Health Seeking Behaviour in Pakistan’s Women and the Role of Community Nursing
In Pakistan women’s health has been a withdrawn spectacle but nowadays the emerging trends are mounting health seeking behaviour as a crucial component of public healthcare in developing countries. Shaikh, Haran and Hatcher, (2008) evaluated the health-seeking behaviour of Pakistani women and they estimated that 80% of the females were thoughtful of seeking consultation but with a median delay of three days. However 20% females didn’t seek any medical advice. Although these estimations reflect worthy proportions but still the delays and non-consulting behaviour are imperative to be noted. In terms of the yearly statistics, Pakistan shows maternal mortality of 272 deaths/100,000 live births, contraceptive prevalence rate of 32%, fertility rate of 3.3 women (UNICEF, 2012), 28% females attend antenatal care clinic (WHO, 2010) and only 39% females are delivered by skilled-birth attendants (Jalal & Shah, 2011).
A vigilant view of these statistics can predict that the health-seeking behaviour of Pakistani women is unsatisfactory. Since the woman has a pivotal role in caring for and raising the family then what barriers actually prevent a woman from seeking health. Therefore by analyzing this phenomenon, we can improve health outcomes, can influence policy makers and also can improve the healthcare providers in providing a culturally sensitive care. Health-seeking behaviour can be defined as “a person in stable health actively seeking ways to alter his/her personal habits or environment in order to move toward a higher level of health” (TheFreeDictionary.com, n.d.). In a more comprehensive form health-seeking can be explained as a person’s approach, desire, and access to seek a health-consult.
Health-seeking in Pakistani women seems to be a very conventional issue however; there are many dimensions that impact the health-seeking behaviours. In 1992, Nash Ojanuga and Gilbert classified four obstacles that are faced by women in seeking health. These are institutional-barrier, cultural-barrier, economic-barrier and educational-barrier (Onah & Govender, 2014).
In terms of the Institutional-barrier lack of healthcare providers and scarcity of healthcare services in private and government sectors are of concern. According to WHO’s health-system framework (Wpro.who.int, 2015) Pakistan lacks in many extents – in terms of health-financing Pakistan invests only 2.8% of its GDP on health (2013) which is regrettable because it indirectly reflects the image of inundating economy (WHO, 2015). Moreover in terms of healthcare facilities and resources we face economic barriers; Pakistan frequently suffers shortage of essential medicines, vaccines and machinery, thus public-health policy makers and leaderships and governance are inept in assuring quality care.
However in terms of healthcare providers, Pakistan lacks in trained staff and female staff. Thus when women need to share their sensitive concerns they need female staff to deal with them and surely the staff should be well trained so that client-satisfying care can be assured. But our healthcare providers and facilities are deprived in well trained female staff due to which women are less likely to avail health facilities. Congruently, Pakistan’s sociocultural trait has always endorsed patriarchy due to which women’s autonomy has been disregarded. Though we think that in urban area women are empowered but even then either consciously or unconsciously women relay on their partner’s will and permissions.
In a study women were asked about preference for using health facility – 65% women notified that head of family or husband will decide about consulting healthcare provider and if male member was not at home, 88% preferred to have someone to go along with, whereas 12% preferred waiting until the male member comes and even in the case of emergency only 20% favoured going alone (Shaikh, Haran and Hatcher, 2008). Thus this study actually depicts the patriarchy system and the cultural-barrier of our society due to which delays in healthcare and treatment are common issues for females.
Lastly the economic-barrier and educational-barrier are displeasing issues in Pakistan. Female literacy rate is 61.5% (UNICEF, 2012) i.e. only half of the female population is educated. Mostly this is due to low socioeconomic status that makes them unable to access education, and in turn vulnerable to inaccessibility of health resources and lack of education and awareness. Since women have responsibility of fulfilling family needs in limited income their own health doesn’t become the priority due to which they often report with severe illness.
In conclusion, it becomes imperative to strive for interventions to improve health seeking behaviour in Pakistani women. For institutional barrier, in terms of healthcare providers we can work for promoting the lady health workers (LHWs) concept more effectively where we can train females from a particular area/community in providing at least basic care so that we can deal with female staff scarcity. Moreover we should promote community nursing that can provide quality care. According to sunrise model by Leininger, (2002) there are few cultural practices that need negotiation/accommodation while others need a complete-reconstruction.
However, reconstructing the patriarchy system seems to be an unachievable goal thus we can negotiate with cultural obligation and can work for women empowerment. It begins by sensitizing women that their health is also a priority because they are the ones raising the family. Moreover we can work as community nurses so that we can spread awareness about health concern.
Furthermore suggesting to the women that they should start saving; however limited their income is, they can try to save for future use. Moreover we can suggest them about microfinance companies that can help them by providing loan for setting up small business. Females, if they prefer can also do small food service within home reach; this might lead them toward autonomy and empowerment while being culturally acceptable. Though these interventions are based on very primary level and can’t make huge differences but they can at least make a difference in the life of a few women, thus improving the health seeking proportions of Pakistan.
- Health seeking behaviors. (n.d.) Miller-Keane Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health, Seventh Edition. (2003). Retrieved September 3 2015 from http://medical-dictionary.thefreedictionary.com/health+seeking+behaviors
- Jalal, S., & Shah, N. (2011). Ante Natal Care (ANC) seeking behaviour among women living in an urban squatter settlement: results from an ethnographic study. Italian Journal of Public Health, Volume 8(3), 261-267.
- Leininger, M. (2002). Culture Care Theory: A Major Contribution to Advance Transcultural Nursing Knowledge and Practices. Journal of Transcultural Nursing, 13(3), 189-192. doi:10.1177/10459602013003005
- Nash Ojanuga, D., & Gilbert, C. (1992). Women’s access to health care in developing countries. Social Science & Medicine, 35(4), 613-617. doi:10.1016/0277-9536(92)90355-t
- Onah, M., & Govender, V. (2014). Out-of-Pocket Payments, Health Care Access and Utilisation in South-Eastern Nigeria: A Gender Perspective. Plos ONE, 9(4), e93887. doi:10.1371/journal.pone.0093887
- Shaikh, B., Haran, D., & Hatcher, J. (2008). Women’s Social Position and Health-Seeking Behaviors: Is the Health Care System Accessible and Responsive in Pakistan? UHCW, 29(8), 945-959. doi:10.1080/07399330802380506
- UDHR, (1948). The Universal Declaration of Human Rights. Un.org. Retrieved 2 September 2015, from http://www.un.org/en/documents/udhr/index.shtml#a3
- UNICEF, (2012). Statistics. Retrieved 1 September 2015, from http://www.unicef.org/infobycountry/pakistan_pakistan_statistics.html#120
- WHO, (2010). World health statistics 2010 Pakistan Health profile, Available from: http://www.who.int/countries/pak/en/
- WHO, (2015). Global Health Observatory Data Repository. Apps.who.int. Retrieved 30th August 2015, from http://apps.who.int/gho/data/node.main.75
Wpro.who.int,. (2015). WPRO | The WHO Health Systems Framework. Retrieved 3 September 2015, from http://www.wpro.who.int/health_services/health_ systems_framework/en/#
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