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Open Access Study protocol

Addressing disparities in maternal health care in Pakistan: gender, class and exclusion

Zubia Mumtaz1*, Sarah Salway2, Laura Shanner3, Shakila Zaman4 and Lory Laing3

Author Affiliations

1 School of Public Health, University of Alberta, 3-309 Edmonton Clinic Health Academy, 11405 – 87 Ave, Edmonton AB T6G 1C9, Canada

2 Centre for Health and Social Care Research, Sheffield Hallam University, Montgomery House, 32 Collegiate Crescent Collegiate Campus, Sheffield S10 2BP, UK

3 3-309 Edmonton Clinic Health Academy, 11405 – 87 Ave, Edmonton AB T6G 1C9, Canada

4 85-K Str 77 Defence Housing Authority Lahore Cantt, Lahore, Pakistan

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BMC Pregnancy and Childbirth 2012, 12:80  doi:10.1186/1471-2393-12-80

Published: 7 August 2012

Abstract

Background

After more than two decades of the Safe Motherhood Initiative and Millennium Development Goals aimed at reducing maternal mortality, women continue to die in childbirth at unacceptably high rates in Pakistan. While an extensive literature describes various programmatic strategies, it neglects the rigorous analysis of the reasons these strategies have been unsuccessful, especially for women living at the economic and social margins of society. A critical gap in current knowledge is a detailed understanding of the root causes of disparities in maternal health care, and in particular, how gender and class influence policy formulation and the design and delivery of maternal health care services. Taking Pakistan as a case study, this research builds upon two distinct yet interlinked conceptual approaches to understanding the phenomenon of inequity in access to maternal health care: social exclusion and health systems as social institutions.

Methods/Design

This four year project consists of two interrelated modules that focus on two distinct groups of participants: (1) poor, disadvantaged women and men and (2) policy makers, program managers and health service providers. Module one will employ critical ethnography to understand the key axes of social exclusion as related to gender, class and zaat and how they affect women’s experiences of using maternal health care. Through health care setting observations, interviews and document review, Module two will assess policy design and delivery of maternal health services.

Discussion

This research will provide theoretical advances to enhance understanding of the power dynamics of gender and class that may underlie poor women’s marginalization from health care systems in Pakistan. It will also provide empirical evidence to support formulation of maternal health care policies and health care system practices aimed at reducing disparities in maternal health care in Pakistan. Lastly, it will enhance inter-disciplinary research capacity in the emerging field of social exclusion and maternal health and help reduce social inequities and achieve the Millennium Development Goal No. 5.

Keywords:
Social exclusion; Maternal health; Gender; Caste system; Pakistan; Health care system; Class; Health policy; Pregnancy and childbirth; Antenatal care