Shela Akbar Ali Hirani

The experiences of urban, professional women when combining breastfeeding with paid employment in Karachi, Pakistan: A qualitative study

INTRODUCTION Pakistan has the second highest child mortality rate in South Asia. Breastfeeding can promote infant health, prevent infection and possibly mortality. However, a gradual decline in breastfeeding is reported for Pakistan; especially among urban, educated, employed women. Little research exists regarding the experiences of professional women in Pakistan who are breastfeeding and employed. AIM To describe the experiences of urban, professional women who breastfeed and are employed, as related to facilitators and barriers of breastfeeding. METHODOLOGY Using a qualitative descriptive design, nine full-time employed women were recruited through purposive sampling from a private tertiary care health setting in Karachi, Pakistan. A pre-tested, semi-structured interview guide was used for an in-depth interview of 40-45min with each participant. FINDINGS Most women spoke about the challenges of combining breastfeeding with employment, which resulted in early cessation of breastfeeding. The study indicated that positive maternal attributes such as knowledge about breastfeeding, planning, self-commitment, and open communication, as well as availability of social and workplace support is essential to enable urban, professional women in Pakistan to continue breastfeeding while employed. CONCLUSION Pakistan has high infant and child mortality rate and decreasing prevalence of breastfeeding, especially among employed professional women. Our findings indicate an urgent need for lactation support programs that include integrated interventions for lactating women that offer informational support, social support, and formal workplace support.

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.

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.

Meeting the 2015 Millennium Development Goals with new interventions for abused women.

In a developing country such as Pakistan, where illiteracy, poverty, gender differences, and health issues are prevalent, violence against women is a commonly observed phenomenon. The rising incidences of abuse among women indicate a need to introduce evidence-based community-derived interventions for meeting Millennium Developmental Goals by 2015. This article discusses the application of counseling, economic skills building, and microcredit programs as practical and effective interventions to improve the health outcomes of abused women and, therefore, improving maternal and child health in the Pakistani society.

Child With Idiopathic Pulmonary Hemosiderosis: A Case Report From Pakistan With Multiple Ethical and Moral Issues

This report discusses the case of a young Pakistani child diagnosed with idiopathic pulmonary hemosiderosis (IPH). The key features of IPH were iron deficiency anemia and pulmonary symptoms due to recurrent pulmonary hemorrhages. The child showed complications of the disease process because of late diagnosis. Because various ethical and moral issues were associated with the diagnosis and management of IPH, this case provides insights about the care burden of health care professionals and a childs parents in a Pakistani pediatric setting. During the course of the childs treatment at one of the private tertiary care settings of Karachi, Pakistan, the key challenges were as follows: declaring the diagnosis to the parents, dealing with the request of the childs parents for withdrawal of ventilatory support and withholding treatment, deciding the code status of the child, and ensuring the quality of the childs life after discharge from the hospital. It was learned from this case report that shared decision making and open communication with the childs family enabled the pediatric health care professionals to determine what was in the best interest of the child, resulting in provision of effective palliative care to the child. Moreover, it was realized that early detection of the disease and availability of hospice care can facilitate palliative care of children diagnosed with IPH.

Vulnerability of Internally Displaced Children in Disaster Relief Camps of Pakistan: Issues, Challenges, and Way Forward.

Pakistan is a developing country with the second highest infant and child mortality rates in South Asia. During the past years this region has undergone several humanitarian emergencies that have negatively affected all the aspects of health and development of young children. During these emergencies relief camps are set up by governmental and non-governmental agencies with the aim of meeting the physical needs of the targeted community by providing basic health care (first aid), food, water, and shelter. As these services do not adequately address childrens rights, all aspects of their health (physical, mental, social, and spiritual) and development, therefore, internally displaced children in the disaster relief camps of Pakistan are highly vulnerable to having a negative impact on all aspects of their health, brain development, learning, coping, and competence. Hence, to enable these children to develop their maximum potentials, cope positively, and become resilient, a well-thought child-care programme is recommended in the disaster relief camps of Pakistan.