Sexual and reproductive health of women

Health seeking behaviour depends largely on the attributes of a healthcare
system and not merely on people’s choices or circumstances.(1) Lack of
proper nutrition for girls, early marriages, and multiparity have been
some of the determinants of the unrelenting ill health of women in
Pakistan.(2) Insufficient primary care services, antenatal care, and
intrapartum care, particularly in the public sector, are the reality.(3)

This situation has contributed to frightening indicators of maternal and
child morbidity and mortality in the country.(4) Qualitative research was
conducted with women of the district of Ghizar in northern Pakistan, a
remote terrain where healthcare provision in the public and private
sectors is even worse. High fertility rates, large family sizes, low
literacy rates, and mediocre income per head are demographic features.

Iron deficiency anaemia is the most widespread nutritional problem among
women and has severe consequences for their reproductive health.

Local women largely rely on traditional practices for prenatal and
postnatal health. The head of the family or any other adult man always
decides about consulting a healthcare provider. Rarely are women allowed
to go alone for a consultation, even in emergencies. Seldom would a woman
have money to spend on her own health. Controlling women’s autonomy has a
perilous impact on their health and health seeking behaviour. A median
delay of three days before a consultation is common among women largely
for economic reasons or because their health has low priority.

The private sector is mostly preferred for seeking health care. The public
sector often has a limited range of services, a dearth of female staff,
poor quality of medicines, and an insensitive attitude of the facility
staff. Appropriateness of services in terms of the sex specific cultural
norms that influence clients’ needs must be visible. Social and cultural
barriers have always had a negative impact on women’s health status.

Women’s health seeking behaviour is complex and must be appreciated to
formulate healthy public policies as opposed to mere delivery of
healthcare services.(5) Maternal morbidity and mortality can be averted
by translating health systems research into policies and introducing
evidence based interventions. Determinants of health seeking behaviour and
the drivers of health service use among women must be studied to create a
more responsive healthcare system in Pakistan.

Department of Community Health Sciences, Aga Khan University, Stadium
Road, PO Box 3500, Karachi 74800, Pakistan

Babar T Shaikh

senior instructor, health systems division
babar.shaikh@aku.edu

Juanita Hatcher

associate professor

Liverpool School of Tropical Medicine, University of Liverpool, Liverpool
L3 5QA

David Haran

senior lecturer

1. MacKian S. A review of health seeking behaviour: problems and
prospects. Internal concept paper. Health Systems Development Programme,
London School of Hygiene and Tropical Medicine. London: LSHTM, 2001.

2. Tinker AG. Improving women’s health in Pakistan. Health, Nutrition and
Population Working Paper series. Human Development Network. Washington DC:
World Bank, 1998.

3. Bhutta ZA, Gupta I, de’Silva H, Manandhar D, Awasthi S, et al. Maternal
and child health: is South Asia ready for change? BMJ 2004;328:816-9.

4. Fikree FF, Ali T, Durocher JM, Rahbar MH. Health service utilization
for perceived postpartum morbidity among poor women living in Karachi. Soc
Sci Med 2004;59:681-94.

5. World Health Organization. Action on the social determinants of health:
learning from previous experiences. Background paper prepared for the
Commission on Social Determinants of Health. Geneva: WHO, 2005.

Competing interests:
None declared