社会和文化实践对产妇死亡率的影响：来自巴基斯坦旁遮普省南部的定性研究。
The influence of social and cultural practices on maternal mortality: a qualitative study from South Punjab, Pakistan.
机构信息
Department of Public Health, Institute of Social and Cultural Studies, University of the Punjab, Lahore, Pakistan.
University of Okara, Okara, Pakistan.
出版信息
Reprod Health. 2021 May 18;18(1):97. doi: 10.1186/s12978-021-01151-6.
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.
背景
世界上发展中和欠发达地区报告的孕产妇死亡率过高。其中很大一部分与社会和文化因素有关，这些因素构成了妇女利用适当的孕产妇保健服务的障碍。关于发展中国家产妇死亡率的研究有很多。然而，在“三延误模型”的背景下，关于导致孕产妇死亡的社会文化因素的文献却很少。本研究旨在探讨导致巴基斯坦旁遮普省南部孕产妇保健中寻求护理延误的社会文化因素。
方法
我们使用定性方法，并对不同目标群体进行了三种类型的数据收集：（1）与妇科医生进行的 60 次关键知情人访谈，（2）与 Lady Health Workers（LHWs）进行的 4 次焦点小组讨论，以及（3）在死者家属中进行的 10 个案例研究。该研究在巴基斯坦旁遮普省的德拉加济汗进行。借助主题分析对数据进行了分析。
结果
研究表明，由于某些社会文化因素，在巴基斯坦，寻求护理的延误——以及由此导致的孕产妇死亡——更有可能发生。农村地区的贫困经济社会地位、对孕产妇保健知识的有限了解以及经济拮据是寻求护理的主要障碍。妇女地位低下和男性主导地位使妇女的权力受到限制。对传统助产士的偏好导致孕产妇死亡。此外，早婚和缺乏计划生育，这些都深深植根于文化价值观、宗教和传统中——例如传统或精神治疗师的影响——阻止年轻女孩获得孕产妇保健。
结论
巴基斯坦的高孕产妇死亡率令人深感震惊。要减少孕妇死亡人数，就必须坚决解决某些社会文化做法，这些做法为妇女寻求孕产妇保健服务造成了障碍。关注减贫和增强决策能力对于支持妇女的医疗保健权利至关重要。
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