Domestic violence against infertile women in Karachi, Pakistan

This study investigates the prevalence of physical and psychological violence against infertile women in Karachi, Pakistan. A total of 400 infertile women attending the selected infertility clinics in Karachi, Pakistan were interviewed using the to investigate their experiences of physical and psychological violence. Out of 400 infertile women, 278 (64%) reported to be the victims of violence during the last 12 months before they were interviewed. Nearly one quarter (23.1%) reported facing physical violence. All women reported their husbands and their family members to be the perpetrators. It is concluded that Clinicians should identify the abused women and provide them with medical care and supportive counseling

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

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

Adoption practices among couples with secondary infertility in Karachi: a triangulation study design

Objective: To explore the perceptions and experiences of couples with secondary infertility regarding adoption practices; to estimate the prevalence of adoption among couples with secondary infertility, and to study the adopted child preference pattern. Methods: To fulfill the objectives of the study both qualitative and quantitative study designs were utilized. In qualitative explorative study design, three Focus Group discussions were conducted with married fertile women to explore their perceptions for adoption practices. Moreover, eight in-depth interviews were conducted with women with secondary infertility to explore their experiences. For quantitative methodology, a case series of 400 secondary infertile couples was conducted. Results: Qualitative methodology result suggests that adoption is the last option for infertile couples. Couples often take this as a Totka , that when they adopt a child, they could end up having their own baby. The husband\u27s family is usually preferred for adopting a child. The results of quantitative component suggest that the prevalence of adoption among 400 women is 7%. Less than half of the respondents (49.3%) reported to ever having thought of adopting a child to cope with the secondary infertility. The main decision maker for adoption of child is the husband (17%) and the mother-in-law (68%). Though majority of these women (72.5%) were supported by their husbands, however, in-laws and relatives were reluctant to pursue this option and less than one third (29%) of these women had a support from them. Conclusions: This study concludes that couples ever thought of or opted for adoption after prolonged duration of secondary infertility. In cses where the condition cannot be treated, it is necessary to counsel, not only the couple but also the in-laws (JPMA 57:55;2007)

Reproductive tract infections among married women in peri-urban areas of Karachi, Pakistan: A population-based study

Background: Reproductive Tract Infections (RTIs) is a major public health problem. In Pakistan, there is dearth of information about the prevalence of RTIs among women and their health seeking behavior. A study was conducted to determine the prevalence, number and types of RTIs among women residing in squatter settlements in Karachi and their health seeking behavior.Methods: The respondents were married non-pregnant women aged 15–49 years residing in peri-urban areas of Karachi, Pakistan. The interviews with women were followed by their physical and pelvic examinations. Samples swabs collected from vagina and endocervix were tested in laboratory.Results: Overall, 23.8% of the women had laboratory-diagnosed RTIs. Nearly 2.6% had trichomoniasis and 1.7% were positive for syphilis. Bacterial vaginosis was diagnosed in 8.8% and vaginal candidiasis in 13.2 %.Conclusion: The study indicates a high prevalence of RTIs among women with Bacterial vaginosis and trichomoniasis to be the most prevalent endogenous infection and STI respectively. The women considered many symptoms as normal and did not seek treatment. These are the cases that have a potential to remain infected for a long time

Are Unhygienic Practices During the Menstrual, Partum and Postpartum Periods Risk Factors for Secondary Infertility?

This study was aimed at identifying practices during the menstrual, partum and postpartum periods posing possible risk factors contributing towards secondary infertility in women of a selected population in Karachi, Pakistan. A matched case-control study was conducted from April 2003 to March 2004. Four hundred cases were selected from five infertility clinics affiliated with tertiary-care hospitals, and 400 age-matched controls were recruited from the neighbourhood of each case. After taking written consents, trained interviewers conducted interviews using a pretested structured questionnaire. Factors found to be independently associated with secondary infertility were: previous delivery at an unclean place (adjusted odds ratio [AOR]=1.7, 95% confidence interval [CI] 1.1-2.6), delivery by a birth attendant without washing hands with soap (AOR=4.2, 95% CI 2.36-7.47), use of unclean material for absorption of lochia (AOR=3.1, 95% CI 1.5-6.5), non-washing of perineal area after urination/defaecation (AOR=7.1, 95% CI 1.4-35.7), and insertion of home-made vaginal medications (AOR=2.5, 95% CI 1.3-4.7). Since these factors are preventable/modifiable to a great extent, public-health interventions are, thus, recommended to address these risk factors at various levels

Risk Factors for Secondary Infertility among Women in Karachi, Pakistan

BACKGROUND: Secondary infertility in developing countries is mostly attributable to blockage of the fallopian tubes due to adhesions caused by reproductive tract infections. There is a dearth of information on the prevalence and causes of secondary infertility from Pakistan. This paper presents results on factors associated with secondary infertility among married women in Karachi, Pakistan. METHODS: A matched case-control study was conducted. Cases were women aged 15-35 years with history of at least one previous conception and currently seeking treatment for secondary infertility. Controls were women residing in the neighborhood of cases with at least one live birth and not taking treatment for secondary infertility. The age of controls was matched by ±5 years to that of cases. Data was collected from June to August 2003. Conditional logistic regression was used to determine crude and adjusted odds ratios (OR) with corresponding 95% confidence intervals (CI) for factors associated with secondary infertility. RESULTS: The final multivariate logistic regression model revealed that after adjusting for age, cases were more likely to be the housewives (AOR = 2.6, 95% CI:1.5-4.4), had used inappropriate material to absorb blood during menstruation (AOR = 9.0, 95% CI: 5.0-16.4), and at their last delivery, had a birth attendant who did not wash hands with soap and water (AOR = 3.0, 95% CI: 1.4-5.7). Moreover, women with secondary infertility were more likely to report current or past history of having STI symptoms (AOR = 3.6, 95% CI: 2.4-5.6) and use of intra-vaginal indigenous medicines during their last post-partum period (AOR = 3.1, 95% CI: 1.6-5.7). CONCLUSION: We recommend health education and awareness messages for safe practices during menstruation, delivery, and the postpartum period for women in general. Additionally, sanitary napkins should be made available at an affordable cost, and safe delivery kits should contain educational/pictorial brochures for appropriate hand washing skills

Smoking practices and nicotine dependence among adolescents in Pakistan

Objective: To find out the smoking prevalence and associated factors among in-school and out-of-school adolescents and their nicotine dependence.METHOD: The cross-sectional study was conducted from April to June 2008 comprising 1014 adolescents aged 12-18 years residing in two rural districts of Sindh and Punjab. Trained interviewers collected information from the adolescents regarding age, ethnicity, religion, occupation and education of parents, smoking behaviour, smoking history of family/friend, type of family system, number of siblings and place of residence. Statistical package Epi-Info version 6 was used to enter the data and analysis was performed by using SPSS version 12.Results: Overall smoking prevalence among the 1014 adolescents was 15.2%, with significant gender stratification (7.9% among girls versus 20.2% among boys). Of these, 50% were moderately nicotine dependent. However, the prevalence among in-school adolescents (14.6%) was not significantly different from out-of-school adolescents (16.1%). The factors associated with adolescents\u27 smoking were father\u27s illiteracy (adjusted odds ratio [OR] = 8.2), friend\u27s smoking (adjusted OR = 6.8), father\u27s smoking (adjusted OR = 5.4) and nuclear family setup (adjusted OR = 3.6). When explored for the first place of smoking, friends\u27 home was mentioned by majority of adolescents boys and girls.CONCLUSION: Although there was a significant difference found between the prevalence of smoking among adolescent males and females, but any difference among in-school and out-of-school adolescents smoking prevalence could not be established

Determinants of contraceptives use amongst youth: an exploratory study with family planning service providers in Karachi Pakistan

Introduction: In Pakistan, Contraceptive Prevalence Rate (CPR) among married female youth is 17.4% and even lower in rural and slum areas leading to rapid population growth on one hand and poor health consequences on the other. The study was conducted to explore family planning service providers\u27 perceptions regarding use of different contraceptive methods and to identify factors that are influencing their use amongst currently married youth aged 18-24 years in slum areas of Karachi.METHOD: Qualitative exploratory study design was adopted and a total of ten in-depth interviews were conducted with family planning service providers of the area. For content analysis coding of transcribed interviews was done and then categories were made and furthermore themes were derived.Results: Our findings revealed that family planning service providers perceived that there is low use of contraceptive methods amongst youth of study area and low usage could be due to side effects; myths and misconceptions; lack of proper knowledge about different contraceptives; unmet needs of contraceptives; socio-cultural and religious factors about different contraceptive methods and family planning service providers own biases against or for use of contraceptive methods amongst youth in the study area. However better education of youth and family planning service providers\u27 improved knowledge about counseling and use of contraceptive methods was perceived to be associated with improved use of family planning methods amongst youth of the study area.CONCLUSION: Exaggerated side effects and socio-cultural factors could be important influences leading to low use of family planning methods amongst youth of Karachi. Some policy initiatives are the training of lady health Workers, lady health visitors, physicians and staff of the pharmacies for counseling youth in the correct use of family planning methods