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Who is excluded and how? An analysis of community spaces for maternal and child health in Pakistan

BACKGROUND: The maternal, newborn, and child health (MNCH) indicators of Pakistan depict the deplorable state of the poor and rural women and children. Many MNCH programmes stress the need to engage the poor in community spaces. However, caste and class based hierarchies and gendered social norms ex...

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Autores principales: Aziz, Ayesha, Khan, Fazal Ali, Wood, Geof
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4895724/
https://www.ncbi.nlm.nih.gov/pubmed/26790620
http://dx.doi.org/10.1186/s12961-015-0043-6
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author Aziz, Ayesha
Khan, Fazal Ali
Wood, Geof
author_facet Aziz, Ayesha
Khan, Fazal Ali
Wood, Geof
author_sort Aziz, Ayesha
collection PubMed
description BACKGROUND: The maternal, newborn, and child health (MNCH) indicators of Pakistan depict the deplorable state of the poor and rural women and children. Many MNCH programmes stress the need to engage the poor in community spaces. However, caste and class based hierarchies and gendered social norms exclude the lower caste poor women from accessing healthcare. To find pathways for improving the lives of the excluded, this study considers the social system as a whole and describes the mechanisms of exclusion in the externally created formal community spaces and their interaction with the indigenous informal spaces. METHODS: The study used a qualitative case study design to identify the formal and informal community spaces in three purposively selected villages of Thatta, Rajanpur, and Ghizer districts. Community perspectives were gathered by conducting 37 focus group discussions, based on participatory rural appraisal tools, with separate groups of women and men. Relevant documents of six MNCH programmes were reviewed and 25 key informant interviews were conducted with programme staff. RESULTS: We found that lower caste poor tenants and nomadic peasants were excluded from formal and informal spaces. The formal community spaces formed by MNCH programmes across Pakistan included fixed, small transitory, large transitory, and emerging institutional spaces. Programme guidelines mandated selection of community notables in groups/committees and used criteria that prevented registration of nomadic groups as eligible clients. The selection criteria and adverse attitude of healthcare workers, along with inadequacy of programmatic resources to sustain outreach activities also contributed to exclusion of the lower caste poor women from formal spaces. The informal community spaces were mostly gender segregated. Infrequently, MNCH information trickled down from the better-off to the lower caste poor women through transitory interactions in the informal domestic sphere. CONCLUSION: A revision of the purpose and implementation mechanisms for MNCH programmes is mandated to transform formal health spaces into sites of equitable healthcare.
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spelling pubmed-48957242016-06-10 Who is excluded and how? An analysis of community spaces for maternal and child health in Pakistan Aziz, Ayesha Khan, Fazal Ali Wood, Geof Health Res Policy Syst Research BACKGROUND: The maternal, newborn, and child health (MNCH) indicators of Pakistan depict the deplorable state of the poor and rural women and children. Many MNCH programmes stress the need to engage the poor in community spaces. However, caste and class based hierarchies and gendered social norms exclude the lower caste poor women from accessing healthcare. To find pathways for improving the lives of the excluded, this study considers the social system as a whole and describes the mechanisms of exclusion in the externally created formal community spaces and their interaction with the indigenous informal spaces. METHODS: The study used a qualitative case study design to identify the formal and informal community spaces in three purposively selected villages of Thatta, Rajanpur, and Ghizer districts. Community perspectives were gathered by conducting 37 focus group discussions, based on participatory rural appraisal tools, with separate groups of women and men. Relevant documents of six MNCH programmes were reviewed and 25 key informant interviews were conducted with programme staff. RESULTS: We found that lower caste poor tenants and nomadic peasants were excluded from formal and informal spaces. The formal community spaces formed by MNCH programmes across Pakistan included fixed, small transitory, large transitory, and emerging institutional spaces. Programme guidelines mandated selection of community notables in groups/committees and used criteria that prevented registration of nomadic groups as eligible clients. The selection criteria and adverse attitude of healthcare workers, along with inadequacy of programmatic resources to sustain outreach activities also contributed to exclusion of the lower caste poor women from formal spaces. The informal community spaces were mostly gender segregated. Infrequently, MNCH information trickled down from the better-off to the lower caste poor women through transitory interactions in the informal domestic sphere. CONCLUSION: A revision of the purpose and implementation mechanisms for MNCH programmes is mandated to transform formal health spaces into sites of equitable healthcare. BioMed Central 2015-11-25 /pmc/articles/PMC4895724/ /pubmed/26790620 http://dx.doi.org/10.1186/s12961-015-0043-6 Text en © Aziz et al. 2015 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research
Aziz, Ayesha
Khan, Fazal Ali
Wood, Geof
Who is excluded and how? An analysis of community spaces for maternal and child health in Pakistan
title Who is excluded and how? An analysis of community spaces for maternal and child health in Pakistan
title_full Who is excluded and how? An analysis of community spaces for maternal and child health in Pakistan
title_fullStr Who is excluded and how? An analysis of community spaces for maternal and child health in Pakistan
title_full_unstemmed Who is excluded and how? An analysis of community spaces for maternal and child health in Pakistan
title_short Who is excluded and how? An analysis of community spaces for maternal and child health in Pakistan
title_sort who is excluded and how? an analysis of community spaces for maternal and child health in pakistan
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4895724/
https://www.ncbi.nlm.nih.gov/pubmed/26790620
http://dx.doi.org/10.1186/s12961-015-0043-6
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