Meanings of blood, bleeding and blood donations in Pakistan: implications for national vs global safe blood supply policies

Contemporary public policy, supported by international arbitrators of blood policy such as the World Health Organization and the International Federation of the Red Cross, asserts that the safest blood is that donated by voluntary, non-remunerated donors from low-risk groups of the population. These policies promote anonymous donation and discourage kin-based or replacement donation. However, there is reason to question whether these policies, based largely on Western research and beliefs, are the most appropriate for ensuring an adequate safe blood supply in many other parts of the world. This research explored the various and complex meanings embedded in blood using empirical ethnographic data from Pakistan, with the intent of informing development of a national blood policy in that country. Using a focused ethnographic approach, data were collected in 26 in-depth interviews, 6 focus group discussions, 12 key informant interviews and 25 hours of observations in blood banks and maternity and surgical wards. The key finding was that notions of caste-based purity of blood, together with the belief that donors and recipients are symbolically knitted in a kin relationship, place a preference on kin-blood. The anonymity inherent in current systems of blood extraction, storage and use as embedded in contemporary policy discourse and practice was problematic as it blurred distinctions that were important within this society. The article highlights the importance—to ensuring a safe blood supply—of basing blood procurement policies on local, context-specific belief systems rather than relying on uniform, one-size-fits-all global policies. Drawing on our empirical findings and the literature, it is argued that the practice of kin-donated blood remains a feasible alternative to the global ideal of voluntary, anonymous donations. There is a need to focus on developing context-sensitive strategies for promoting blood safety, and critically revisit the assumptions underlying contemporary global blood procurement policies.