IDEAS home Printed from https://ideas.repec.org/a/eee/socmed/v313y2022ics0277953622007328.html
   My bibliography  Save this article

Professional competition amidst intractable maternal mortality: Midwifery in rural Pakistan during the COVID-19 pandemic

Author

Listed:
  • Siddiqui, Shayzal
  • Smith-Morris, Carolyn

Abstract

Low-income countries with intransigent maternal mortality rates often follow WHO guidelines that prioritize access to skilled, or professionalized, prenatal and birthing care. Yet the impact of these initiatives in areas still suffering high maternal mortality is opaque. Despite heavy and long investments, the professionalization of midwifery in Pakistan is incomplete, and declines in maternal mortality have plateaued. Traditional midwives have lost status, but they continue to see clients and have influence in their rural communities. We conducted a rapid ethnography among traditional midwives (Dais) and trained Lady Health Workers (LHWs) in two communities of Attock, Pakistan from May to July of 2020. Our findings underscore the importance of long-term presence and trust to maternal care, especially in conditions of resource scarcity or fear (e.g., fear of COVID). We provide evidence of overt disparagement of Dais by LHWs; (2) illustration of the conflicts between gender norms and biomedical priorities of hospitalized births; and (3) exacerbated fear of hospitals during COVID, which served to highlight the advantages of Dai care. Professionalization programs for midwifery must include structures and training to ensure collaborative communications across the country's midwives. Failure to respect the rational decisions of traditional midwives and their patients in circumstances of scarcity, high stress, and isolation only ignores the material and cultural conditions of these vulnerable communities.

Suggested Citation

  • Siddiqui, Shayzal & Smith-Morris, Carolyn, 2022. "Professional competition amidst intractable maternal mortality: Midwifery in rural Pakistan during the COVID-19 pandemic," Social Science & Medicine, Elsevier, vol. 313(C).
    • Handle: RePEc:eee:socmed:v:313:y:2022:i:c:s0277953622007328
    DOI: 10.1016/j.socscimed.2022.115426
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S0277953622007328
    Download Restriction: Full text for ScienceDirect subscribers only
    File URL: https://libkey.io/10.1016/j.socscimed.2022.115426?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    as
    1. Hou, Xiaohui & Ma, Ning, 2011. "Empowering women : the effect of women's decision-making power on reproductive health services uptake -- evidence from Pakistan," Policy Research Working Paper Series 5543, The World Bank.
    2. Mumtaz, Zubia & Salway, Sarah, 2005. "'I never go anywhere': extricating the links between women's mobility and uptake of reproductive health services in Pakistan," Social Science & Medicine, Elsevier, vol. 60(8), pages 1751-1765, April.
    3. Hyde, Abbey & Roche-Reid, Bernadette, 2004. "Midwifery practice and the crisis of modernity: implications for the role of the midwife," Social Science & Medicine, Elsevier, vol. 58(12), pages 2613-2623, June.
    4. Bogdan-Lovis, Elizabeth A. & Sousa, Aron, 2006. "The contextual influence of professional culture: Certified nurse-midwives' knowledge of and reliance on evidence-based practice," Social Science & Medicine, Elsevier, vol. 62(11), pages 2681-2693, June.
    5. Mumtaz, Zubia & Salway, Sarah, 2009. "Understanding gendered influences on women's reproductive health in Pakistan: Moving beyond the autonomy paradigm," Social Science & Medicine, Elsevier, vol. 68(7), pages 1349-1356, April.
    6. Usman Rashid Malik & Naveel Atif & Furqan Khurshid Hashmi & Fahad Saleem & Hamid Saeed & Muhammad Islam & Minghuan Jiang & Mingyue Zhao & Caijun Yang & Yu Fang, 2020. "Knowledge, Attitude, and Practices of Healthcare Professionals on COVID-19 and Risk Assessment to Prevent the Epidemic Spread: A Multicenter Cross-Sectional Study from Punjab, Pakistan," IJERPH, MDPI, vol. 17(17), pages 1-13, September.
    7. Jenkins, Gwynne L., 2003. "Burning bridges: policy, practice, and the destruction of midwifery in rural Costa Rica," Social Science & Medicine, Elsevier, vol. 56(9), pages 1893-1909, May.
    8. Berry, Nicole S., 2006. "Kaqchikel midwives, home births, and emergency obstetric referrals in Guatemala: Contextualizing the choice to stay at home," Social Science & Medicine, Elsevier, vol. 62(8), pages 1958-1969, April.
    9. Mumtaz, Zubia & Levay, Adrienne & Bhatti, Afshan & Salway, Sarah, 2013. "Signalling, status and inequities in maternal healthcare use in Punjab, Pakistan," Social Science & Medicine, Elsevier, vol. 94(C), pages 98-105.
    10. Mumtaz, Zubia & Salway, Sarah & Nykiforuk, Candace & Bhatti, Afshan & Ataullahjan, Anushka & Ayyalasomayajula, Bharati, 2013. "The role of social geography on Lady Health Workers' mobility and effectiveness in Pakistan," Social Science & Medicine, Elsevier, vol. 91(C), pages 48-57.
    11. Neiterman, Elena & Bourgeault, Ivy Lynn, 2015. "Professional integration as a process of professional resocialization: Internationally educated health professionals in Canada," Social Science & Medicine, Elsevier, vol. 131(C), pages 74-81.
    12. Chapman, Rachel R., 2003. "Endangering safe motherhood in Mozambique: prenatal care as pregnancy risk," Social Science & Medicine, Elsevier, vol. 57(2), pages 355-374, July.
    13. Jeremy Shiffman & Stephanie Smith, 2007. "Generation of Political Priority for Global Health Initiatives: A Framework and Case Study of Maternal Mortality," Working Papers 129, Center for Global Development.
    14. Goodman, Steffie, 2007. "Piercing the veil: The marginalization of midwives in the United States," Social Science & Medicine, Elsevier, vol. 65(3), pages 610-621, August.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. World Bank, 2011. "Empowering Women through BISP," World Bank Publications - Reports 27367, The World Bank Group.
    2. Lee-Rife, Susan M., 2010. "Women's empowerment and reproductive experiences over the lifecourse," Social Science & Medicine, Elsevier, vol. 71(3), pages 634-642, August.
    3. Pourette, Dolorès & Pierlovisi, Carole & Randriantsara, Ranjatiana & Rakotomanana, Elliot & Mattern, Chiarella, 2018. "Avoiding a "big" baby: Local perceptions and social responses toward childbirth-related complications in Menabe, Madagascar," Social Science & Medicine, Elsevier, vol. 218(C), pages 52-61.
    4. Arps, Shahna, 2009. "Threats to safe motherhood in Honduran Miskito communities: Local perceptions of factors that contribute to maternal mortality," Social Science & Medicine, Elsevier, vol. 69(4), pages 579-586, August.
    5. Sandberg, Kristin Ingstad & Andresen, Steinar & Bjune, Gunnar, 2010. "A new approach to global health institutions? A case study of new vaccine introduction and the formation of the GAVI Alliance," Social Science & Medicine, Elsevier, vol. 71(7), pages 1349-1356, October.
    6. Mitchell, Ellen M.H. & Kwizera, Amata & Usta, Momade & Gebreselassie, Hailemichael, 2010. "Choosing early pregnancy termination methods in Urban Mozambique," Social Science & Medicine, Elsevier, vol. 71(1), pages 62-70, July.
    7. Małgorzata Gałązka-Sobotka & Aldona Frączkiewicz-Wronka & Iwona Kowalska-Bobko & Hanna Kelm & Karolina Szymaniec-Mlicka, 2021. "HB-HTA as an implementation problem in Polish health policy," PLOS ONE, Public Library of Science, vol. 16(9), pages 1-24, September.
    8. Yuxue Yang & Xuejiao Tan & Yafei Shi & Jun Deng, 2023. "What are the core concerns of policy analysis? A multidisciplinary investigation based on in-depth bibliometric analysis," Palgrave Communications, Palgrave Macmillan, vol. 10(1), pages 1-12, December.
    9. Phanhpakit Onphanhdala & Vanvisa Philavong & Yoshihiko Kadoya & Mostafa S. Rahim Khan, 2020. "Access to Antenatal Care in Laos: Analysis Using National Level Survey," Asian Economic Journal, East Asian Economic Association, vol. 34(3), pages 327-349, September.
    10. Han, Lu & Koenig-Archibugi, Mathias & Opsahl, Tore, 2018. "The social network of international health aid," Social Science & Medicine, Elsevier, vol. 206(C), pages 67-74.
    11. Lisa Jamieson & Dandara Haag & Helena Schuch & Kostas Kapellas & Rui Arantes & W. Murray Thomson, 2020. "Indigenous Oral Health Inequalities at an International Level: A Commentary," IJERPH, MDPI, vol. 17(11), pages 1-6, June.
    12. Valadez, Joseph J. & Hage, Jerald & Vargas, William, 2005. "Understanding the relationship of maternal health behavior change and intervention strategies in a Nicaraguan NGO network," Social Science & Medicine, Elsevier, vol. 61(6), pages 1356-1368, September.
    13. Uddin, Jalal & Pulok, Mohammad Habibullah & Sabah, Md. Nasim-Us, 2015. "Couple’s reports of household decision-making, unmet need for contraception, and unintended pregnancy in Bangladesh," MPRA Paper 63757, University Library of Munich, Germany.
    14. Hannah Tappis & Anis Kazi & Waqas Hameed & Zaib Dahar & Anayat Ali & Sohail Agha, 2015. "The Role of Quality Health Services and Discussion about Birth Spacing in Postpartum Contraceptive Use in Sindh, Pakistan: A Multilevel Analysis," PLOS ONE, Public Library of Science, vol. 10(10), pages 1-18, October.
    15. Hirose, Atsumi & Borchert, Matthias & Niksear, Homa & Alkozai, Ahmad Shah & Cox, Jonathan & Gardiner, Julian & Osmani, Khadija Ruina & Filippi, Véronique, 2011. "Difficulties leaving home: A cross-sectional study of delays in seeking emergency obstetric care in Herat, Afghanistan," Social Science & Medicine, Elsevier, vol. 73(7), pages 1003-1013.
    16. Nandagiri, Rishita, 2021. "What’s so troubling about ‘voluntary’ family planning anyway? A feminist perspective," LSE Research Online Documents on Economics 112535, London School of Economics and Political Science, LSE Library.
    17. Mogues, Tewodaj & Billings, Lucy, 2019. "The making of public investments: The role of champions, co-ordination, and characteristics of nutrition programmes in Mozambique," Food Policy, Elsevier, vol. 83(C), pages 29-38.
    18. Thapa, Deependra Kaji & Niehof, Anke, 2013. "Women's autonomy and husbands' involvement in maternal health care in Nepal," Social Science & Medicine, Elsevier, vol. 93(C), pages 1-10.
    19. Ha, Bui Thi Thu & Green, Andrew & Gerein, Nancy & Danielsen, Katrine, 2010. "Health policy processes in Vietnam: A comparison of three maternal health case studies," Health Policy, Elsevier, vol. 98(2-3), pages 178-185, December.
    20. Jasmine Gideon & Fenella Porter, 2014. "Unpacking Women's Health in Public-Private Partnerships: A Return to Instrumentalism in Development Policy and Practice?," WIDER Working Paper Series wp-2014-009, World Institute for Development Economic Research (UNU-WIDER).

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:eee:socmed:v:313:y:2022:i:c:s0277953622007328. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Catherine Liu (email available below). General contact details of provider: http://www.elsevier.com/wps/find/journaldescription.cws_home/315/description#description .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.