Nargis Asad

Intimate partner violence in urban Pakistan: prevalence, frequency, and risk factors

Background: Intimate partner violence (IPV) is an important public health issue with severe adverse consequences. Population-based data on IPV from Muslim societies are scarce, and Pakistan is no exception. This study was conducted among women residing in urban Karachi, to estimate the prevalence and frequency of different forms of IPV and their associations with sociodemographic factors. Methods: This cross-sectional community-based study was conducted using a structured questionnaire developed by the World Health Organisation for research on violence. Community midwives conducted face-to-face interviews with 759 married women aged 25–60 years. Results: Self-reported past-year and lifetime prevalence of physical violence was 56.3 and 57.6%, respectively; the corresponding figures for sexual violence were 53.4% and 54.5%, and for psychological abuse were 81.8% and 83.6%. Violent incidents were mostly reported to have occurred on more than three occasions during the lifetime. Risk factors for physical violence related mainly to the husband, his low educational attainment, unskilled worker status, and five or more family members living in one household. For sexual violence, the risk factors were the respondent’s low educational attainment, low socioeconomic status of the family, and five or more family members in one household. For psychological violence, the risk factors were the husband being an unskilled worker and low socioeconomic status of the family. Conclusion: Repeated violence perpetrated by a husband towards his wife is an extremely common phenomenon in Karachi, Pakistan. Indifference to this type of violence against women stems from the attitude that IPV is a private matter, usually considered a justifiable response to misbehavior on the part of the wife. These findings point to serious violations of women’s rights and require the immediate attention of health professionals and policymakers.

Prevalence of Anxiety, Depression and Associated Factors Among Pregnant Women of Hyderabad, Pakistan

Background: Few studies have examined the relationship between antenatal depression, anxiety and domestic violence in pregnant women in developing countries, despite the World Health Organization’s estimates that depressive disorders will be the second leading cause of the global disease burden by 2020. There is a paucity of research on mood disorders, their predictors and sequelae among pregnant women in Pakistan. Aims: To determine the prevalence of anxiety and depression and evaluate associated factors, including domestic violence, among pregnant women in an urban community in Pakistan. Methods: All pregnant women living in identified areas of Hyderabad, Pakistan were screened by government health workers for an observational study on maternal characteristics and pregnancy outcomes. Of these, 1,368 (76%) of eligible women were administered the validated Aga Khan University Anxiety Depression Scale at 20—26 weeks of gestation. Results: Eighteen per cent of the women were anxious and/or depressed. Psychological distress was associated with husband unemployment (p = 0.032), lower household wealth (p = 0.027), having 10 or more years of formal education ( p = 0.002), a first (p = 0.002) and an unwanted pregnancy ( p < 0.001). The strongest factors associated with depression/anxiety were physical/sexual and verbal abuse; 42% of women who were physically and/or sexually abused and 23% of those with verbal abuse had depression/anxiety compared to 8% of those who were not abused. Conclusions: Anxiety and depression commonly occur during pregnancy in Pakistani women; rates are highest in women experiencing sexual/physical as well as verbal abuse, but they are also increased among women with unemployed spouses and those with lower household wealth. These results suggest that developing a screening and treatment programme for domestic violence and depression/anxiety during pregnancy may improve the mental health status of pregnant Pakistani women.

Gender roles and their influence on life prospects for women in urban Karachi, Pakistan: a qualitative study

Background Pakistan is a patriarchal society where men are the primary authority figures and women are subordinate. This has serious implications on womens and mens life prospects. Objective The aim was to explore current gender roles in urban Pakistan, how these are reproduced and maintained and influence mens and womens life circumstances. Design Five focus group discussions were conducted, including 28 women representing employed, unemployed, educated and uneducated women from different socio-economic strata. Manifest and latent content analyses were applied. Findings Two major themes emerged during analysis: ‘Reiteration of gender roles’ and ‘Agents of change’. The first theme included perceptions of traditional gender roles and how these preserve womens subordination. The power gradient, with men holding a superior position in relation to women, distinctive features in the culture and the role of the extended family were considered to interact to suppress women. The second theme included agents of change, where the role of education was prominent as well as the role of mass media. It was further emphasised that the younger generation was more positive to modernisation of gender roles than the elder generation. Conclusions This study reveals serious gender inequalities and human rights violations against women in the Pakistani society. The unequal gender roles were perceived as static and enforced by structures imbedded in society. Women routinely faced serious restrictions and limitations of autonomy. However, attainment of higher levels of education especially not only for women but also for men was viewed as an agent towards change. Furthermore, mass media was perceived as having a positive role to play in supporting womens empowerment.

Prevalence of suicidal thoughts and attempts among pregnant Pakistani women

Objective. To determine the prevalence of suicidal thoughts and attempts and to identify demographic variables and mental health correlates such as anxiety/depression and domestic violence among pregnant women in an urban community in Pakistan. Design. Cross‐sectional data from a prospective cohort study are presented. Setting. Women enrolled in an antenatal care clinic and followed to delivery in an urban area of Pakistan. Population. Cohort of pregnant women in Pakistan. Methods. A total of 1,369 pregnant women were enrolled and interviewed regarding various maternal characteristics and pregnancy outcomes, and were asked specific questions about suicidal thoughts and attempts and administered the Aga Khan University Anxiety Depression Scale at 20–26 weeks of gestation. Main outcome measures. Suicidal thoughts and attempts, verbal, sexual or physical abuse. Results. Overall, 148 of the 1,369 (11%) women studied had considered suicide. Of these, 148 women, 67 (45%) had attempted suicide. In all, 18% of the women were classified as having depression/anxiety, almost half (48%) reported experiencing verbal abuse and 20% reported physical/sexual abuse. Women who had anxiety/depression or had experienced verbal or physical/sexual abuse were significantly more likely to have had suicidal thoughts and attempts. Conclusions. Women at the greatest risk for having suicidal thoughts or a suicide attempt were those who were depressed/anxious and had experienced some form of domestic abuse. With the high prevalence of these conditions, attention should be given to the establishment of effective mental health treatment programs for pregnant women.

Applying community-based participatory research methods to improve maternal and child health in Karachi, Pakistan

To achieve health for all, the development of partnerships between community residents and researchers is essential. Community-based participatory research (CBPR) engages community members, uses local knowledge in the understanding of health problems and the design of interventions, and invests community members in the processes and products of research. CBPR pivots on an iterative process of open communication, mutual respect, and power sharing to build community capacity to sustain effective health interventions. This article describes how the tenets of CBPR were applied by a multidisciplinary, international research team of maternal-child health specialists toward better health for women and children in multilingual, multiethnic, low socioeconomic communities in Karachi, Pakistan.

Development of an Economic Skill Building Intervention to Promote Women's Safety and Child Development in Karachi, Pakistan

Violence against women is a global epidemic phenomenon that can result in major mental health problems. Not only are women affected but also the health and well-being of their children are in jeopardy. To prevent violence and promote womens safety, several strategies have been tested in various cultural contexts. This article describes the process of developing and validating an economic skill building intervention for women of an urban slum area of Karachi, Pakistan. The purpose of the intervention is to increase womens economic independence, promote womens safety, and improve the behavioral functioning of their children.

Preventing Abuse and Trauma to Internally Displaced Children Living in Camps Due to Disasters in Pakistan

Recently, Pakistan has experienced several natural disasters—such as the earthquake of 2005 in Swat, measuring 7.5 on the Richter scale, and unprecedented flooding that caused havoc from the Himalayas to the shores of the Arabian Sea in 2010. In addition, people are affected by armed conflicts both within Pakistans borders and in Afghanistan, such as the decade-long conflict in the Northern provinces along the border. Consequently, a large number of refugees and internally displaced people, mostly women and children, are in shelters in internally displaced population camps. These camps lack sufficient supply and storage of daily ration, sanitation, health and educational facilities. Inhuman living conditions add an enormous burden to the level of post-traumatic stress disorder and depression of these internally displaced people. While women are extremely vulnerable to these mental health problems, their children are equally exposed and suffer with mental stresses, as mothers do not have the capacity to supervise and protect their children from the potential physical, psychological and sexual abuse prevalent in marginalised living conditions and an environment of easy exposure to social hazards and the toxic mentality of men. This conceptually based paper addresses some of the challenges and risks identified and faced by children of the camps for displaced persons in Pakistan. The authors propose a psycho-social framework based on public health interventions to decrease the risk of abuse and trauma, to protect these vulnerable children, and to maximise the strength and resilience of the family unit.

Validation of the Urdu Version of Wagnild and Young's Long and Short Resilience Scales Among 20- to 40-Year-Old Married Women Living in Urban Squatter Settlements of Karachi, Pakistan

Background: There were no instrument exists in South Asia to assess resilience. Thus, this study assessed the validity and reliability of the Urdu version of Wagnild and Young’s long and short Resilience Scales. Methods: Study was carried out in two urban squatter settlements of Karachi, Pakistan. Resilience Scales were validated against the depression, anxiety, and life satisfaction scales among 20- to 40-year-old married women. Sample size for validity and reliability were 636 and 319. Results: Moderate negative correlation with the depression and anxiety and moderate positive significant correlation with life satisfaction were found with both scales. The test–retest correlation were .54 and .49, respectively. Internal consistency were found acceptable. Concurrent validity were .729 and .813. Conclusions: Study found a valid and reliable resilience scale in Urdu language.

Violence against women in Pakistan: contributing factors and new interventions.

Pakistan ranks 125th out of 169 countries on the Gender Development Index and has high prevalence rates of Violence against Women (VAW). Contributing factors toward gender based violence at the micro, meso and macro levels include the acceptability of violence amongst both men and women, internalization of deservability, economic disempowerment, lack of formal education, joint family systems, entrenched patriarchal norms and values, and a lack of awareness of legal and other support systems. These factors have a long-lasting impact on the health of women and children. The gender disparities in the experience of women seeking health care in Pakistan are well-recognized and documented. In the past, common government policy responses to these disparities have included developing the role of community health workers (CHWs) and lady health visitors (LHVs). Despite being commendable initiatives, these too have been unsuccessful in addressing these multi-faceted disparities. Within this complex scenario, new interventions to address VAW and its impact on health in Pakistan include Group Counselling, Economic Skills Building, Health-Based Microfinance, and Family-Based models that increase male involvement, especially at the primary health care level. The purpose of this article is to outline key contributing factors to VAW, explore tested and new interventions, and highlight the opportunities that exist in implementing them.

Lifetime Prevalence of Emotional/ Psychological Abuse among Qualified Female Healthcare Providers

The purpose of this study was to determine the lifetime prevalence of emotional/psychological abuse among married female healthcare providers in tertiary care hospitals in Karachi, Pakistan. A descriptive cross-sectional study was conducted in a sample of 350 married female nurses and doctors, recruited from three tertiary healthcare hospitals (one public and two private). This study used the self administered modified truncated WHO multi-country questionnaire. Descriptive and univariate analysis was performed. Of the total sample of 350 female married healthcare providers, 97.7% (n = 342) were reported with one or more forms of domestic violence at some point in their married life, whereby 62.6% (n = 214) lifetime prevalence of emotional abuse was found due to any forms of violence. The univariate analysis showed that those female healthcare providers who had done their diploma were more prone to emotional abuse 46.7% (n = 100). And, nurses experienced more emotional abuse 57.9% (n = 124) in their life than doctors. Moreover, there was a significant difference of emotional abuse among those participants’ husband who used and do not use alcohol (p = .009). The most common study participants responses against emotional abuse were: 62% (n = 212), verbally fighting back, 15.2% (n = 52) keeping quiet, 27.2% (n = 93) talking to husband, family/friends, 7% (n = 24) returning to parents’ home and 5.8% (n = 20) attempting suicide. Domestic violence leads to emotional scars and should be considered as an inhuman act. However, its prevalence exists in every culture and more so in underdeveloped, economically challenged cultures. Emotional abuse is frequent among nurses and doctors. Socio-demographic factors of women have been identified as one of the determinants of emotional abuse among healthcare professionals. Future research should investigate emotional abuse patterns not only for professional women but also for housewives.