Living with violence in the home: Exposure and experiences among married women, residing in urban Karachi, Pakistan

AIM: A study was conducted in urban Karachi, Pakistan to investigate prevalence, frequency, risk factors, and mental health effects of husbands’ violence against their wife. It also explores current gender roles in urban Karachi, Pakistan, how these are reproduced and maintained, and their influence on life circumstances for both men and women. Further, it explores the women’s perceptions of situations which create conflicts and potentially lead to different forms of violence and the immediate consequences of violence exposure. METHOD: The research collected quantitative and qualitative data. The quantitative part used a questionnaire developed by the World Health Organization (WHO) for violence research for data collection among 759 married women living in lower and middle income areas of Karachi city. For the qualitative part, five focus group discussions were carried through, in which 28 women were included, representing employed, unemployed, educated and uneducated women from different socioeconomic strata. Analysis of the focus group discussions was conducted by applying manifest and latent content analyses. FINDINGS: The quantitative studies indicate that violence against women is a common phenomenon within family life among low and middle income groups in Karachi, whether it is exercised as physical, sexual or psychological violence. Further, overlapping between the different forms of violence was huge and most women were exposed to two or all three forms of violence. Risk factors for physical violence related mainly to the husband, his low educational attainment and his being an unskilled worker, as well as there being five or more family members living in one household. For sexual violence, the risk factors were the respondent's low education, low socio-economic status of the family and there being five or more family members living in one household. For psychological violence, the risk factors were the husband's being an unskilled worker and the low socio-economic status of the family. The mental health effects as an outcome of the violence were serious. Suicidal thoughts showed associations with all three forms of violence. Through qualitative studies with manifest and latent content analysis, three major themes emerged: 1) ‘Reiteration of gender roles’, 2) ‘Agents of change’ and 3) ‘Family violence through the eyes of females’. The first theme included perceptions of traditional gender roles and how these preserve women’s subordination. The power gradient, where men given a superior position in relation to women, distinctive features in the culture and the role of the extended family were considered to interact to suppress women. The second theme included agents of change, where the role of education was prominent, as well as the role of mass media. It was further emphasised that the younger generation was more positive to modernisation of gender roles than the elder generation. The third theme describes the circumstances that provoke and sustain violence, situations evoking suicidal thoughts and actions, and how violence can be avoided through women’s awareness and actions. CONCLUSION: This study reveals serious gender inequalities and human rights violations against women within marriage, in her extended family and within Pakistani society. The unequal gender roles were perceived as static and enforced by structures imbedded in society. The female victims of abuse are trapped in a society where violence, from a partner or other family members, is viewed as acceptable, where divorce is a largely unavailable option for the majority, and where societal support directed at women is sparse. Women routinely face serious restrictions and limitations of autonomy, which contribute to the development of multiple forms of psychological stress and serious mental health problems. However, attainment of higher levels of education, especially for women but also for men, was viewed as an agent towards change. Further, mass media was perceived as having a positive role to play in supporting women’s empowerment. Reliable health surveillance system and healthcare services are needed to serve abused women

Gender based violence and health effects

Gender Based Violence (GBV) violates the basic human right of a person’s physical, sexual and emotional integrity and health ([i]) such that globally, one out of every three women is subject to some form of violence, ranging from verbal and physical abuse to emotional blackmailing and psychological torture eventually leading to futile despair and hopelessness. The ironical perception of gender equality in our society is the root cause of gender based violence, with women being more afflicted by such a form of gender discrimination than men. [i]. Ali TS, Krantz G, Gul R, Asad N, Johansson E, Mogren I. Gender roles and their influence on life prospects for women in urban Karachi, Pak0istan: a qualitative study. Global health action. 2011;4(1):7448

Evaluation of efficacy of self breast examination for breast cancer prevention: a cost effective screening tool

Breast cancer is the most prevalent neoplasm among females and every year the number of associated deaths increases so that there is a dire need for implementation of cancer screening and early detection. A survey conducted by various locally organised cancer registries indicated breast cancer to be the most prevalent cancer among females and the second most common cause of cancer deaths among Pakistani women. Since Pakistani females do not generally engage in screening practices we argue that nurses and lady health workers should team up to educate women for the possible early detection of cancer using Self Breast Examination as a screening tool. In this paper, we attempt to evaluate the primary efficacy of self breast examination as an early and cost effective cancer screening measure, and to discuss the relation of community health nurses as well as the lady health workers to education of females of low income countries such as Pakistan to possibly lower the cancer burden

Health seeking behavior of couples with secondary infertility

OBJECTIVE: To determine the factors affecting the health-seeking behavior of couples with secondary infertility in Karachi. DESIGN: A descriptive case series. PLACE AND DURATION OF STUDY: The data was collected from women attending infertility clinics in five tertiary care hospitals in Karachi from March to June 2003. PATIENTS AND METHODS: All currently married women, between the age of 15-35 years, with at least one previous conception, irrespective of outcome, attending an infertility clinic and consenting to participate in the study, were included. Women with corrective surgery on vagina and uterus, and cases of primary infertility, were excluded. Multiple logistic regression models were used to determine the association of various factors, affecting the health-seeking behavior, with statistical significance set at p \u3c 0.05 for the covariates and the interaction terms between various factors. RESULTS: The women consulted multiple health care providers for treatment of secondary infertility. The main reasons for seeking treatment were couple s wish (54.2%), family pressure (22.6%) and want of a son by husbands or in-laws (20.4%). The most commonly sought providers were physicians (74.7%), Traditional Birth Attendants (TBA, 39.5%), Spiritual healers (26%), Hakeems (23%) and Homeopaths (17.2%). Most of the women who consulted non-physicians were illiterate (69.4%) as compared to those who consulted a physician (37.8%, p-value = 0.00). The non-physicians were more commonly consulted by women belonging to low socioeconomic group. The posttreatment complications were more common among women who consulted non-physicians. CONCLUSION: Pressure from husbands and in-laws compels women for consulting multiple providers. Health seeking behavior for infertility is affected by the literacy and socioeconomic status of the women

Psycho-social consequences of secondary infertility in Karachi.

OBJECTIVE: To explore the experiences of social consequences among women suffering from secondary infertility. METHODS: Descriptive case series of 400 women with secondary infertility attending tertiary care hospitals in Karachi, Pakistan. RESULTS: More than two thirds (67.7%) of women stated that their inability to give live births or give birth to sons had resulted in marital dissonance. The respondents had been threatened for divorce (20%), husband\u27s remarrying (38%) or to be returned to their parent\u27s home (26%) by their in laws or husbands. Majority (68%) of the women threatened did not have any live births. However, those who had live births (32%) had a girl child only followed by difficulty in conceiving again. Secondary infertility was described as a cause of violence against infertile women. The women reported that they were being physically and verbally abused by husbands (10.5%) and in-laws (16.3%) for being infertile. Nearly 70% of women facing physical abuse and 60% of the women facing verbal abuse suffered severe mental stress. CONCLUSION: The experience of infertility is a stressful condition itself. This becomes particularly traumatic with previous pregnancies ending up in abortions, stillbirths and neonatal/infant deaths or the live births being daughters only. However, it subjects the woman to contempt and exploitation resulting in severe psychological

Factors associated with the compliance of standard precaution; review article

Compliance with standard precautions is very important for healthcare workers because studies have shown that it helps in minimising the transmission of infectious diseases and healthcare-associated infections which is directly proportional to the patient cost and stay of the patient in hospitals. As healthcare associated infections increase, the cost and the stay of the patient will increase. Researchers suggest that all healthcare workers need to follow the standard precautions guideline and it can be possible with the help of health education, training, provision of equipment and supervision by the management. Barriers to the compliance identified are lack of education, heavy workload, unavailability of equipment, lack of resources and lack of access to supplies. The lack of education and heavy workload are the major factors faced by the nurses

Evaluation of a cancer awareness campaign: experience with a selected population in Karachi

The incidence and prevalence of cancer is rapidly increasing in both developed and developing countries. The most common cancers reported in Pakistan are breast and cervical cancers in females, and lung and oral cancers in males. Public awareness of cancer can play a vital role in its prevention, early diagnosis and treatment. A pilot survey conducted by the Cancer Support Group (CSG) of Aga Khan University Hospital from 2001 till 2004 to gauge the public awareness of cancer in Pakistan revealed that people were afraid of cancer and had little knowledge about its prevention and early detection. The survey also identified several social, religious and cultural misconceptions which hinder cancer screening and treatment. In order to create awareness amongst the general public, especially the young generation, members of the CSG also organized fifteen health education sessions in schools, colleges, hospitals and communities in Karachi which were attended by more than 1,500 people. With the help of the results generated in the pilot project, education material was designed and developed for these health education sessions. Ten percent of the participants contacted CSG members for some unusual finding after administering a self screening tests taught in these sessions. This indicates the importance of holding cancer awareness sessions and the positive feedback obtained suggests that people would like to have cancer awareness sessions continued. Key Words

Misconceptions and Mismanagement of Menstruation among Adolescents Girls who do not attend School in Pakistan

Background: Menstruation is perceived and interpreted differently under different social and cultural norms. There are a number of different practices, conceptions and misconceptions that have been reported in studies conducted in various countries. In Pakistan, there is a dearth of knowledge related to hygienic and unhygienic practices, discomforts, misconceptions related to nutrition, and restrictions imposed during menstruation. Therefore, this study was conducted with the objectives to identify the conceptions and misconceptions about menstruation, explore hygienic and unhygienic practices during menstruation along with the socio- cultural and religious restrictions imposed, and the discomforts with its management among adolescents who do not attend schools between the ages of 13-19 years, residing in the squatter settlements of urban Karachi. Based on the study outcomes, the community midwives can be used as vectors to disseminate published information related to management of menstruation. Consequently, midwives can contribute in improving the health indicators of the country. Methodology: The methodology of the study used a qualitative exploratory study design. Three focus group discussions were conducted with 6-8 participants in each group. Six in-depth interviews were conducted with the key informants selected from three focus groups. The participants were non-school going adolescent girls. The data collected were thematically analyzed. Results: The themes that emerged were; lack of knowledge about menstrual physiology, misconceptions about normal menstrual blood flow; discomforts and mismanagement, unhygienic practices during menstruation, alteration in nutrition, bathing, and socialization in both the religious and social activities. Conclusion: Adolescent girls held misconceptions and beliefs regarding menstruation and its management. Dissemination of the findings to the health professionals will increase their awareness regarding menstrual management which would be helpful for improved reproductive health of the girls

Perceptions and Experiences of Women in Karachi, Pakistan Regarding Secondary Infertility: Results from a Community-Based Qualitative Study

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 with no live child. Conclusions. Since infertility can have a serious effect on both the psychological well-being and the social status of women in Pakistan, effective interventions are the need of the day. There is a dire need for health education and counseling to be integrated into infertility management plans