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

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

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

Prevalence of needlestick injury and nursing practices regarding safe injection and sharp disposal while working in critical care settings of two tertiary care hospitals

This observational cross-sectional study design (Pilot) was conducted to assess the prevalence of needle stick injury (NSI) and nursing practices regarding safe injection and sharp disposal in critical care units of two tertiary care hospitals from 1st July to 30th August 2014. Data was collected using a self-developed questionnaire about the prevalence of NSI and nurses’ pract­ices regarding safe injection and sharp disposal after a thorough literature review and then was given to the expert for review. Finally, the data was collected from the participants after verbal consent. The study result showing that about half of the nurses have no knowledge regarding the disposal of sharp and it has been found that 47.8% re-cap the needle before disposal. While 32.6% reported needle prick injury. The study concluded that inadequate knowledge among nurses about safe nursing practices and lack of using preventive measures from NSI were identified. Lack of reporting is also a factor identified in this study

Knowledge and Practice Gaps among Pediatric Nurses at a Tertiary Care Hospital Karachi Pakistan

The advancement in medical science has created health care environments that require nursing professionals who posses specialized clinical knowledge and skills to provide care and deal with critically and acutely ill children. This study explored gaps between knowledge and practice as perceived by the registered nurses of pediatric units by further recommending the changes suggested by them. A descriptive exploratory study design under the quantitative research methodology was utilized using universal sampling of all pediatric nurses working at a tertiary care hospital in Karachi, Pakistan. The gaps between knowledge and practice, as perceived by the participants, were categorized into five major categories: (1) medication (34%), (2) skills (28.3%), (3) knowledge (13.36%), (4) handling of code blue and intubations (12.6%), and (5) operating medical devices (11.58%). As a result, anxiety and incompetency were notably seen in the participants which had great amount of impact on the level of care provided to the patients. The implications of the findings for quality patient care were also analyzed

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