Ali Tazeen Saeed, Asif Nimira, Adnan Farzana, Farooq Maria, Shahid Shahnaz, Bhutto Kinza, Lashari Laraib, Sarfaraz Aamir, Khan Mir Baz, Memon Zahid Ali, Soofi Sajid, Bhutta Zulfiqar A
Department of Community Health Sciences, The Aga Khan University, Karachi, Sindh, Pakistan.
School of Nursing and Midwifery, The Aga Khan University, Karachi, Sindh, Pakistan.
BMJ Public Health. 2025 Jun 18;3(1):e000870. doi: 10.1136/bmjph-2023-000870. eCollection 2025.
Sexual and reproductive health has been gaining more and more attention due to its all-encompassing definitions and inclusivity of all people, including the marginalised. However, social taboos, lack of political will, broken healthcare system, and sociocultural and economic factors continue to stand as barriers to normalising sexual and reproductive health. This paper explores this topic through focus group discussions and in-depth interviews (IDIs) (exploring both through FGD and direct view from IDIs) in Chitral, Gilgit-Baltistan and Sindh, Pakistan.
This qualitative study was conducted using a descriptive exploratory approach. The target population comprised community members from two districts in Khyber Pakhtunkhwa-Upper and Lower Chitral-as well as two districts in Sindh and six districts in Gilgit-Baltistan. These groups included married adults (aged 18-51), adolescent girls and boys (aged 14-21) and healthcare workforce members. 57 FGDs were conducted with the community and healthcare professionals between October 2020 and December 2020. A purposive sampling technique was used to identify participants, and data analysis was conducted simultaneously with data collection. Consent was obtained from each participant. Qualitative thematic analysis was conducted to identify key themes, through using manual method and NVivo.
Identified themes include gender inequality, adolescent health, family planning, maternal health and sexual and reproductive health.
Gender inequality in Chitral and Sindh, Pakistan, significantly impacts gaps in the healthcare system, adolescent health, sexual and reproductive health, maternal health, and family planning. The lack of access to healthcare in Chitral and rural Sindh, coupled with gender inequality, significantly impacts family planning. The limited availability of modern contraception and secondary family planning education worsens these difficulties. It will take a broad strategy to address these problems, including initiatives to promote access to family planning services, boost access to education for girls and strengthen the healthcare system in the region.
There is a need to take a multidimensional approach that promotes women's empowerment, community involvement and focused investments in healthcare facilities and services to address gender disparity and improve access to healthcare. To accomplish these objectives, it is essential to increase educational accessibility, support gender-sensitive policies and initiatives and invest in the training of the healthcare workforce.
性与生殖健康因其全面的定义以及对包括边缘化群体在内的所有人的包容性而越来越受到关注。然而,社会禁忌、缺乏政治意愿、破碎的医疗体系以及社会文化和经济因素仍然是性与生殖健康正常化的障碍。本文通过在巴基斯坦奇特拉尔、吉尔吉特 - 巴尔蒂斯坦和信德省进行焦点小组讨论和深入访谈(通过焦点小组讨论和深入访谈的直接观察进行探索)来探讨这一主题。
本定性研究采用描述性探索性方法。目标人群包括开伯尔 - 普赫图赫瓦省两个地区(上奇特拉尔和下奇特拉尔)、信德省两个地区以及吉尔吉特 - 巴尔蒂斯坦六个地区的社区成员。这些群体包括已婚成年人(18 - 51岁)、青少年女孩和男孩(14 - 21岁)以及医疗保健工作人员。2020年10月至2020年12月期间,与社区和医疗专业人员进行了57次焦点小组讨论。采用目的抽样技术确定参与者,并在数据收集的同时进行数据分析。获得了每位参与者的同意。通过使用手动方法和NVivo进行定性主题分析,以确定关键主题。
确定的主题包括性别不平等、青少年健康、计划生育、孕产妇健康以及性与生殖健康。
巴基斯坦奇特拉尔和信德省的性别不平等对医疗体系、青少年健康、性与生殖健康、孕产妇健康和计划生育方面的差距产生了重大影响。奇特拉尔和信德省农村地区缺乏医疗服务,再加上性别不平等,对计划生育产生了重大影响。现代避孕方法的有限供应和二级计划生育教育加剧了这些困难。解决这些问题需要一项广泛的战略,包括促进获得计划生育服务的举措、增加女孩受教育机会以及加强该地区的医疗体系。
需要采取多维度方法,促进妇女赋权、社区参与并对医疗设施和服务进行有针对性的投资,以解决性别差距并改善医疗服务的可及性。为实现这些目标,增加教育可及性、支持对性别问题敏感的政策和举措以及投资于医疗保健工作人员的培训至关重要。