title: Improving maternal health in Pakistan: toward a deeper understanding of the social determinants of poor women's access to maternal health services.
abstract: Evidence suggests national- and community-level interventions are not reaching women living at the economic and social margins of society in Pakistan. We conducted a 10-month qualitative study (May 2010-February 2011) in a village in Punjab, Pakistan. Data were collected using 94 in-depth interviews, 11 focus group discussions, 134 observational sessions, and 5 maternal death case studies. Despite awareness of birth complications and treatment options, poverty and dependence on richer, higher-caste people for cash transfers or loans prevented women from accessing required care. There is a need to end the invisibility of low-caste groups in Pakistani health care policy. Technical improvements in maternal health care services should be supported to counter social and economic marginalization so progress can be made toward Millennium Development Goal 5 in Pakistan.
authors.affiliation: Zubia Mumtaz, Laura Shanner, and Lory Laing are with the School of Public Health, University of Alberta, Edmonton. Sarah Salway is with the University of Sheffield, Sheffield, United Kingdom. Afshan Bhatti is with the Real Medicine Foundation, Islamabad, Pakistan. Shakila Zaman is with the Lahore Medical and Dental College, Lahore, Pakistan. George T. H. Ellison is with the University of Johannesburg's Centre for Anthropological Research, Johannesburg, South Africa.
authors.forename: Zubia
authors.initials: Z
authors.lastname: Mumtaz
authors.forename: Sarah
authors.initials: S
authors.lastname: Salway
authors.forename: Afshan
authors.initials: A
authors.lastname: Bhatti
authors.forename: Laura
authors.initials: L
authors.lastname: Shanner
authors.forename: Shakila
authors.initials: S
authors.lastname: Zaman
authors.forename: Lory
authors.initials: L
authors.lastname: Laing
authors.forename: George T H
authors.initials: GT
authors.lastname: Ellison
mesh_terms: D005260:Female; D017144:Focus Groups; D006297:Health Services Accessibility / Q000458:organization & administration* / Q000592:standards; D006801:Humans; D007407:Interviews as Topic; D008427:Maternal Health Services / Q000600:supply & distribution*; D008429:Maternal Welfare; D010154:Pakistan / Q000453:epidemiology; D011203:Poverty; D011247:Pregnancy; D036301:Qualitative Research; D058996:Quality Improvement; D012923:Social Class; D064890:Social Determinants of Health; D013240:Stereotyping