sadiq

Reproductive Health

The FALAH project, launched in 2007, funded by USAID and implemented by a consortium of partners led by The Population Council, sought to shift family planning (FP) perception. This report details the findings of an assessment of FALAH’s FP and birth spacing impact. The study assessed public health facility readiness for offering FP and birth spacing services by interviewing in-charges and providers, as well as assessing the types of services provided and service providers’ characteristics. The study also examined the facilities’ quality of care through observing client and provider interactions, while client satisfaction was assessed in exit interviews. FALAH’s objective …

Perceptions And Experiences Of Women In Karachi, Pakistan Regarding Secondary Infertility: Results From A Community-Based Qualitative Study, Neelofar Sami, Tazeen S. Ali

Community Health Sciences

Background: The prevalence of infertility in Pakistan is 22% with primary infertility at 4% and secondary infertility at 18%. This study explored perceptions and experiences of women in Karachi, Pakistan regarding the causes, treatment-seeking behavior for and consequences of secondary infertility.
Methods: Focus group discussions and in-depth interviews with married women explored their perceptions and experiences for issues related to secondary infertility.
Results: The knowledge of women about the causes and scientific treatment options for infertility was limited resulting in inclination for traditional unsafe health care. Infertility was stated to result in marital instability, stigmatization and abuse specially for women …

Determining The Factors Associated With Unmet Need For Family Planning: A Cross-Sectional Survey In 49 Districts Of Pakistan, Waqas Hameed, Syed Khurram Azmat, Mohsina Bilgrami, Muhammad Ishaqe

Community Health Sciences

Introduction & Background: Around 137 million women in the developing world who would like to avoid childbearing are unable to do so, despite a huge increase in contraceptive access and use globally. Ironically, the prevalence of unmet need in Pakistan is among the highest in the world despite being one of the first countries in South Asia to launch national family planning program. The aim of this paper is to estimate the prevalence of unmet need for contraception and to indentify the factors associated with it.
Methods: A cross-sectional survey was conducted in forty nine districts of Pakistan across all …

Gender Roles And Their Influence On Life Prospects For Women In Urban Karachi, Pakistan: A Qualitative Study, Tazeen S. Ali, Gunilla Krantz, Raisa Gul, Nargis Asad, Eva Johansson, Ingrid Mogren

School of Nursing & Midwifery

BACKGROUND: Pakistan is a patriarchal society where men are the primary authority figures and women are subordinate. This has serious implications on women's and men's life prospects.
OBJECTIVE: The aim was to explore current gender roles in urban Pakistan, how these are reproduced and maintained and influence men's and women's life circumstances.
DESIGN: Five focus group discussions were conducted, including 28 women representing employed, unemployed, educated and uneducated women from different socio-economic strata. Manifest and latent content analyses were applied.
FINDINGS: TWO MAJOR THEMES EMERGED DURING ANALYSIS: 'Reiteration of gender roles' and 'Agents of change'. The first theme included perceptions …

The Association Between Parity, Infant Gender, Higher Level Of Paternal Education And Preterm Birth In Pakistan: A Cohort Study, Kiran Shaikh, Shahirose Sadrudin Premji, Marianne S. Rose, Ambreen Kazi, Shaneela Khowaja, Suzanne Tough

School of Nursing & Midwifery

Background:

High rates of antenatal depression and preterm birth have been reported in Pakistan. Self reported maternal stress and depression have been associated with preterm birth, however findings are inconsistent. Cortisol is a biological marker of stress and depression, and its measurement may assist in understanding the influence of self reported maternal stress and depression on preterm birth.

Methods:

In a prospective cohort study pregnant women between 28 to 30 weeks of gestation from the Aga Khan Hospital for Women and Children completed the A-Z Stress Scale and the Centre for Epidemiology Studies Depression Scale to assess stress and depression …

Social Mobilization Strategy, Family Advancement For Life And Health (Falah)

Reproductive Health

This document outlines social mobilization strategies at the national and community levels of the Family Advancement for Life and Health (FALAH) project in Pakistan. The project aims to improve the health and well-being of women, men, and their children through tackling the major obstacles in adoption of birth spacing to improve maternal and child health outcomes and family well-being, by increasing knowledge of the benefits of birth spacing as well as knowledge, increased demand for, and effective use of contraceptive methods. The strategy aims to achieve a significant increase in couples’ knowledge and understanding of the need for and benefits …

Expanding Access To Safe Abortion And Post-Abortion Care: Recommendations Of A South Asia Regional Consultation, Population Council

Reproductive Health

A South Asia Regional Consultation, organized by the Population Council with representation from governments and key stakeholders of Bangladesh, India, Nepal, and Pakistan, was held in New Delhi, to discuss ways of expanding women’s access to safe abortion services. The Consultation deliberated on ways of expanding the provider base for safe induced abortion so as to overcome inadequate and inequitable access to safe abortion. They also looked to expand access to services for the management of incomplete abortion and complications of unsafe abortion that persist in the region and, thereby, to reduce morbidity and mortality resulting from unsafe abortion. In …

A Multicentre Matched Case Control Study Of Risk Factors For Preeclampsia In Healthy Women In Pakistan., Uzma Shamsi, Juanita Hatcher, Azra Shamsi, Nadeem Zuberi, Zeeshan Qadri, Sarah Saleem

Community Health Sciences

Background: Preeclampsia is one of the leading causes of maternal and perinatal morbidity and mortality world-wide. The risk for developing preeclampsia varies depending on the underlying mechanism. Because the disorder is heterogeneous, the pathogenesis can differ in women with various risk factors. Understanding these mechanisms of disease responsible for preeclampsia as well as risk assessment is still a major challenge. The aim of this study was to determine the risk factors associated with preeclampsia, in healthy women in maternity hospitals of Karachi and Rawalpindi. Methods: We conducted a hospital based matched case-control study to assess the factors associated with preeclampsia …

Father's Support And Literacy--Factors Associated With Child Mortality In Gambat, Sindh-Pakistan, Ajmal Agha, Fozia Ajmal, Azam Iqbal, Franklin White

Community Health Sciences

Objectives: To determine Under Five Mortality Rate (U5MR) in Gambat and to identify causes of and factors associated with it.
Methods: The study was conducted in taluka Gambat of Sindh, Pakistan from December 2002 to August 2003. The sample of at least 510 mothers was needed to capture expected 1020 live births. We interviewed mothers to elicit information about live births in the past five years, under-five mortality and its cause. Additionally, the mothers were also asked about their mobility and availability of husband's support in child's rearing, other than economic support. Approval was sought from Aga Khan University's Ethical …

Effect Of Dai Training On Maternal And Neonatal Care: An Operations Research Study, Peter C. Miller, Gul Rashida, Abdul Wajid, Zeba Tasneem, Lubna Mahmood, Minhaj Ul Haque

Reproductive Health

This study examines the use of training traditional birth attendants, or "dais" as they are known in Pakistan, to reduce maternal mortality. By training dais to adopt safer routine delivery, newborn care practices, and recognize and refer in case of emergencies, dais can improve maternal and neonatal health. While one group of women met with specially trained dais who received Safe Motherhood Applied Research Training (SMART), a control group met with dais who offered health services only. The objectives of this evaluation were to determine whether dais substantially improved their performance after attending the "SMART dai" training course, to determine …

Greenstar Social Marketing Private-Sector Activities In Paiman Project: Process Evaluation Of Greenstar Social Marketing Initiatives To Improve And Expand Maternal And Newborn Health Services And Coverage, Munir Afridi

Reproductive Health

The Population Council provided support for this process evaluation of Greenstar Social Marketing which established a healthcare private provider network (GoodLife clinics) primarily in the urban areas in 10 districts of the PAIMAN project in Pakistan. This network provides maternal and newborn health and reproductive health and family planning services and products. The information collected in this survey points to areas where Greenstar strategies are close to being fully met as well as to areas where the strategies are not being met. The detailed findings should allow Greenstar to focus on those areas most in need of attention: all groups—provider, …

Deaths Of Women Of Reproductive Age: In-Depth Analysis Of Data From The Pakistan Demographic And Health Survey 2006-07, Pakistan Initiative For Mothers And Newborns (Paiman)

Reproductive Health

The Population Council, a partner of the Pakistan Initiative for Mothers and Newborns project, was responsible for undertaking operations research and a program evaluation to revisit and conduct an in-depth analysis of 1,085 verbal autopsies. The analysis had the following objectives: to identify psycho-socio-cultural issues present in the lives of the women whose verbal autopsies were reviewed, to reassess category of maternal death, and to unpack the indirect maternal deaths. The review yielded important information as to the social determinants of women’s deaths in Pakistan. The major psychological and cultural factors identified with the deaths included poverty, neglect, ignorance, disenfranchisement, …

Improving Maternal And Neonatal Health: Measuring The Impact Of The Paiman Project In Ten Districts In Pakistan—Comparing Baseline And End-Line Household Survey Findings (2005-2010), Arshad Mahmood

Reproductive Health

The Pakistan Initiative for Mothers and Newborns (PAIMAN) project was implemented by a consortium including the Population Council to assist the Government of Pakistan to improve the status of maternal and newborn health in 10 districts. PAIMAN strategized specific interventions designed to improve awareness and promote positive maternal and neonatal health behaviors; to increase access to maternal and child health services; to improve service quality in the public and private sectors to manage obstetric and neonatal complications; to increase the capacity of healthcare system managers and providers in maternal and neonatal health; and to improve management and integration of services …

Initial Assessment Of Community Midwives In Rural Pakistan, Abdul Wajid, Zubaida Rashid, Ali M. Mir

Reproductive Health

The goal of this Population Council study, funded by USAID through the Pakistan Initiative for Mothers and Newborns (PAIMAN) project, was to assess the potential of community midwifery services in rural Pakistan in order to provide necessary evidence for future decisions regarding the training, practice, and placement of community midwives (CMWs). The introduction of a new cadre of skilled birth attendants is significant, especially at a time when Pakistan is working toward achieving the Millennium Development Goals. The report makes the following recommendations: 1) opportunities for practical training should be followed meticulously; 2) selection criteria should be revised especially for …

Improving Maternal And Neonatal Health: Measuring The Impact Of The Paiman Project In Ten Districts In Pakistan—A Summary: Comparing Baseline And Endline Survey Findings (2005-2010), Pakistan Initiative For Mothers And Newborns (Paiman)

Reproductive Health

This is a summary of the Pakistan Initiative for Mothers and Newborns (PAIMAN) project’s endline report. The project interventions fell into two broad areas: 1) health systems upgradation and 2) behavior change communication/community mobilization. The thrust of PAIMAN efforts were aimed at reducing the health risk to mothers and newborns by increasing knowledge of danger signs, risks and birth preparedness and, most importantly, improving antenatal and delivery practices. The report concludes that PAIMAN has had a positive impact on overall maternal and neonatal health indicators; success has been recorded in almost all areas, albeit with varying degrees of coverage and …

Training Institutions For Community Midwives In Pakistan: An Initial Assessment, Zakir Hussain Shah, Momina Salim, Mumraiz Khan

Reproductive Health

This study focuses on the training of community midwives (CMWs) in Pakistan, to specifically look at the institutions providing CMW training to see what resources (both physical and human resources) they had available and how these resources were being utilized. This study served as an early evaluation of the trainings and upgrades by the PAIMAN project, to assess how their interventions fared, and provides documentation for future decisions regarding the management, training, and practice of CMWs in Pakistan. As Pakistan transitions from a country with a high level of home births to a country where most births take place in …

Assessing The Feasibility Of Home Administration Of Misoprostol In The Prevention Of Postpartum Hemorrhage In Rural Pakistan, Ali M. Mir, Abdul Wajid, Sadaf Gull

Reproductive Health

This report details an operations research project carried out by the Population Council as part of the Pakistan Initiative for Mothers and Newborns. The overall goal of the project was to test the feasibility of administering misoprostol for the prevention of postpartum hemorrhage (PPH) in a home setting through community‐based healthcare providers, including traditional birth attendants (TBAs), or family members, in two districts of Pakistan. Furthermore, it aimed to identify common side effects of misoprostol and determine the reduction in demand for referral due to PPH after oral ingestion of misoprostol. The results provide a useful addition to the literature …

Assessing The Potential Acceptability Of A New Cadre Of Community Midwives For Pregnancy And Delivery Related Care In Rural Pakistan: Findings From A Qualitative Study, Abdul Wajid, Ali M. Mir, Zubaida Rashid, Abida Aziz

Reproductive Health

The Population Council designed an operations research study to assess the potential acceptability of a new cadre of community midwives (CMWs) for pregnancy and delivery-related care in rural Pakistan. Specific objectives of the study were to determine the need for skilled birth attendants, identify any misconceptions in the community about CMWs, determine levels of acceptance in the community, and explore barriers to the placement of CMWs in the community. The report recommends sensitizing family members so they are more willing to grant permission for pregnant women to consult CMWs, developing flexible fee structures, giving clients greater accessibility, building a network …

Process Evaluation Of Community Mobilization Activities, Zakir Hussain Shah

Reproductive Health

This report presents the findings of a process evaluation by the Population Council of community mobilization (CM) activities implemented under the PAIMAN project in Pakistan. PAIMAN developed a comprehensive communication, advocacy, and mobilization (CAM) strategy to increase knowledge and awareness of harmful practices among women and their family and to improve their health-seeking behaviors. The CAM roadmap acknowledges the importance of engaging communities in order to achieve behavior change and links clients with providers and services. The main objective of this evaluation was to assess the process of CM implementation and to identify its gaps in order to develop corrective …

Study Of Sexually Transmitted Infections Among Urban Men In Pakistan: Identifying The Bridging Population, Ali M. Mir, Laura Reichenbach, Abdul Wajid, Mumraiz Khan

Reproductive Health

Pakistan currently has low levels of HIV infection, however the country is considered at high potential risk for an HIV epidemic. In major cities there are large concentrations of individuals whose behaviors make them extremely vulnerable to the rapid spread of HIV and of classical sexually transmitted infections (STIs), including male and female sex workers, men who have sex with men, and injecting drug users. HIV can spread to the general population through individuals who have contact with both high-risk groups and the general heterosexual population (the “bridging population”). Identifying the bridging population and bridging behaviors among urban men and …

Assessment Of Knowledge And Attitudes Of Married Women On Maternal And Newborn Health (Mnh) In Selected Union Councils Of Project Districts, Pakistan Initiative For Mothers And Newborns (Paiman)

Reproductive Health

The World Health Organization estimates that 585,000 women die from pregnancy-related conditions each year. Pregnancy-related conditions, including dysfunctional labor, hemorrhage, infection, toxemia, and unsafe abortion, are the leading cause of death among women of reproductive age in many developing countries. The Pakistan Initiative for Mothers and Newborns (PAIMAN) is a five-year project funded by USAID. Its goal is to reduce maternal and newborn mortality in Pakistan, through viable initiatives and capacity building of existing programs and structures within health systems and communities to ensure improvements and supportive linkages in the continuum of health care for women from the home to …

Assessing Routine Health Information System In Selected Paiman Districts By Using Lot Quality Assurance Sampling (Lqas) Technique, Pakistan Initiative For Mothers And Newborns (Paiman)

Reproductive Health

The Pakistan Initiative for Mothers and Newborns (PAIMAN) is a five-year project funded by USAID. Its goal is to reduce maternal and newborn mortality in Pakistan through viable initiatives and capacity building of existing programs and structures within health systems and communities to ensure improvements and supportive linkages in the continuum of health care for women from the home to the hospital. PAIMAN is compiling data from three data sources and making efforts to improve the functioning of these Health Information Systems (HISs) for efficient management of health services at the district level through generation of quality data and their …

Breast Cancer In Pakistan - Awareness And Early Detection, Saba Sohail, Shams Nadeem Alam

Department of Radiology

No abstract provided.

Exploring The Choices Of Contraception And Abortion Among Married Couples In Tret, Rural Punjab, Pakistan, Muhammad Shafique Arif, Iram Kamran

Reproductive Health

In Pakistan, the contraceptive prevalence rate is 28 percent, unmet need for family planning services is 33 percent, and unwanted pregnancies are on the rise. A national study showed a fairly high induced abortion rate of 29 per 1,000 married women of reproductive age, and 1 out of 6 pregnancies resulted in induced abortion. This study explored how contraception and induced abortion are perceived as options for avoiding unwanted births by Pakistani men and women, to what extent they deliberately choose one over the other, and the language they use to talk about reproductive behavior decision-making. As noted in this …

Health Systems And Maternal Mortality, Neonatal Mortality And Child Health: Review Of Selected Service Delivery Models, Md. Noorunnabi Talukder, Ubaidur Rob

Reproductive Health

Effective maternal and child health services at the community level in developing countries are rarely available. In many developing countries the health systems cannot provide quality maternal and child health care services due to lack of adequate human resources; shortages of equipment, drugs, and supplies; and absence of proper referral mechanisms. Strengthening health systems is central to improving maternal and child health. A variety of targeted interventions have been implemented in the health systems of developing countries. This study was conducted to identify the health service delivery models that have contributed to the reduction of maternal, infant, and child mortality …

Adults' Perceived Prevalence Of Enteric Fever Predicts Laboratory-Validated Incidence Of Typhoid Fever In Children, Xinguang Chen, Bonita Stanton, Al Pach, Andrew Nyamete, R. Leon Ochiai, Linda Kaljee, Baiqing Dong, Dipika Sur, S.K. Bhattacharya, Siti Sapardiyah Santoso, Magdarina Agtini, Zahid Memon, Zulfiqar Ahmed Bhutta, Canh Gia Do, Lorenz Von Seidlein, John Clemens

Centre of Excellence in Women and Child Health

This study was undertaken to develop a model to predict the incidence of typhoid in children based on adults’ perception of prevalence of enteric fever in the wider community. Typhoid cases among children, aged 5-15 years, from epidemic regions in five Asian countries were confirmed with a positive Salmonella Typhi culture of the blood sample. Estimates of the prevalence of enteric fever were obtained from random samples of adults in the same study sites. Regression models were used for establishing the prediction equation. The percentages of enteric fever reported by adults and cases of typhoid incidence per 100,000, detected through …

Linking Reproductive Health To Social Power: Community Health Workers In Belize And Pakistan, Susana Galdos, Lucella Campbell, Patricia Mohammed, Debbie Rogow, Saumya Ramarao, Ali M. Mir, Nicole Haberland

Poverty, Gender, and Youth

This issue of Quality/Calidad/Qualité focuses on two traditional family planning programs that undertook projects to help women enlarge their zone of influence in both the private and public spheres. The first case study focuses on the Belize Family Life Association (BFLA), a nongovernmental organization in a small Caribbean country. The second case study recounts the experience of the Pakistani government, which has an enormous, but entrenched, target-oriented family planning program. Both programs began by recognizing that women’s lack of social power is a major obstacle to their being able to protect their own health. Both trained village workers to regard …