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

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  • 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
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    References listed on IDEAS

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    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 & 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.
    3. 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.
    4. 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.
    5. 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.
    6. 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.
    7. 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.
    8. 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.
    9. 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.
    10. 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.
    11. 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.
    12. 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.
    13. 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.
    14. 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.
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