Voices of Strength and Struggle Zakar, Rubeena; Zakar, Muhammad Zakria; Krämer, Alexander
Journal of interpersonal violence,
11/2012, Volume:
27, Issue:
16
Journal Article
Peer reviewed
This article documents the coping strategies adopted by women victims of spousal violence in Pakistan. By drawing on 21 in-depth interviews conducted in Lahore and Sialkot (Pakistan), we found that ...the women tried to cope with violence by using various strategies, both emotion focused (e.g., use of religion, placating the husband, etc.) and problem focused (e.g., seeking support from formal institutions, etc.). The data showed that a majority of the women used emotion-focused strategies, especially spiritual therapies, which somehow reduced the violence and provided them with psychosocial solace. Nonetheless, these strategies incurred some costs, such as the consumption of scarce resources, time, and emotional energy. Our data also showed that few women opted for problem-focused strategies, such as seeking help from formal institutions, as these strategies could lead to overt confrontation with their husbands and may result in divorce, the outcome least desired by most of the Pakistani women. We noted that the coping behavior of Pakistani women was complex, subjective, and nonlinear and that the boundaries between emotion-focused and problem-focused strategies were diffuse and blurred. Although the women never surrendered to violence, they were fully aware of their structural limitations and vulnerabilities. Being mindful of the consequences of their actions, women carefully tailored a combination of strategies which could be helpful in resisting or reducing violence but, at the same time, should not be counterproductive. This article argues that Pakistani women alone cannot effectively resist violence while living under a harshly patriarchal regime, where violence against women is embedded in the social, political, and legal structures of society. There are no quick fixes to change the status quo. The Pakistani government, civil society, and formal institutions must proactively support women in reducing their vulnerabilities and facilitate them in expanding their capabilities to address the real causes of violence against them.
We aimed to discern paternal factors associated with neonatal deaths and births with low weight, independent of maternal and other socio-demographic factors. We analyzed the nationally representative ...sample of 5,724 ever-married women of reproductive age (15–49 years) who delivered their last child during the past 5 years preceding the Pakistan Demographic and Health Survey 2006–2007. We assessed adverse birth outcomes using two variables i.e. neonatal deaths (<28 days) and small size births (as a proxy for birth weight). Associations between paternal factors and adverse birth outcomes were assessed by calculating unadjusted and adjusted odds ratios using logistic regression models after controlling for maternal and socio-demographic factors. The analysis was performed by using the statistical package for social sciences (SPSS) version 17. About 4.5 % mothers reported neonatal deaths and 34 % had small size births (SSB). We found that fathers involved in manual occupation were more likely to have neonatal deaths than fathers involved in managerial/professional jobs (adjusted odds ratio (aOR): 1.64; 95 % Confidence Interval (CI) 1.01, 3.55). Similarly, fathers who belonged to poorer wealth index had higher risk of SSB (aOR: 1.62; 95 % CI 1.18, 2.22). Additionally, consanguinity was a major risk factor which was associated with neonatal deaths (aOR: 1.73; 95 % CI 1.09, 2.74) and SSB (aOR: 1.25; 95 % CI 1.03, 1.55). Fathers’ occupation including unemployment and consanguinity were associated with increased risk of adverse birth outcomes. Further studies are warranted to discern other paternal risk factors related to adverse birth outcomes.
Evidence shows that Pakistan has an increasing rate of children with low birth weight (LBW). Employed mothers in paid work (EMPW) in the country have predominantly been disadvantaged in terms of ...access to education and low-income employment; with negative consequences on maternal and child health. The objective of this study was to determine socio-demographic characteristics of EMPW and identify the association between maternal employment and child birth weight in Pakistan. Secondary data from the Pakistan Demographic Health Survey (PDHS) conducted for the year 2006–2007 was used. PDHS is a nationally representative household survey. Relevant data needed from the PDHS data file were coded and filtered. The sample size of EMPW with at least one child born in the last 5 years was 2,515. Data was analyzed by using SPSS. Descriptive and inferential statistics were used to see the association between EMPW characteristics and LBW. Findings confirm that the majority of EMPW in Pakistan are illiterate, poor, employed in unskilled work, and belonging to rural regions. Multivariate regression analysis revealed statistical association between EMPW and LBW among mothers who did not receive prenatal care from unskilled healthcare provider (AOR 1.92; 95 % CI 1.12–3.30), had lack of access to information such as radio (AOR 1.88; 95 % CI 1.28–2.77), during pregnancy did not receive calcium (AOR 1.19; 95 % CI 1.05–1.34), and iron (AOR 1.33; 95 % CI 1.05–1.69), had experienced headaches during pregnancy (AOR 1.41; 95 % CI 1.12–1.76), and were not paid in cash for their work (AOR 1.41; 95 % CI 1.04–1.90). EMPW in Pakistan, especially in low-income jobs and rural regions, need urgent support for healthcare awareness, free supplementation of micronutrients and frequent consultation with trained practitioner during the prenatal period. Long-term mobilization of social structure and governance is needed to encourage maternal health awareness, hospital deliveries, and formal sector employment for EMPW.
Objective
To assess the combined effect of consanguineous and child marriages (CCM) on children health, which has not previously been explored, either globally or locally.
Methods
We analyzed ...secondary data from a series of cross-sectional, nationally representative Pakistan Demographic and Health Surveys 1990–91, 2006–07, and 2012–13. A total of 5406 mothers with 10,164 children were included in the analysis. Child health was assessed by variables such as history of diarrhea, acute respiratory infection (ARI), ARI with fever, Under-5 child mortality (U5CM) and small-size birth (SSB). Associations among variables were assessed by calculating unadjusted Odd Ratios (OR) and adjusted OR (AOR).
Results
A majority (n = 6,247, 61%) of the births were to mothers having CCM as compare to non-CCM (3917, 39%). There was a significant association between CCM and U5CM during 1990–91 (AOR 1.24, 95% CI 1.03–1.49) and 2006–07 (AOR 1.25, 95% CI 1.05–1.51), and infant mortality in 1990–91 (AOR 1.39, 95% CI 1.05–1.85) and 2006–07 (AOR 1.61, 95% CI 1.17–2.21). A significant association was also found between CCM and SSB infants in the period 2006–07 (AOR 1.19, 95% CI 1.01–1.42) and 2012–13 (AOR 1.22, 95% CI 1.02–1.46). We noted no effect of CCM on diarrhea, ARI, and ARI with fever.
Conclusion
CCM increases the likelihood of U5CM, infant mortality and SSB infants. Further quantitative and qualitative research should be conducted to assess the effects of environmental, congenital and genetic factors on the health of children born to mothers in CCM.
The importance of the hidden curriculum is recognised as a practical training ground for the absorption of medical ethics by healthcare professionals. Pakistan's healthcare sector is hampered by the ...exclusion of ethics from medical and nursing education curricula and the absence of monitoring of ethical violations in the clinical setting. Nurses have significant knowledge of the hidden curriculum taught during clinical practice, due to long working hours in the clinic and front-line interaction with patients and other practitioners.
The means of inquiry for this study was qualitative, with 20 interviews and four focus group discussions used to identify nurses' clinical experiences of ethical violations. Content analysis was used to discover sub-categories of ethical violations, as perceived by nurses, within four pre-defined categories of nursing codes of ethics: 1) professional guidelines and integrity, 2) patient informed consent, 3) patient rights, and 4) co-worker coordination for competency, learning and patient safety.
Ten sub-categories of ethical violations were found: nursing students being used as adjunct staff, nurses having to face frequent violence in the hospital setting, patient reluctance to receive treatment from nurses, the near-absence of consent taken from patients for most non-surgical medical procedures, the absence of patient consent taking for receiving treatment from student nurses, the practice of patient discrimination on the basis of a patient's socio-demographic status, nurses withdrawing treatment out of fear for their safety, a non-learning culture and, finally, blame-shifting and non-reportage of errors.
Immediate and urgent attention is required to reduce ethical violations in the healthcare sector in Pakistan through collaborative efforts by the government, the healthcare sector, and ethics regulatory bodies. Also, changes in socio-cultural values in hospital organisation, public awareness of how to conveniently report ethical violations by practitioners and public perceptions of nurse identity are needed.
This is a historical and sociological overview of violence and violence research in and on North Africa, West Asia, and South Asia, considering only studies for a global audience. The main focus is ...on political violence, with a brief look at religious and communal violence, youth violence, and domestic and gendered violence. These regions have been consistently affected by political violence for many decades, the main source of which seems to be the ongoing state formation process, as well as social transformation in general. The literature on violence is dominated by international debates, at times with little regard to realities in the ground. It would be highly desirable for scholars from North Africa, West Asia and South Asia to play a more active role in research and debate. Adapted from the source document.
This is a historical and sociological overview of violence and violence research in and on North Africa, West Asia, and South Asia, considering only studies for a global audience. The main focus is ...on political violence, with a brief look at religious and communal violence, youth violence, and domestic and gendered violence. These regions have been consistently affected by political violence for many decades, the main source of which seems to be the ongoing state formation process, as well as social transformation in general. The literature on violence is dominated by international debates, at times with little regard to realities in the ground. It would be highly desirable for scholars from North Africa, West Asia and South Asia to play a more active role in research and debate. PUBLICATION ABSTRACT
In this article we investigates the primary care physicians' response to the victims of spousal violence in Pakistan. By drawing upon the data collected by in-depth interviews from 24 physicians from ...Lahore and Sialkot, in this research we documented their knowledge, attitudes, and behavior treating the victims of violence. Data revealed that the physicians lacked competence, training, and resources to provide comprehensive care to the victims and relied on a reductionist biomedical model. While identifying some barriers that inhibited the physicians' ability to help the victims, in this article we offer some recommendations for the improvement of physicians' response to spousal violence within Pakistan's cultural context.
Aim
To explore the possibility of exploiting gender segregation as a benefit for registered female nurses.
Background
Nursing is a highly gendered profession in Pakistan with 95% of nurses comprising ...females who suffer from low professional status, negative identity and unfavourable work environments.
Methods
A qualitative research design was used to interview 12 nurses in management positions through purposive sampling. Face‐to‐face in‐depth interviews were conducted to explore the views of female nurses on the benefits, if any, of gender segregation in the nursing profession.
Results
Content analysis identified three major categories of benefits of gender segregation for female nurses including: (1) demand for female nurses compared with demand for males, (2) resilience of female nurses in the face of difficult work environments and (3) comfort and safety of female co‐workers in a male‐dominated setting.
Conclusion
Realising the benefits of gender segregation could mobilise nurse teamwork and union efforts in order to improve nurse identity, professional status and work environments.
Implications for nurse management
The present study highlights the nurse manager role in advancing knowledge of gender segregation benefits, team‐building for gender solidarity, control of nurse supply, union mobilization and raising community awareness for women's health development.
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