Reasons for low modern contraceptive use—Insights from Pakistan and neighboring countries

This literature review forms part of an extensive research project to determine why, despite evident demand, contraceptive prevalence remains so low in Pakistan, especially for modern methods. The research has been conducted by the Population Council with the support of the Research and Advocacy Fund (RAF) and comprises four component studies: review of relevant academic, program, and policy literature; qualitative study of perspectives of men, women, and service providers in the country on family planning; situation analysis of contraceptive quality, supply, and access factors at health facilities; and examination of supply-chain issues affecting the availability of contraceptives. This review presents the first study, i.e., the review of relevant academic, program, and policy literature on contraceptive demand and supply in Pakistan, and neighboring regions where relevant

Analysis of the Effects of Marginalization on Women's Health in Metropolitan Cities Tehran, Mashhad, Tabriz and Kermanshah

In recent years, due to the importance of paying attention to the development of women's affairs, this group has been considered as one of the main target groups in the programs of organizing margins and empowering the marginalized metropolises of Iran. Although about half of the marginalized population in these metropolises are women, despite the high emphasis on informal settlement issues, unfortunately, the social and cultural beliefs system of this group, such as the subculture of poverty in the margins, women's beliefs about participation, neighborly relationships, attitudes to social harms, family, childbearing and lifestyle has been neglected by urban managers. The aim of this study was to evaluate and measure the mental health of women living in the city in two marginal areas and the main text of the city and the impact of Slum on them. The type of applied research and the method used descriptive-analytical and for data collection, library and field methods (questionnaires) have been used. The statistical comprehensive of this study is women living in four cities that based on Cochran's formula, 384 questionnaires were distributed in Tehran, Mashhad, Tabriz and Kermanshah randomly in two marginal regions and the main text of the city. In addition to descriptive and inferential tests, logit model has been used to analyze the effect of Slum on women's mental health. The findings showed that mental health status in the main text of the city is higher than the margins of the city. The average of the main text of the city from the perspective of urban women is 2.79 and for urban margins is 2.22. Also, the results of logit model showed that with increasing Slum of mental health of women in the first situation (disease) increases by 35%, but in border condition this variable is effective and the amount of this variable in normal mental health is 0.29%, which indicates that if the person is in normal mental health condition. The effect of Slum on it is less than the state of disease

Young Adults in Urban Pakistan; Barriers and Challenges for Improving Health Behaviors in the wake of the HIV/AIDS Epidemic

Background: HIV/AIDS is spreading globally more specifically among the younger generation. The impact of HIV/AIDS on the youth cannot be underestimated. According to the UNAIDS report 2008; an estimated number of 33 million people around the globe were living with HIV in 2007, and overall, 2.0 million people died due to AIDS, compared with an estimated 1.7 million in 2001. The HIV/AIDS epidemic is most likely to affect health status, economic conditions and family situations. Unprotected sex with an infected partner, contact with infected blood, sharing of drug needles or syringes and mother to child transmission are the modes which cause HIV infection. Surveillance data of Sindh AIDS Control Program, Pakistan suggest that HIV infection is rapidly increasing among injecting drug users (IDUs) and had reached 9% in 2004-5 indicating that Pakistan has entered the concentrated epidemic stage for HIV/AIDS i.e. the HIV prevalence in high-risk subpopulations is 5% or higher. This poses a serious threat of a generalized epidemic especially among the younger population of Pakistan. The prevalence of HIV infection among female sex workers was minimal. Cultural and religious constraints in discussing reproductive health issues and lack of youth clinics further makes the younger generation more vulnerable to HIV/AIDS. Aim: The overall aim of this thesis is to explore and describe young adults knowledge and perceptions on sexual and reproductive health with special reference to HIV/AIDS, future gender roles and implications for health behaviors and prevention in Karachi, Pakistan. Methods: The studies were conducted in the city of Karachi, Pakistan, which is the largest city and the economic and commercial hub of Pakistan and comprises of people from all ethnic backgrounds. Karachi is divided into 18 towns based on administrative units. This project has used both quantitative (study I and II) and qualitative methods (study III and IV). A population-based, cross-sectional study of 1,650 young adults (male n=826) and (female, n=824) aged 17-21 years living in Karachi was conducted using a structured questionnaire (study I and II). A multi-stage cluster sampling design was used to collect data representative of the general population in an urban area in all 18 towns of Karachi. School/college dropouts and preliminary knowledge about STDs were assessed (Study I), further knowledge about HIV/AIDS was assessed (study II). Bivariate and multivariate analyses were performed separately for males and females. A qualitative exploratory study was carried out (study III and IV). Focus group discussions were used for data collection. Participants, both males and females aged 17-21 years were purposively chosen from three different social strata. Altogether, six FGDs (6-8 participants in each FGD) were conducted in the local language Urdu, two from each social stratum. Knowledge and perceptions of HIV/AIDS and family planning were explored (study III), the perception of future life prospects and gender roles were also discussed (study IV). Qualitative content analysis was applied to identify manifest and latent content. Results/findings: Study I revealed that females were twice as likely to dropout of school/college as males. The risk factors for school/college dropout for both males and females were migrant residential status, living in an extended family and low socio-economic status. Furthermore, females exhibited a higher level of awareness about STDs and HIV/AIDS than the males, irrespective of whether they had dropped out of school or not. While the males who dropped out were considerably less aware than those who remained at school, there was no such difference among females. Knowledge of HIV/AIDS was assessed in detail (study II), and it was found that out of 1,650 subjects, 24 per cent (n=390) reported that they had not heard of HIV/AIDS. Among the males, those with a poor HIV knowledge were younger (AOR=2.20; 95 per cent CI, 1.38, 3.49) and had less than six years of schooling (AOR=2.46; 1.29 4.68) with no access to computer at home (AOR=1.88; 1.06 3.34). Among the females, the risk factors for poor knowledge were young age (AOR=1.74; 1.22, 2.50), low socio-economic status (AOR=1.54; 1.06, 2.22), lack of enrolment at school/college (AOR= 1.61; 1.09, 2.39) and being unmarried (AOR=1.85; 1.05, 3.26). Knowledge and perceptions of HIV/AIDS and family planning was further explored (study III). The main theme that emerged from the focus group discussions was Need for multilevel strategies to combat the spread of HIV/AIDS and enhanced acceptance of family planning . A knowledge gap was revealed concerning HIV/AIDS and family planning among young males and females, who had to rely on media and peers for seeking information. Participants perceived that HIV/AIDS is incurable and carries a social stigma. Female participants pointed at the existence of societal discrimination against women with HIV/AIDS. The opposition of family planning from religious leaders was revealed. Exploring the perceptions of future life prospects and gender roles (study IV), the main theme that emerged from the focus group discussions was Expectations of young adults in a changing society is hampered by psychosocial and gender equality constraints . Not only did young males but young females too perceive that good education and a respectable job are obligatory for better life prospects. The major obstacles in this regard were lack of merit system and scarceness of jobs. The younger generation believes that both men and women should share household tasks. Gender inequality and the lower status of women in society were considered obstacles to development. Conclusion: Pakistani young adults having inadequate knowledge and awareness are vulnerable to the global HIV/AIDS epidemic. Both young men and women are well motivated to acquire good education and employment; and seem to belief in gender equality. Transition to better education and gender equality will result in new health related challenges, which emphasize that these young people should be equipped with proper knowledge about STDs and health related behaviors. Religious and cultural barriers to discuss reproductive health issues further deteriorate the situation. Nevertheless, as the prevalence of HIV/AIDS is still comparatively low, the epidemic has not yet enforced a general discussion on the importance of a well-informed younger generation

The determinants of unmet need for contraception in Mozambique.

Thesis (M.A.)-University of KwaZulu-Natal, 2005This work aimed at achieving two objectives; estimating unmet need for contraception and analysing socio-economic factors that are associated with unmet need for contraception in Mozambique. The 1997 Mozambique DHS data were used for this study. Both bivariate and multivariate analyses were applied. The results show that in Mozambique, despite considerable knowledge about modern methods of contraception, unmet need is 29.4 per cent. The estimate among married women is 31.1 percent while among unmarried women is 25.2 percent. Unmet need for contraception is also found to be higher for spacing rather than for limiting purposes. Variables like desired number of children, number of living children and age of women are significant variables for both unmet need for spacing and for limiting. Variables like number of dead children, place of residence and woman's occupation are significant among women who have unmet need for limiting purposes, while for spacing are more in religion. In order to address the issue of unmet need for contraception, planners and other interested parties should aim at the strategies and policies that reach those women who have unmet need for contraception especially women who are living in rural areas, women aged 20-29 and those who are working. In addition, women and their partners must reduce the negative factors that impede the use of contraception if they want to space or to limit their family size

The state as capitalist patriarchy: Women and politics in developing countries, 1995

This inquiry considers how class and gender concerns affect the emergence of women in developing countries as political leaders and how they fare in power. In the contemporary era, the Marxist and the Classical approaches have been used in explicating the state. While Marxism focuses on class conflict, its classical variant perceives the state as a neutral arbiter acting in protection of its national interest. The theoretical inadequacies in the above assumptions stem from the fact that gender is not central to the state-centered models. Women as a group compose a vital segment of the global population and should not be merely described as interests and classes. My attempt is to establish a woman-centered framework in evaluating the state, while focusing on women in the contemporary era who have governed their countries. This research centers on the Philippines, India, Pakistan and Nicaragua and involves an in-depth assessment of gender/class issues. The research postulates that the mutual alliance between gender and class had a direct bearing on the emergence and decline of women as policy makers in developing countries. The research question is: How did patriarchy reinforce capitalism so as to pave the way for women to rise and fall from power? From the standpoint of methodology, the image of gender-biased state is the feminist starting point for developing hypotheses and theories about the differentiated inclusion of women and men into the state system. The case study approach was used in testing this hypothesis. The preliminary findings are that women's class affiliations affect their political advancement. While they are in office, the class and gender factors impact their performance leading to their subsequent downfall. Women, therefore, are not positioned equally with men in the state system. The state is patriarchal no matter who governs

Fertility transition in Pakistan: neglected dimensions and policy implications

This research addresses some of the neglected non-program dimensions related to stagnant fertility transition in Pakistan. Previous research identified a range of factors influencing fertility in Pakistan, particularly the effect of distortions in reported ages, fertility inhibiting variables, timing of first marriage and first birth, and birth intervals. The literature provides evidence that there is no systematic analysis of these dimensions particularly at the regional levels. This research addresses these dimensions by evaluating the fertility and reproductive health data in particular using the cross-sectional data from the 1990 and 2006 Pakistan Demographic and Health Survey, and 2000-01 Pakistan Reproductive Health and Family Planning Survey.Based on the application of relevant demographic and statistical techniques, the study demonstrates evidence of clear discrepancies in age reporting among married females across the seven geographic regions. This had influence on the estimated marital fertility rates which tend to be significantly higher when the reporting effects were adjusted. The analysis of fertility inhibiting factors reveals that timing of marriage and contraceptive use are crucial determinants associated with fertility reduction in Pakistan. By far, the strongest factor driving increase at first marriage in Pakistan is the level of female education which tends to vary significantly across different geographic regions. The analysis of the duration between marriage and first conception shows rather unexpected complex hazard functions with two peaks suggesting the behaviour of two different groups of women: those adhering to the traditional pattern in which conception take place soon after marriage; and those who postpone conception after marriage. Punjab, Baluchistan and urban regions are ahead of the fertility transition at the national level, confirming the effect of longer birth intervals. Based on the analysis of the proximate determinants framework, it can be concluded that Pakistan has entered the early third phase of the fertility transition. Urban Punjab and Baluchistan have also showed convergence to the third phase of the fertility transition. Breastfeeding and amenorrhea have emerged as significant determinants of birth interval duration.The results of this study highlight various areas for programme intervention and policy development. There is a dire need for a policy to improve the levels of female literacy and education especially in poorly developed regions which are in the second phase of fertility transition. A cost-effective intervention would be using mass media, for example radio broadcasting as the medium to disseminate reproductive health and family planning information. Pakistan needs specific policy interventions aimed at empowering girls with education for delaying marriage and encouraging contraceptive use. In formal education programmes, the syllabus should include the introduction to contraception, sexual health education as well as information on sexually transmitted diseases

"The poor have no memories" - Oral histories of women with oral cancer in Pakistan

This thesis explores how women with oral cancer in Pakistan make sense of their experiences. The social context of Pakistan is seen as integral to people’s meanings and experiences because it is intimately connected. Oral history interviews were conducted with fifteen women diagnosed with oral cancer receiving treatment at the Foundation University College of Dentistry, Pakistan. The findings suggested that the pathways to diagnosis with oral cancer could be direct or circuitous. These variations reflected the interplay of the social determinants of health, which included socioeconomic status, gender, beliefs in alternative medicine and religious influences. Socioeconomic status mediated access to diagnosis with some participants reporting extensive consultations with spiritual healers before accessing medical services. This contributed to late presentation for diagnosis. The diagnosis often left participants feeling that God had decided they would develop cancer. Cancer was interpreted as a death sentence and in some cases as a personal punishment. Participants also tended to resort to home remedies and alternative medicines before accessing dental professionals. Gender acted as a determinant by promoting the isolation of women from social participation in education and health. Participants interpreted the use of naswar, areca nut, chillum, bleeding gums, boils/ulcers and past sins as the main causes of oral cancer. Some women reported having to go through their husbands and complex private networks in order to secure diagnosis. This meant that they would often present late, which has implications for disease progression. The social position of women also affected how they made sense of their disease through their faith and talking more about its impact on their family. The findings of this thesis suggest that oral cancer diagnosis in the context of Pakistan develops within complex individual cosmologies and pathways, determined by the perplex interplay of the social determinants of health