Study Update, Are Community Midwives Addressing Gender, Social and Class Inequities?

March 15, 2013

Dr. Rubina Mumtaz and Abdullah Nasar

Our research project, titled “Are community midwives (CMWs) addressing the inequities in access to skilled birth attendance in Punjab, Pakistan? Gender, class and social exclusion”, funded by RAF enters its 7th and final quarter.

Photo: RMF Pakistan field team and Machi old woman in Kot Sultan, Layyah

The first five quarters were spent in the field (Jhelum and Layyah) collecting data under Modules 1, 2 and 3. The research methodology adopted was a qualitative phase followed by a quantitative survey. In module 1, more than 1,400 questionnaires were filled out in the quantitative survey phase in Jhelum and Layyah combined. Module 2 was to qualitatively map the challenges faced by CMWs in providing care to socially marginalized women; approximately 80 in-depth interviews were conducted with practising and newly inducted CMWs and their families. Over 100 interviews were conducted with ‘dais’ (traditional birth attendants). Also 20 health facilities were visited where more than 60 patient-provider interactions were observed and about a dozen complicated maternal health cases explored in depth. In addition the RMF field team attended monthly meetings with CMWs during the seven months of field work and also observed several classroom lectures in the Nursing and Midwifery Schools in Jhelum and Layyah. 

Under the qualitative Module 3 to identify the barriers poor, marginalized women face in accessing CMW care, about 90 in-depth interviews were conducted with socially excluded poor young women and men. Since elder women play a significant role during pregnancy, delivery and post-delivery of younger women of the family, about a dozen in-depth interviews were conducted with socially excluded poor older women. A total of 15 focus group discussions were conducted with men and women respectively from the same social strata population. In addition to this, more than 200 informal interviews were conducted with men and women from the villages visited.

Photo: A Baloch family house in Noshra Nashaib, Research Manager, Afshan Bhatti, in the field.

With the start of the sixth quarter, the field teams were disbanded and the key research staff returned to the Islamabad office and embarked on the transcription of the qualitative data and entry of the quantitative data. The transcription aspect proved to be challenging in terms of the massive amount of data and dearth of capacity for conversion from ‘Potwari’ language to English. This gap was addressed by splitting the transcription process from ‘Potwari’ to Urdu to English. Both aspects were implemented simultaneously with the latter outsourced to a local NGO, “Humanity Friends Organization”. So far, more than hundred hours of field data have been transcribed.  

Photo: A Baloch family house in Noshra Nashaib, CMW Khursheeda Manzaoor.

Although work on data collection in the field had already been completed, while consolidating the data it was found that the total number of interviews with socially excluded men and old women were short according to the planned number. So the Research Manager and Research Associate went back to Layyah and conducted the required interviews. The RMF team visited 14 households in total, where they conducted 5 in-depth interviews with SE men and 8 in-depth interviews with SE old women. Alongside this, the team also conducted 19 informal interviews.

Keeping up with the networking with the provincial MNCH health departments, RMF Research Manager Ms. Afshan Bhatti met up with the Director General Health, Dr. Nisar Ahmad Cheema. The current status of the research study was presented to the DG Health who expressed great interest in the findings and field experiences of this research. He appreciated the research idea and said that such unique types of research will be of great help in improvement and further development for the MNCH program. He ensured his team’s cooperation in any upcoming activities within this research arena. Dr. Cheema acknowledged the deprivation of socially excluded groups in Pakistan and shared his experiences about the complex social structure of caste hierarchies in Pakistan. He emphasized that Kammi class in rural Pakistan is deprived of access to many services like health, education and justice. This is placing them in a vicious circle of deprivation and marginalization. The meeting concluded with requesting Dr. Cheema to honour the knowledge dissemination workshop of this research project in early May of this year. He agreed and ensured his availability.

Photo: A Baloch family house in Noshra Nashaib, CMW Khursheeda Manzaoor meeting with family.

Getting the continuous involvement of MNCH Program personnel in project activities, discussion of important policy implication with the DG Health Punjab, his serious notice of the issues and the possibility of incorporating them in the next PC1 of MNCH and LHW Program are considered to be the greatest successes of the quarter.