The Impact of Women’s Autonomy on the Reproductive Behavior in Gilgit-Baltistan, Pakistan

The Impact of Women’s Autonomy on the Reproductive Behavior in Gilgit-Baltistan, Pakistan

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  Pensee JournalVol 75, No. 11;Nov 2013  The Impact of Women’s Autonomy on the Reproductive Behavior in Gilgit-Baltistan, Pakistan Sarfraz Khan, Zia-ur-Rehman, Anwaar Mohyuddin, Waheed Chaudhry, Farhan Ahmad Faiz, Ikram Badshah Department of Sociology & Anthropology, Quaid-i-Azam University PO Box 45320 Islamabad Pakistan Tel: 092-51-90643062 E-mail: Abstract: Besides the ample vibrant problems prevailing in the society this study is pointed to ponder on the most delicate issue of women’s position and its influence on the maternal health care utilization (MHCU) pattern in the context of Pakistan. The study is anomalous because it is conducted in a tribal society where women’s position is a scarce phenomenon. The study is based on a representative sample of 211 married female respondents who have passed a period of 6 weeks after their child birth. In this study both the dimensions of women’s autonomy and maternal health care were analyzed through sub-indicators. Among the key indicators of women’s autonomy education, household decision making, control over finance and freedom of movement is inbounded while the maternal health care indicators are prenatal care, postnatal care and care taken by respondents at the time of delivery. SPSS software version 16 was used to draw correlation between variables of Women’s autonomy and MHCU. It has been evidenced that the indicators of women’s autonomy affects the health care seeking patterns in multidimensional manners. Keywords:   Women’s autonomy, Maternal health care utilization, Gilgit-Baltistan, Pakistan  1. Introduction In the present ear when all of the global humanitarian and development organizations are trying focus of the women’s emancipation at the same time there are some communities likewise the present study locale i.e. Astore in Gilgit-Baltistan, Pakistan experiencing the difference to the women liberation. Different studies in the context of South Asia and more specifically in the context of Pakistan have time and again identified that there is a huge difference between those women who lives in the rural setting and among those who are living in the urban settings. These studies have also concluded that there is a greater influence of the women’s education and autonomy on the health care utilization or reproductive behavior as Khan, Sajid, and Iqbal (2010) stated that in the context of the Pakistan that those women who have higher education and enjoys more autonomy are positively associated to the health care utilization at three different levels during the reproductive process i.e. i) prenatal, ii) at the time of delivery of child, and iii) postnatal. When one overview the same phenomenon at world level different studies have identified that women’s autonomy have been challenged and blocked by the men-folk throughout the ages. There are different processes through which the women-folk has been blocked and challenged by their counterparts. These process remained variant in different localities and regions like majority of women are blocked by the major indicators of women’s autonomy through restricting them to the boundary of home i.e. usurping them freedom of movement and simultaneously devoid them from the right to get education, then marginalizing their role from the mainstream decision making avenues in domestic and public circles and to some extent they are also blocked in the process of voting as well. Ultimately this antagonism has restricted the exposure for women in the social world, therefore, by adversely affecting the primary child rearing avenues of mother, eventually leading to issues of maternal mortality and infant mortality. Greater autonomy increases utilization of maternal health care which involves antenatal and delivery care services, compared with fertility and family planning (Woldemicael, 2010). So once again a vital matter of concern arises that what are the main factors which act as driving force for a women to get autonomy. Several researchers agree that the effect of women’s autonomy on reproductive health outcomes should be examined using measures that reflect women’s extent of freedom of movement and of control over  Pensee JournalVol 75, No. 11;Nov 2013  financial resources and their decision-making power in household needs (Bloom, Wypij & Das, 2001; Dharmalingam & Morgan, 1996; Furuta & Salway, 2006; Ghuman, 2003; Saleem & Bobak, 2005). The blooming modernization trends have not altogether succeeded to alter the perceptions of traditional society regarding women empowerment, rather culture has continued its legacy of imprinting the impact on the categorization of the role and position of women in the society, a phenomenon that is global (Presser & Sen, 2000). Woman plays a pivotal role in raising children and caring for the home, as well as interacting with the world outside the home (Shaikh, Haran & Hatcher, 2008). So, in one context the social circle of interaction for women is same as that of men but the itching hurdle in the way of women’s life is the dubious cultural restriction over their autonomy. Over half a million women from developing countries die each year as a result of complications related to pregnancy and childbirth (Stephenson, Baschieri, Clements, Hennink, & Madise, 2006; WHO, 2005). Hence, the matter of fact is that the society has even not granted enough confidence to women to independently enjoy their mobility in order to seek better health care facilities. Maternal health-seeking behavior is a complex phenomenon, and its appreciation could be very intriguing and informative for designing a coherent policy (Shaikh, 2008). On the other hand autonomy on primary maternal health care utilization is much interrelated. The male-female disparity in health and wellbeing has been well documented in developing countries and particularly in the Asian context (Das Gupta, 1987; Santow, 1995). Prominently in Asian studies work on various dimensions of women’s autonomy and maternal health care seeking has gained new heights. In Asian setup the lack of consistency among relationships found between reproductive behavior and female education or employment has led many analysts to measure women’s autonomy directly, rather than using education or employment as proxies for their decision making power (Balk, 1994; Jejheebhoy, 1995;Visaria, 1993). This is so because in South Asia the adult female literacy rate is less than 50 per cent according to the report published by the World Bank in 2011. Therefore, much of the women-folk in South Asia are devoid of seeking the appropriate maternal health care due to illiteracy, because education is the primary weapon which dispenses the sense of realization among women to attain the better health consultation. Moreover, the health-seeking behavior depends largely upon the dynamics of communities that influence the overall well-being of the inhabitants and not merely on individual’s choice or circumstances (MacKian, 2001). These anomalous dynamics are the cultural structures and practices which sometimes limit the women not to attain MHCU by even restricting her freedom of mobility. This phenomenon certainly and firmly exists in South Asian topography because traditional societies still prevail here. In many countries the female counterparts in house do job either due to financial constraints or due to set pattern or either because of status quo, now this diversification is embedded not only in single country but in entire South Asia. Pondering on the Pakistani domain the crucial issue of maternal health care arises due to the scarcity of primary care services, antenatal care and intrapartum care which act as the major factors leading to high maternal mortality in the country (Bhutta, Ali, Hyder & Wajid, 2004). One of the primary reasons behind this catastrophe is that Pakistani society is dominated by the traditional mindset in majority because of the prevalent orthodox societal setup since centuries, and adoption of modern facilities are sometimes not preferred prominently in Pakistani rural setup. Study conducted by Sathar and Kazi (2000) in Pakistani domain also testifies the vital relationship of women’s autonomy and maternal health care issues. Another study conducted by Khan, Sajid and Iqbal (2010) in Gujrat, Punjab concludes that women’s autonomy with its sub-indicators prominently affects the prenatal and postnatal care of women in Pakistan. 1.1 Research Objectives  1.   To study the socioeconomic position of respondents. 2.   To study the levels of autonomy of women through various indicators in the locale. 3.   To investigate the practices of prenatal care, postnatal care and care taken at the time of delivery. 4.   Impact of women’s autonomy, if any, on maternal health care utilization.  Pensee JournalVol 75, No. 11;Nov 2013  1.2 Research Hypothesis “Higher the levels of women’s autonomy higher will be the reproductive health care utilization.” 2. Materials and Methods The research is being carried out in Rehmanpur Union of district Astore Gilgit-Baltistan. The anomalous attribution in selecting this area for study is that this territory is entirely devoid of the basic life facilities i.e. transportation, telecommunication and proper health care but culturally and ecologically this region is exceptional due to the immense variety of tourism and highly practiced cultural structures existing there. Ultimately, under this scenario the issue of women’s autonomy and health care services is quite appealing. Therefore in order to examine the practices of women autonomy and maternal health care, a sample of 211 respondents (20% of the total target population) was approached using simple random method. The respondents were approached after devising the complete list of those women who have gone through the process of birthing child and also passed through the initial 6 weeks. Moreover, for the purpose of data procurement, interview schedule was designed as a research tool which comprised of three distinct parts i.e. i) demographic profile: related to the personal attributes of the respondent, ii) women’s autonomy: listing indicators of women’s autonomy as education, household decision making, control over finance in the form of assests and salary, freedom of movement towards doctor and relatives, and iii) women’s MHCU focusing three major indicators likewise; prenatal checkups, care taken at the time of delivery, and postnatal checkups. In order to analyze and to make inferences Statistical Package for Social Sciences (SPSS) version 16 was employed. 3. Results and Discussion [Inset tables and description here] 4. Conclusion The ample maneuvers to decelerate the maternal health issues through women’s empowerment in the world are in state of Pyrrhic victory. Despite the side by side ongoing development in the world still the society is encountering maternal mortality and infant mortality at large ratio. As per the panacea of women’s autonomy is concerned, it is unequally practiced i.e. the women of urban regions are the only target in this regard while the rural women-folk are being ignored in rural settings. In this wake the societies should play their role in order to initially empower the women-folk so that they become able to produce a healthy society. Our traditional values also exercise their authority which should be addressed by the weapon of education. The bloom of awareness and innovation in this regard can cater this challenge effectively. The results show that there is good impact of the women’s autonomy on the maternal health care utilization in the context of the local. References Balk, D. (1994). Individual and community aspects of women’s status and fertility in rural Bangladesh. Population Studies, 48, 21–45 Basu, A. M. (1992). Culture, the status of women and demographic behavior illustrated with the case of India. UK: Clarendon Press. Bhatia, J. C., & Cleland, J. (1995). Determinants of maternal care in a region of South India. Health Transition Review, 5, 142 Bhutta, Z. A. et al. (2004). Prenatal and newborn care in Pakistan. In Z. A. Bhutta (Ed.). Maternal and Child Health in Pakistan: Challenges and Opportunities. Karachi: Oxford University Press. Bloom, S. et al. (2001). Dimensions of women’s autonomy and the influence on maternal health care utilization in a north Indian city. Demography, 38, 67-78 Das Gupta. M. (1987). Selective discrimination against female children in rural Punjab, India. Population and Development Review, 13, 77-100 Das Gupta. M. (1990). Death clustering, mother’s education, and determinants of child mortality in rural Punjab, India. Population Studies, 44, 489–505 Dharmalingam, A., & Morgan, S. P. (1996). Women’s work, autonomy and birth control: evidence from two South Indian villages. Population Studies, 50, 187–201  Pensee JournalVol 75, No. 11;Nov 2013  Furuta, M., & Salway, S. (2006). Women’s position within the household as a determinant of maternal health care use in Nepal. International Family Planning Perspectives, 32, 17–27 Ghuman, S. (2003). Women’s autonomy and child survival: A comparison of Muslims and non-Muslims in four Asian countries. Demography, 40, 419–436 Jejeebhoy, S. J. (1995). Women’s education, autonomy and reproductive behavior. Clarendon: Oxford University Press. Khan, S. et al. (2010). The impact of women’s autonomy on maternal health care utilization in rural Punjab. The Pakistan journal of social issues, 2, 74-83 MacKian, S. (2001). A review of health seeking behavior: problems and prospects. Internal concept paper. London: Health Systems Development Programme, London School of Hygiene and Tropical Medicine. Murthi, M. et al. (1995). Mortality, fertility and gender bias in India: a district level analysis. Population and Development Review, 21, 745–82 Presser, H., & G, Sen. (2000). Women’s empowerment and demographic processes: Moving beyond Cairo. London, Oxford: University Press. Saleem, S, & M. Bobak. (2005). Women’s autonomy, education and contraceptive use in Pakistan: A national study. Reproductive Health, 21–8. Santow, G. (1995). Social roles and physical health: the case of female disadvantage in poor countries. Social Science and Medicine, 40(2), 147–161. Sathar, Z. A., & S. Kazi. (2000). Women’s autonomy in the context of rural Pakistan. Pakistan development review, 39(2), 89-110. Shaikh, Babar. T. et al. (2008). Women's social position and health-seeking behaviors: is the health care system accessible and responsive in Pakistan. Health Care for Women International, 29(8-9), 945-959. Stephenson, R. et al. (2006). Contextual influences on the use of health facilities for childbirth in Africa. American Journal of Public Health, 96, 84–93. Visaria, L. (1993). Female autonomy and fertility behavior: an explanation of Gujarat data. Pp. 263–75. In Meeting of the International Unit for the Scientific Study of Population Montreal: Liège. WHO, (2005). The world health report: make every mother and child count. Geneva: Department of Reproductive Health and Research, World Health Organization. Woldemicael, G. (2010). Do women with higher autonomy seek more maternal health care? evidence from Eritrea and Ethiopia. Health care for women international, 31, 599-620. Table1. Demographic profile of the respondents Variable N % Age group of respondents 20-24 10 4.7 25-29 44 20.9 30-34 46 21.8 35-39 80 37.9 40-44 27 12.8 45-49 2 .9 50+ 2 .9 Total 211 100.0 Education  Pensee JournalVol 75, No. 11;Nov 2013   The data presented in the Table 1 focuses on the demographic profile of the respondents with subsequent six areas i.e. age of the respondents, education, occupation, income, social class, and family structure. Table 1.1 describes the age groups of the reported respondents. According to the statistics majority of the respondents (37%) were 35-39 years of age while 21% respondents fall between age group of 30-34, 20% respondents fall in age group of 25-29. 12% respondents were aged 40-44. 4% respondents were of age 20-24. Only 1.8% respondents were more than 45 years of age. Table 1.2 illustrates the education level of the respondents. The results show that more than half 55% are under matriculation while 18% respondents are those who have passed matriculation, whereas 10% respondents are educated up to higher secondary level. 6% respondents are graduated and only 9% respondents have education up to master’s level. Table 1.3 exhibits the employment ratio of the respondents. The reported data shows that more than one third of the population (92%) is unemployed. Only 7% respondents were reported to be employed which shows that there is no such availability of paid jobs for women or they are not allowed to do a job. Table 1.4 depicts the monthly income of the respondents. As the employment ratio is very less, therefore, these statistics are encompassing the employed respondents only which are 15 in number. Out of the total employed respondents 73% have monthly income ranging 6000-10000 rupees. 20% have monthly income of 16000-20000 rupees. Only 6% have 1000-5000 rupees income per month. Table 1.5 explains the social class of the respondents. On the basis of two major variables, social class of the respondent has been constituted i.e. i) monthly family income, and ii) the assets of the family. The upper class respondents consist of the agricultural land, household business, and maximum capital, while the middle class bears 5-9 118 55.9 10 39 18.5 12 21 10.0 14 13 6.2 16 20 9.5 Total 211 100.0 1.3 Respondent’s employment status Yes 15 7.1 No 196 92.9 Total 211 100.0 1.4 Monthly income of the respondent 1000-5000 1 6.7 6000-10000 11 73.3 16000-20000 or above 3 20.0 Total Employed 15 100.0 1.5 Social class of the respondents upper class (rich) 16 7.6 middle class 183 86.7 lower class 12 5.7 Total 211 100.0 1.6 Family structure of the respondents Nuclear 122 57.8 Joint 73 34.6 Extended 16 7.6 Total 211 100
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