Socio-cultural Constraints and Women’s Decision-making Power Regarding Reproductive Behaviour

In a previous study [Ali, Siyal and Sultan (1995)], we observed a big gap between behaviour and desires. Only 35 percent women had the number of children that they had desired. Whereas, a very large number of women had more children than their stated ideal number of children. The same data set also showed that a majority of women (54 percent) either wanted to stop having children or wanted to wait at least two years before having another child [Ali and Rukanuddin (1992)]. In practice, all of these women were not protected; instead only 12 percent were practising contraception [Shah and Ali (1992)]. An argument was put forward that, had these women been empowered to decide about the number of children to be born, the scenario would have been different and small family size norms would have prevailed. However, the finding of that study revealed that generally, the women who were considered to be empowered were actually constrained to exercise fertility control behaviour. It was hypothesised that socio-cultural influences including those of husbands, in-laws and other family members impelled women to become incapacitated. In the present study, an effort has been made to investigate and identify factors that influence women’s decision making about reproductive behaviour. Furthermore, an attempt to measure the extent of these influences has been made.

Socio-cultural Constraints and Women’s Decision-making Power Regarding Reproductive Behaviour

In a previous study [Ali, Siyal and Sultan (1995)], we observed a big gap between behaviour and desires. Only 35 percent women had the number of children that they had desired. Whereas, a very large number of women had more children than their stated ideal number of children. The same data set also showed that a majority of women (54 percent) either wanted to stop having children or wanted to wait at least two years before having another child [Ali and Rukanuddin (1992)]. In practice, all of these women were not protected; instead only 12 percent were practising contraception [Shah and Ali (1992)]. An argument was put forward that, had these women been empowered to decide about the number of children to be born, the scenario would have been different and small family size norms would have prevailed

The family planning programme and its effect on fertility in Pakistan

This study attempts to analyse the impact of the family planning programme on fertility in Pakistan during 1976-85. Data on family planning acceptors were obtained from the Population Welfare Division, Government of Pakistan. Secondary data from the 1975 Pakistan Fertility Survey, the 1981 Census and the 1984 Contraceptive Prevelance Survey have been used for estimating the family planning programme effect on fertility. The estimated contraceptive use on the basis of service statistics has been compared with survey results. A brief comparison has also been made between the last decade (1975-85) and the first decade (1965-75) of the programme operation in terms of contraceptive use. Areas of further investigation are also identified for generating the data required for adequate monitoring of the family planning programme and its effect on fertility. Indirect estimates of contraceptive use have also been derived using bivariate regression between the reported contraceptive use and the values of the "m" parameter for 26 countries. The values of "m" were obtained by Coale and Trussell's method. These values signify deliberate fertility control in a population at a particular period in time. The indirectly estimated contraceptive use levels are found to be consistent (around 20 per cent) and on the basis of this analysis, are judged to be more accurate than the levels reported in surveys (5 to 10 percent)

How Similar are the Determinants of Mortality and Fertility?*

In a pre-transition situation both fertility and mortality are high. However, in the process of demographic transition, fertility decline follows mortality decline and when the demographic transition is complete both these variables vary closely at a low level. In other words, both these variables behave in a way which are oomplimentaJy to each other and hence it may be hypothesised that the factors which explain variation in fertility should explain variation in mortality or vice versa. Nevertheless, the strength and sometimes even direction of these determinants may vary from time to time and from place to place. Presently, Pakistan is in the process of demographic transition. By using the 1990-91 Pakistan Demographic and Health Survey data, here in this exercise, an attempt is made to identify and investigate' the similarities and the differences if any, in the determinants of both fertility and mortality

Women's Empowerment and Reproductive Choices

The 1994 Cairo International Conference on Population and Development (ICPD) in their Programme of Action calls for promoting gender equality and equity and the empowerment of women. Furthermore, the conference also recognises the basic rights of all couples and individuals to decide freely and responsibly the number, spacing, and timing of their children, as well as the right to the information and the means to do so [Sadik (1994)]. The need for such a programme of action arose in view of the fact that in many countries, including Pakistan, women are generally least empowered and hence they have negligible rights to decide about the number of their children. According to the 1990-91 Pakistan Demographic and Health Survey, over 54 percent women either wanted to stop having children or wanted to wait at least two years before having another child [Ali and Rukanuddin (1992)]. However, in practice, all of these women were not protected; instead, only 12 percent were practising contraception [Shah and Ali (1992)]. The low incidence of family planning practice on the part of the women is not so much due to the dearth of family planning services; rather it is due to resistance by husbands, in-laws, and other peer pressures. Demographers like Caldwell (1982) and Cain et al. (1979) also contend that in patriarchal societies it is the patriarchy which militates against the fertility decline.

Virtual Reality in Neurosurgery- A Neurostimulator – Based Postgraduate Residency Training: A Novel Step Towards Skillful Young Neurosurgeons

Introduction/Objective:  Virtual Reality (VR) is the need of time in every field of life. Recent biotechnological advances have molded the surgeon-computer relationship. Department of Neurosurgery Jinnah Hospital Lahore has updated the postgraduate training program by adding the virtual reality simulator. We aim to explore the current and future roles and applications of VR and simulation in neurosurgical training that may reduce the learning curve, improve conceptual understanding and enhance visuospatial skills. Materials & Methods:  Eight residents were enrolled in this program. They exercised the basic skills of neurosurgery e.g. suction, use of bipolar cautery, handling of CUSA, use of micro scissors, etc., and the automated software recorded each participant’s graph of performance separately. After 1.5 years, they were assessed in real-time on actual patients under the direct supervision of a qualified neurosurgeon. The assessment was done on DOPS (Directly Observed Procedural Skills) Performa. Results:  The results showed that there was a gradual upward learning curve in simulator-based procedures from negative marking to 70% in basic surgical skills and 60% in advanced procedures on average for all the residents whereas the DOPS showed that all residents performed above expectation i.e., 4 or above. Conclusion:  Neurostimulator-based postgraduate training program is opening new horizons for the safe and skillful training of residents. With the advancement of artificial intelligence, its use in training programs will lead to structured and systematic training patterns in the world of neurosurgery

Early Experience with Percutaneous Transpedicular Screw Fixation for Thoracolumbar Fractures at a Tertiary Hospital in Pakistan.

Objective:  To present our early experience with percutaneous transpedicular screw fixation for thoracolumbar fractures at a tertiary care hospital in Pakistan. Material & Methods:  A case series of 20 patients with thoracolumbar fractures, who met the inclusion and exclusion criteria were followed for up to six months to evaluate their functional status using the Oswestry Disability Index (ODI). Kendall’s tau, Spearman’s rho and Pearson correlations were conducted to draw useful conclusions. Results:  85% patients’ injury was reported from ‘fall from height’. 55% of the fracture was the dorsal-lumbar junction (T12-L1). Burst type morphology was reported in maximum number of patients (65%). 55% of patients were reported to be neurologically intact. ODI score’s mean percentage decreased from 40% to 23% during the first week to six months, indicates an improvement in the disabilities. A significant (p<0.050) positive correlation was found between fracture morphology and ODI. All patients had an accurate screw trajectory postoperatively and no postoperative complications were documented. Neurology was stable for all patients at 1, 3 and 6 months. Conclusion:  Percutaneous transpedicular screw fixation can be a viable approach for thoracolumbar burst fractures with intact posterior ligamentous complex in all types of thoracolumbar fractures, including type C and leads to an improvement the quality of life. Fracture morphology has a significantly positive correlation with a higher disability index score, with more severe fracture morphologies as per the Thoracolumbar Injury Classification and Severity (TLICS) score having a higher disability

Impact of Microcredit Scheme on Socio-economic Status of Farmers (A case study of PRSP in District Gujranwala)

Pakistan is an agricultural country and the majority of the population belongs to rural areas, therefore rural sector is the main source of economic development and manpower in the country. The development of rural areas is essential for the enhancement of agriculture sector and for the betterment of rural communities. The aim of the present study was to find the impact of microcredit on socio- economic status and living standards of the farmers in rural areas of district Gujranwala. The universe for the present study was all farmers who got loan from the Punjab Rural Support Program in district Gujranwala for agricultural purpose. The Sample of 185 respondents was selected from the targeted population using the simple random sampling technique. A survey was conducted to carry out the study in which a close ended structured questionnaire was developed to collect data from the farmers. Both descriptive and inferential statistics were used to draw the results from the study. Through descriptive analysis, the study clearly demonstrated that microcredit has played a positive role in improving the socioeconomic status of farmers after getting the loan. In this regard the study observed that microcredit played the positive role in changing and improving the living standards, diet patterns, health status and childrens education of the respondents. Chi square test was used to test the proposed hypothesis of the study and to verify the association between variables. The results of the Chi square test revealed that there was a significant impact of microcredit in improving socioeconomic status and household living standard of the farmers.&nbsp