SOCIO-ECONOMIC AND CULTURAL DETERMINANTS OF ATTITUDE TOWARDS REPRODUCTIVE HEALTH RIGHTS IN PUNJAB, PAKISTAN

Abstract

Women’s health status is affected by complex biological, social and cultural factors, which are interrelated and only can be addressed in a comprehensive manner. Reproductive health is determined not only by the quality and availability of health care, but also by socio-economic development levels, lifestyles and women’s position in society. Women health is compromised not by lack of medical knowledge, but by infringement on women’s human rights including reproductive health rights. Poor women, who lack adequate food, basic health care, or modern contraception, suffer grave consequences for reproductive health. A woman who is malnourished and in poor health runs much greater risks in reproductive health issues and usually suffers without proper treatment and dies in most of cases. The negative consequences of denying RHR extend beyond women’s reproductive health to their overall health, the welfare of their children, and even the economic and social fabric of nations. This thesis presents a study of socio-economic and cultural determinants of attitude towards reproductive health rights in Punjab, Pakistan. The immediate objective of the study was to ascertain the socio-economic and cultural characteristics of the respondent’s attitude towards reproductive health rights which have affect on married women’s knowledge about reproductive health rights and their attitude towards the practices of RHR to maintain their health and to meet their reproductive health need and to investigate the relationship between respondent’s socio cultural factors and their attitude towards reproductive health rights. A cross-sectional study was conducted with 700 married women having at least one child in three districts; Toba-Tek Singh, Bahawalpur, and Rawalpindi of Punjab province, Pakistan. In addition, focus group discussions were also carried out for detailed qualitative information on the issue. After editing and cleaning, a three-fold analysis, at uni-variate, bi-variate and multi-variate levels, of coded data, was undertaken. The main findings at bi-variate level analysis show a significant relationship between all socio-economic and cultural factors (i.e. monthly income, gender role, women’s economic status, inter-spousal communication, mobility, decision making, awareness about HIV/AIDS, modernity, life style aspiration) and the married women’s attitudes towards the acquisition of knowledge and the practice of RHR to maintain their reproductive health rights. Multi-variate analysis showed that the most important and contributing socio-economic factors in explaining married women’s’ attitudes towards the practice of RHR were; monthly income, women’s economic status (currently paid employment), women’s communication with her husband, and women’s decision making power. Therefore, it was concluded on the basis of multi-variate analysis that socio- economic and cultural factors were more important than structural/ environmental and programmatic factors in making women’s attitude positive and more consistent for practicing RHR in Pakistan. From the focus groups discussions it was found that there was a lack of inter-spousal communication particularly over the issue of adoption and practice of RHR. Generally a feeling of forced sex in marriage prevailed. Majority of participants had no participation in decision making process because they assumed and accepted that their husband had final authority to take decision because they wereeconomically dependent upon them and they had to follow the husbands’ decisions otherwise they had to face the music in their marital life. That’s why decisions regarding total number of siblings, to move independently even for the sake of their reproductive health were settled by their husbands. In other words, the qualitative results supported the survey findings that the prevailing socio-economic and cultural situation had the principle influence on such reflexive attitude of married women. On the basis of major findings it is suggested that there is a need to encourage women’s employment; to promote inter-spousal communication particularly initiative taken by women and to support women’s participation in decision making process generally at household level and particularly in family formation to enable them to practice this reproductive health rights.