Sarah Salway

Understanding gendered influences on women's reproductive health in Pakistan: Moving beyond the autonomy paradigm

Recent research and policy discourse commonly view the limited autonomy of women in developing countries as a key barrier to improvements in their reproductive health. Rarely, however, is the notion of womens autonomy interrogated for its conceptual adequacy or usefulness for understanding the determinants of womens reproductive health, effective policy formulation or program design. Using ethnographic data from 2001, including social mapping exercises, observation of daily life, interviews, case studies and focus group discussions, this paper draws attention to the incongruities between the concept of womens autonomy and the gendered social, cultural, economic and political realities of womens lives in rural Punjab, Pakistan. These inadequacies include: the concepts undue emphasis on womens independent, autonomous action; a lack of attention to men and masculinities; a disregard for the multi-sited constitution of gender relations and gender inequality; an erroneous assumption that uptake of reproductive health services is an indicator of autonomy; and a failure to explore the interplay of other axes of disadvantage such as caste, class or socio-economic position. This paper calls for alternative, more nuanced, theoretical approaches for conceptualizing gender inequalities in order to enhance our understanding of womens reproductive wellbeing in Pakistan. The extent to which our arguments may be relevant to the wider South Asian context, and womens lives in other parts of the world, is also discussed.

A profile of women's work participation among the urban poor of Dhaka

Abstract Drawing on survey data and ethnographic findings, this paper presents a profile of women’s work participation among slum dwellers in Dhaka city. Overall, almost 50% of adult women are engaged in income-generating work outside the home. Life-cycle factors, socioeconomic status and residential location are associated with both level of work participation and type of employment. Women’s contributions to household livelihoods via paid employment are found to be significant and multifaceted. The analysis highlights heterogeneity among poor women’s work experiences and the intense “informalization” of most employment options. Implications for policy aimed at improving the conditions of working women are identified.

Principles for research on ethnicity and health: the Leeds Consensus Statement.

Background: There is substantial evidence that health and health-care experiences vary along ethnic lines and the need to understand and tackle ethnic health inequalities has repeatedly been highlighted. Research into ethnicity and health raises ethical, theoretical and methodological issues and, as the volume of research in this area grows, so too do concerns regarding its scientific rigour and reporting, and its contribution to reducing inequalities. Guidance may be helpful in encouraging researchers to adopt standard practices in the design, conduct and reporting of research. However, past efforts at introducing such guidance have had limited impact on research practice, and the diversity of disciplinary perspectives on the key challenges and solutions may undermine attempts to derive and promote guiding principles. Methods: A consensus building Delphi exercise—the first of its kind in this area of research practice—was undertaken with leading academics, practitioners and policymakers from a broad range of disciplinary backgrounds to assess whether consensus on key principles could be achieved. Results: Ten key principles for conducting research on ethnicity and health emerged, covering: the aims of research in this field; how such research should be framed and focused; key design-related considerations; and the direction of future research. Despite some areas of dispute, participants were united by a common concern that the generation and application of research evidence should contribute to better health-care experiences and health outcomes for minority ethnic people. Conclusion: The principles provide a strong foundation to guide future ethnicity-related research and build a broader international consensus.

Marriage among the urban poor of Dhaka: instability and uncertainty

Qualitative and quantitative data from the Urban Livelihoods Study (ULS) are used to describe the patterns of marriage, and in particular the rising incidence of marital instability, among the bustee (slum) population of Dhaka. The changing nature of bustee society provides greater options for women compared with their rural counterparts. Reduced social sanctions against divorce, dysfunction of the goshti, weaker familial ties and increased options for labour force participation are giving women greater freedom. Bustee women appear more able to avoid serious domestic violence by rejecting unfavourable marital ties. However, despite these factors, women are faced with a dilemma regarding marriage. Marital discord, insecurity and instability are high and yet marriage remains a necessity. The unstable nature of bustee life, harassment from men, social and economic dependency, the difficulty of returning to the village, and absence of strong kin networks, force women to marry. On balance, women appear to be suffering from the increasingly unstable and uncertain nature of marriage. The experience of marital breakdown has serious social and financial implications. Women living without husbands are poorer than their married counterparts. Children, too, are faring badly. Copyright

Economic Activity among UK Bangladeshi and Pakistani Women in the 1990s: Evidence for Continuity or Change in the Family Resources Survey

Recent research has suggested that patterns of economic activity among UK Pakistani and Bangladeshi women may be changing. It is argued that a younger, UK-educated generation of women is both better equipped to compete in the labour market than older migrants and more likely to subscribe to gender roles that view employment outside the home as a legitimate option. Thus far, small sample sizes have restricted investigation into the relationships between life-stage variables and economic activity among qualified Bangladeshi and Pakistani women. Furthermore, these two groups have often been combined in quantitative analyses, thereby precluding any examination of differences. Analyses of data from the UK Family Resources Survey reveal that economic activity was persistently low between 1996/7 and 2001/2 for both Pakistani and Bangladeshi women as a whole, and particularly low among Bangladeshis. Though economic activity was far more common among well-qualified Bangladeshi and Pakistani women than among those without qualifications, marriage and presence of young children continue to be important predictors of economic inactivity. There is evidence that the ‘domestic role’ may be a preferred option for many of these women. Nevertheless, it should be recognised that such ‘preferences’ are constructed within particular socio-economic contexts. I suggest that, although gender roles are fluid and negotiable, they are unlikely to be challenged unless female labour force participation presents good prospects in terms of economic returns and social status.

Good on paper: the gap between programme theory and real‐world context in Pakistan's Community Midwife programme

To understand why skilled birth attendance—an acknowledged strategy for reducing maternal deaths—has been effective in some settings but is failing in Pakistan and to demonstrate the value of a theory‐driven approach to evaluating implementation of maternal healthcare interventions.

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

BackgroundA 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.MethodsUsing 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.FindingsShida 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.ConclusionsThe 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.

Social research for a multiethnic population: do the research ethics and standards guidelines of UK Learned Societies address this challenge?

There is increasing recognition in the UK that social science research should generate an evidence base that reflects the ethnic diversity of the population and informs positive developments in public policy and programmes for all. However, describing and understanding ethnic diversity, and associated disadvantage, is far from straightforward. In practice, the ethical and scientific arguments around whether and how to incorporate ethnicity into policy-relevant social research are complex and contentious. In particular, untheorised or insensitive inclusion of data on ethnic ‘groups’ can have negative consequences. The present investigation begins to explore the extent to which social scientists have access to advice and guidance in this area of research. Specifically, the paper examines how ethnic diversity is explicitly or implicitly considered within the research ethics and scientific standard guidance provided by UK social science Learned Societies to their members. The review found little in the way of explicit attention to ethnic diversity in the guidance documents, but nevertheless identified a number of pertinent themes. The paper compiles and extrapolates these themes to present a tentative set of principles for social scientists to debate and further develop.

Improving Maternal Health in Pakistan: Toward a Deeper Understanding of the Social Determinants of Poor Women’s Access to Maternal Health Services

Evidence suggests national- and community-level interventions are not reaching women living at the economic and social margins of society in Pakistan. We conducted a 10-month qualitative study (May 2010-February 2011) in a village in Punjab, Pakistan. Data were collected using 94 in-depth interviews, 11 focus group discussions, 134 observational sessions, and 5 maternal death case studies. Despite awareness of birth complications and treatment options, poverty and dependence on richer, higher-caste people for cash transfers or loans prevented women from accessing required care. There is a need to end the invisibility of low-caste groups in Pakistani health care policy. Technical improvements in maternal health care services should be supported to counter social and economic marginalization so progress can be made toward Millennium Development Goal 5 in Pakistan.

Researching ethnic inequalities.

Since the landmark introduction of an ethnic group question to the 1991 Census (Bulmer, 1996) and the influential Fourth National Survey of Ethnic Minorities in 1993-4 (Modood et al., 1997), the volume of social research addressing ethnicity has grown dramatically in the UK. Social researchers are increasingly required to produce evidence capable of informing policy and practice development that is sensitive to the diversity of the UK’s multiethnic population. In particular, there is Researching ethnic inequalities