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This article is part of the supplement: Global health research case studies: lessons from partnerships addressing health inequities

Open Access Research article

Maternal deaths in Pakistan: intersection of gender, caste, and social exclusion

Zubia Mumtaz1*, Sarah Salway2, Laura Shanner1, Afshan Bhatti1 and Lory Laing1

Author Affiliations

1 University of Alberta, School of Public Health, Edmonton, Alberta, Canada

2 Sheffield Hallam University, City Campus, Howard Street, Sheffield, UK

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BMC International Health and Human Rights 2011, 11(Suppl 2):S4  doi:10.1186/1472-698X-11-S2-S4

Published: 8 November 2011

Abstract

Background

A key aim of countries with high maternal mortality rates is to increase availability of competent maternal health care during pregnancy and childbirth. Yet, despite significant investment, countries with the highest burdens have not reduced their rates to the expected levels. We argue, taking Pakistan as a case study, that improving physical availability of services is necessary but not sufficient for reducing maternal mortality because gender inequities interact with caste and poverty to socially exclude certain groups of women from health services that are otherwise physically available.

Methods

Using a critical ethnographic approach, two case studies of women who died during childbirth were pieced together from information gathered during the first six months of fieldwork in a village in Northern Punjab, Pakistan.

Findings

Shida did not receive the necessary medical care because her heavily indebted family could not afford it. Zainab, a victim of domestic violence, did not receive any medical care because her martial family could not afford it, nor did they think she deserved it. Both women belonged to lower caste households, which are materially poor households and socially constructed as inferior.

Conclusions

The stories of Shida and Zainab illustrate how a rigidly structured caste hierarchy, the gendered devaluing of females, and the reinforced lack of control that many impoverished women experience conspire to keep women from lifesaving health services that are physically available and should be at their disposal.