skip to main content
10.1145/3313831.3376294acmconferencesArticle/Chapter ViewAbstractPublication PageschiConference Proceedingsconference-collections
research-article

Patriarchy, Maternal Health and Spiritual Healing: Designing Maternal Health Interventions in Pakistan

Authors Info & Claims
Published:23 April 2020Publication History

ABSTRACT

We examine the opportunities and challenges in designing for maternal health in low-income, low-resource communities in patriarchal and religious contexts. Pakistan faces a crisis in maternal health with a maternal mortality ratio of 178 deaths per 100,000 live births, as compared to the developed-country average of just 12 deaths per 100,000. Through a 6-month long qualitative, empirical study we examine the prevalent beliefs and practices around maternal health in Pakistan, the access women have to health-care, the existing religious practices that influence them and the agency they exert in their own health-care decision making. We reveal the rampant misinformation among mothers and health workers, house-hold power dynamics that impact maternal health and the deep link between maternal health and religious beliefs. We also show how current maternal health care interventions fit poorly into this context and discuss alternate design recommendations for meeting the maternal health needs of these women.

Skip Supplemental Material Section

Supplemental Material

a167-mustafa-presentation.mp4

mp4

48.8 MB

References

  1. 2018. Maternal mortality in Asia-Pacific - 5 key facts. (2018). https://asiapacific.unfpa.org/en/news/maternal-mortality-asia-pacific-5-key-factsGoogle ScholarGoogle Scholar
  2. Syed Ishtiaque Ahmed, Nusrat Jahan Mim, and Steven J Jackson. 2015. Residual mobilities: infrastructural displacement and post-colonial computing in Bangladesh. In Proceedings of the 33rd Annual ACM Conference on Human Factors in Computing Systems. ACM, 437--446.Google ScholarGoogle ScholarDigital LibraryDigital Library
  3. Marine Al Dahdah, Annabel Desgrées Du Loû, and Cécile Méadel. 2015. Mobile health and maternal care: a winning combination for healthcare in the developing world? Health Policy and Technology 4, 3 (2015), 225--231.Google ScholarGoogle ScholarCross RefCross Ref
  4. Muhammad b. Hasan b. 'Ali b. Muhammad b. Husayn al-Hurr al 'Amili. 1661. Wasa'il al-Shi'a. Vol. 25. 134,223 pages.Google ScholarGoogle Scholar
  5. Mohammad Zafir Al-Shahri. 2016. Islamic theology and the principles of palliative care. Palliative and Supportive Care 14, 6 (2016), 635--640. DOI: http://dx.doi.org/10.1017/S1478951516000080Google ScholarGoogle ScholarCross RefCross Ref
  6. Radi al-Din Hasan b. Fadl al Tabrisi. 1305. Makarim al-akhlaq. 362 pages.Google ScholarGoogle Scholar
  7. Teresa Almeida, Rob Comber, and Madeline Balaam. 2016a. HCI and Intimate Care as an Agenda for Change in Women's Health. In Proceedings of the 2016 CHI Conference on Human Factors in Computing Systems. ACM, 2599--2611.Google ScholarGoogle ScholarDigital LibraryDigital Library
  8. Teresa Almeida, Rob Comber, Gavin Wood, Dean Saraf, and Madeline Balaam. 2016b. On Looking at the Vagina through Labella. In Proceedings of the 2016 CHI Conference on Human Factors in Computing Systems. ACM, 1810--1821.Google ScholarGoogle ScholarDigital LibraryDigital Library
  9. David Arnold. 1993. Colonizing the body: State medicine and epidemic disease in nineteenth-century India. Univ of California Press.Google ScholarGoogle Scholar
  10. Deborah Balk. 1994. Individual and community aspects of women's status and fertility in rural Bangladesh. Population Studies 48, 1 (1994), 21--45.Google ScholarGoogle ScholarCross RefCross Ref
  11. Amna Batool, Samia Razaq, Maham Javaid, Beenish Fatima, and Kentaro Toyama. 2017. Maternal Complications: Nuances in Mobile Interventions for Maternal Health in Urban Pakistan. In Proceedings of the Ninth International Conference on Information and Communication Technologies and Development. ACM, 3.Google ScholarGoogle ScholarDigital LibraryDigital Library
  12. Nicola J Bidwell, Heike Winschiers-Theophilus, Gereon Koch Kapuire, and Mathias Rehm. 2011. Pushing personhood into place: Situating media in rural knowledge in Africa. International Journal of Human-Computer Studies 69, 10 (2011), 618--631.Google ScholarGoogle ScholarDigital LibraryDigital Library
  13. Waylon Brunette, Wayne Gerard, Matthew A Hicks, Alexis Hope, Mitchell Ishimitsu, Pratik Prasad, Ruth E Anderson, Gaetano Borriello, Beth E Kolko, and Robert Nathan. 2010. Portable antenatal ultrasound platform for village midwives. In Proceedings of the First ACM Symposium on Computing for Development. ACM, 23.Google ScholarGoogle ScholarDigital LibraryDigital Library
  14. John B Casterline, Zeba A Sathar, and Minhaj ul Haque. 2001. Obstacles to contraceptive use in Pakistan: A study in Punjab. Studies in family planning 32, 2 (2001), 95--110.Google ScholarGoogle ScholarCross RefCross Ref
  15. Carl DiSalvo, Phoebe Sengers, and Hrönn Brynjarsdóttir. 2010. Mapping the landscape of sustainable HCI. In Proceedings of the SIGCHI conference on human factors in computing systems. ACM, 1975--1984.Google ScholarGoogle ScholarDigital LibraryDigital Library
  16. Kevin Doherty, José Marcano-Belisario, Martin Cohn, Nikolaos Mastellos, Cecily Morrison, Josip Car, and Gavin Doherty. 2019. Engagement with Mental Health Screening on Mobile Devices: Results from an Antenatal Feasibility Study. In Proceedings of the 2019 CHI Conference on Human Factors in Computing Systems. ACM, 186.Google ScholarGoogle ScholarDigital LibraryDigital Library
  17. Tim Dyson and Mick Moore. 1983. On kinship structure, female autonomy, and demographic behavior in India. Population and development review (1983), 35--60.Google ScholarGoogle Scholar
  18. Abdul Ghaffar, Sathirakorn Pongpanich, and Sheh Mureed. 2012. "I Have Missed Three Moons: What Should I Do Now?" A Pregnant Mother In The Baloch Community, Balochistan, Pakistan. Journal of Health Research 26, Special (2012), S9--S17.Google ScholarGoogle Scholar
  19. Xiaohui Hou and Ning Ma. 2012. The effect of women's decision-making power on maternal health services uptake: evidence from Pakistan. Health policy and planning 28, 2 (2012), 176--184.Google ScholarGoogle Scholar
  20. Lilly Irani, Janet Vertesi, Paul Dourish, Kavita Philip, and Rebecca E Grinter. 2010. Postcolonial computing: a lens on design and development. In Proceedings of the SIGCHI conference on human factors in computing systems. ACM, 1311--1320.Google ScholarGoogle ScholarDigital LibraryDigital Library
  21. Shireen J Jejeebhoy and Zeba A Sathar. 2001. Women's autonomy in India and Pakistan: the influence of religion and region. Population and development review 27, 4 (2001), 687--712.Google ScholarGoogle Scholar
  22. R Khadduri, DR Marsh, B Rasmussen, A Bari, R Nazir, and GL Darmstadt. 2008. Household knowledge and practices of newborn and maternal health in Haripur district, Pakistan. Journal of Perinatology 28, 3 (2008), 182.Google ScholarGoogle ScholarCross RefCross Ref
  23. Bran Knowles, Adrian K Clear, Samuel Mann, Eli Blevis, and Maria Håkansson. 2016. Design patterns, principles, and strategies for sustainable HCI. In Proceedings of the 2016 CHI Conference Extended Abstracts on Human Factors in Computing Systems. ACM, 3581--3588.Google ScholarGoogle ScholarDigital LibraryDigital Library
  24. Neha Kumar and Richard J Anderson. 2015. Mobile phones for maternal health in rural India. In Proceedings of the 33rd Annual ACM Conference on Human Factors in Computing Systems. ACM, 427--436.Google ScholarGoogle ScholarDigital LibraryDigital Library
  25. Neha Kumar, Waylon Brunette, Nicola Dell, Trevor Perrier, Beth Kolko, Gaetano Borriello, and Richard Anderson. 2015a. Understanding sociotechnical implications of mobile health deployments in India, Kenya, and Zimbabwe. Information Technologies & International Development 11, 4 (2015), pp--17.Google ScholarGoogle Scholar
  26. Neha Kumar, Trevor Perrier, Michelle Desmond, Kiersten Israel-Ballard, Vikrant Kumar, Sudip Mahapatra, Anil Mishra, Shreya Agarwal, Rikin Gandhi, Pallavi Lal, and others. 2015b. Projecting health: community-led video education for maternal health. In Proceedings of the Seventh International Conference on Information and Communication Technologies and Development. ACM, 17.Google ScholarGoogle ScholarDigital LibraryDigital Library
  27. Alain B Labrique, Lavanya Vasudevan, Erica Kochi, Robert Fabricant, and Garrett Mehl. 2013. mHealth innovations as health system strengthening tools: 12 common applications and a visual framework. Global health: science and practice 1, 2 (2013), 160--171.Google ScholarGoogle Scholar
  28. Abdullahi Mohammed Maiwada, Nik Mazlan Mamat, Nor Azlina A Rahman, Suzanah Abdul Rahman, and Tukur Mohammed Baba. 2018. Islamic Perspectives of Reproductive and Maternal Health: What Role Can Nigerian Muslim Religious Leaders Play in the Prevention of Maternal Mortality?-With Particular Reference to Zamfara State North-West Nigeria. International Medical Journal Malaysia 17 (2018).Google ScholarGoogle Scholar
  29. Jeffrey P Mayer. 1997. Unintended childbearing, maternal beliefs, and delay of prenatal care. Birth 24, 4 (1997), 247--252.Google ScholarGoogle ScholarCross RefCross Ref
  30. Kevin McQuillan. 2004. When does religion influence fertility? Population and development review 30, 1 (2004), 25--56.Google ScholarGoogle Scholar
  31. Samantha Merritt and Shaowen Bardzell. 2011. Postcolonial language and culture theory for HCI4D. In CHI'11 Extended Abstracts on Human Factors in Computing Systems. ACM, 1675--1680.Google ScholarGoogle ScholarDigital LibraryDigital Library
  32. Valentine M Moghadam. 1992. Patriarchy and the politics of gender in modernising societies: Iran, Pakistan and Afghanistan. International Sociology 7, 1 (1992), 35--53.Google ScholarGoogle ScholarCross RefCross Ref
  33. Dorothy S Mull. 1992. Mother's milk and pseudoscientific breastmilk testing in Pakistan. Social Science & Medicine 34, 11 (1992), 1277--1290.Google ScholarGoogle ScholarCross RefCross Ref
  34. Zubia Mumtaz and Sarah Salway. 2009. Understanding gendered influences on women's reproductive health in Pakistan: moving beyond the autonomy paradigm. Social Science & Medicine 68, 7 (2009), 1349--1356.Google ScholarGoogle ScholarCross RefCross Ref
  35. Zubia Mumtaz and Sarah M. Salway. 2007. Gender, pregnancy and the uptake of antenatal care services in Pakistan. Sociology of health & illness 29, 1 (2007), 1--26.Google ScholarGoogle Scholar
  36. Maria GN Musoke. 2002. Maternal health care in rural Uganda: Leveraging traditional and modern knowledge systems. (2002).Google ScholarGoogle Scholar
  37. Maryam Mustafa, Noor Mazhar, Ayesha Asghar, Maryem Zafar Usmani, Lubna Razaq, and Richard Anderson. 2019. Digital Financial Needs of Micro-entrepreneur Women in Pakistan: Is Mobile Money The Answer?. In Proceedings of the 2019 CHI Conference on Human Factors in Computing Systems. ACM, 260.Google ScholarGoogle ScholarDigital LibraryDigital Library
  38. Sajida Naseem, Umme Kulsoom Khattak, Haider Ghazanfar, and Awais Irfan. 2017. Maternal health status in terms of utilisation of antenatal, natal and postnatal services in a Periurban setting of Islamabad: A community based survey. J Pak Med Assoc 67, 8 (2017), 1186--1191.Google ScholarGoogle Scholar
  39. A Camielle Noordam, Barbara M Kuepper, Jelle Stekelenburg, and Anneli Milen. 2011. Improvement of maternal health services through the use of mobile phones. Tropical Medicine & International Health 16, 5 (2011), 622--626.Google ScholarGoogle ScholarCross RefCross Ref
  40. Oluwaseun Ireti Obasola, Iyabo Mabawonku, and Ikeoluwa Lagunju. 2015. A review of E-health interventions for maternal and child health in sub-Sahara Africa. Maternal and child health journal 19, 8 (2015), 1813--1824.Google ScholarGoogle Scholar
  41. World Health Organization. 2018. Maternal mortality. (2018). https://www.who.int/news-room/fact-sheets/detail/maternal-mortalityGoogle ScholarGoogle Scholar
  42. Rahat Najam Qureshi, Sana Sheikh, Asif Raza Khowaja, Zahra Hoodbhoy, Shujaat Zaidi, Diane Sawchuck, Marianne Vidler, Zulfiqar A Bhutta, and Peter von Dadeslzen. 2016. Health care seeking behaviours in pregnancy in rural Sindh, Pakistan: a qualitative study. Reproductive health 13, 1 (2016), 34.Google ScholarGoogle Scholar
  43. Divya Ramachandran, John Canny, Prabhu Dutta Das, and Edward Cutrell. 2010a. Mobile-izing health workers in rural India. In Proceedings of the SIGCHI Conference on Human Factors in Computing Systems. ACM, 1889--1898.Google ScholarGoogle ScholarDigital LibraryDigital Library
  44. Divya Ramachandran, Vivek Goswami, and John Canny. 2010b. Research and reality: using mobile messages to promote maternal health in rural India. In Proceedings of the 4th ACM/IEEE international conference on information and communication technologies and development. ACM, 35.Google ScholarGoogle ScholarDigital LibraryDigital Library
  45. Md Rashidujjaman Rifat, Jay Chen, and Kentaro Toyama. 2017. Money, God, and SMS: Explorations in Supporting Social Action Through a Bangladeshi Mosque. In Proceedings of the 2017 CHI Conference on Human Factors in Computing Systems. ACM, 5941--5953.Google ScholarGoogle ScholarDigital LibraryDigital Library
  46. Carine Ronsmans, Wendy J Graham, Lancet Maternal Survival Series steering group, and others. 2006. Maternal mortality: who, when, where, and why. The lancet 368, 9542 (2006), 1189--1200.Google ScholarGoogle Scholar
  47. Umaira Uzma Sajjad and Suleman Shahid. 2016. Baby+: A mobile application to support pregnant women in Pakistan. In Proceedings of the 18th International Conference on Human-Computer Interaction with Mobile Devices and Services Adjunct. ACM, 667--674.Google ScholarGoogle ScholarDigital LibraryDigital Library
  48. Nithya Sambasivan, Garen Checkley, Amna Batool, Nova Ahmed, David Nemer, Laura Sanely Gaytán-Lugo, Tara Matthews, Sunny Consolvo, and Elizabeth Churchill. 2018. " Privacy is not for me, it's for those rich women": Performative Privacy Practices on Mobile Phones by Women in South Asia. In Fourteenth Symposium on Usable Privacy and Security ({SOUPS} 2018). 127--142.Google ScholarGoogle ScholarDigital LibraryDigital Library
  49. Mariyam Sarfraz, Saira Tariq, Saima Hamid, and Nafeesa Iqbal. 2016. Social and societal barriers in utilization of maternal health care services in rural punjab, Pakistan. Journal of Ayub Medical College Abbottabad 27, 4 (2016), 843--849.Google ScholarGoogle Scholar
  50. Sidney Ruth Schuler, Syed Mesbahuddin Hashemi, and Ann P Riley. 1997. The influence of women's changing roles and status in Bangladesh's fertility transition: evidence from a study of credit programs and contraceptive use. World Development 25, 4 (1997), 563--575.Google ScholarGoogle ScholarCross RefCross Ref
  51. Christopher Seebregts, Thomas Fogwill, Gaurang Tanna, Christopher Seebregts, Peter Barron, and Peter Benjamin. 2016. MomConnect : an exemplar implementation of the Health Normative Standards Framework in South Africa. South African Health Review (2016).Google ScholarGoogle Scholar
  52. Jelle Stekelenburg, Sindele Kyanamina, M Mukelabai, Ivan Wolffers, and Jos Van Roosmalen. 2004. Waiting too long: low use of maternal health services in Kalabo, Zambia. Tropical Medicine & International Health 9, 3 (2004), 390--398.Google ScholarGoogle ScholarCross RefCross Ref
  53. Sharifa Sultana and Syed Ishtiaque Ahmed. 2019. Witchcraft and HCI: Morality, Modernity, and Postcolonial Computing in Rural Bangladesh. In Proceedings of the 2019 CHI Conference on Human Factors in Computing Systems. ACM, 356.Google ScholarGoogle ScholarDigital LibraryDigital Library
  54. Sharifa Sultana, François Guimbretière, Phoebe Sengers, and Nicola Dell. 2018. Design Within a Patriarchal Society: Opportunities and Challenges in Designing for Rural Women in Bangladesh. In Proceedings of the 2018 CHI Conference on Human Factors in Computing Systems (CHI '18). ACM, NY, NY, USA, Article 536, 13 pages. DOI: http://dx.doi.org/10.1145/3173574.3174110Google ScholarGoogle ScholarDigital LibraryDigital Library
  55. Reem Talhouk, Sandra Mesmar, Anja Thieme, Madeline Balaam, Patrick Olivier, Chaza Akik, and Hala Ghattas. 2016. Syrian refugees and digital health in Lebanon: Opportunities for improving antenatal health. In Proceedings of the 2016 CHI Conference on Human Factors in Computing Systems. ACM, 331--342.Google ScholarGoogle ScholarDigital LibraryDigital Library
  56. Tigest Tamrat and Stan Kachnowski. 2012. Special delivery: an analysis of mHealth in maternal and newborn health programs and their outcomes around the world. Maternal and child health journal 16, 5 (2012), 1092--1101.Google ScholarGoogle Scholar
  57. Sereen Thaddeus and Deborah Maine. 1994. Too far to walk: maternal mortality in context. Social science & medicine 38, 8 (1994), 1091--1110.Google ScholarGoogle Scholar
  58. Anupriya Tuli, Shaan Chopra, Neha Kumar, and Pushpendra Singh. 2018. Learning from and with Menstrupedia: Towards Menstrual Health Education in India. Proc. ACM Hum.-Comput. Interact. 2, CSCW, Article 174 (Nov. 2018), 20 pages. DOI: http://dx.doi.org/10.1145/3274443Google ScholarGoogle ScholarDigital LibraryDigital Library
  59. Unicef. 2017. Maternal and Newborn Health Disparities Pakistan. (2017). https://www.who.int/news-room/fact-sheets/detail/maternal-mortalityGoogle ScholarGoogle Scholar
  60. United Nations. 2019. Sustainable Developmen Goals. (2019). https://www.un.org/sustainabledevelopment/sustainable-development-goals/Google ScholarGoogle Scholar
  61. Alastair Van Heerden, Shane Norris, Stephen Tollman, Linda Richter, and Mary Jane Rotheram-Borus. 2013. Collecting maternal health information from HIV-positive pregnant women using mobile phone-assisted face-to-face interviews in Southern Africa. Journal of medical Internet research 15, 6 (2013), e116.Google ScholarGoogle ScholarCross RefCross Ref
  62. Aditya Vashistha, Neha Kumar, Anil Mishra, and Richard Anderson. 2016. Mobile Video Dissemination for Community Health. In Proceedings of the Eighth International Conference on Information and Communication Technologies and Development. ACM, 20.Google ScholarGoogle ScholarDigital LibraryDigital Library
  63. World Bank. 2017. The World Bank - Country Data : Pakistan. (2017). http://data.worldbank.org/country/pakistanGoogle ScholarGoogle Scholar

Index Terms

  1. Patriarchy, Maternal Health and Spiritual Healing: Designing Maternal Health Interventions in Pakistan

    Recommendations

    Comments

    Login options

    Check if you have access through your login credentials or your institution to get full access on this article.

    Sign in
    • Published in

      cover image ACM Conferences
      CHI '20: Proceedings of the 2020 CHI Conference on Human Factors in Computing Systems
      April 2020
      10688 pages
      ISBN:9781450367080
      DOI:10.1145/3313831

      Copyright © 2020 ACM

      Permission to make digital or hard copies of all or part of this work for personal or classroom use is granted without fee provided that copies are not made or distributed for profit or commercial advantage and that copies bear this notice and the full citation on the first page. Copyrights for components of this work owned by others than ACM must be honored. Abstracting with credit is permitted. To copy otherwise, or republish, to post on servers or to redistribute to lists, requires prior specific permission and/or a fee. Request permissions from [email protected]

      Publisher

      Association for Computing Machinery

      New York, NY, United States

      Publication History

      • Published: 23 April 2020

      Permissions

      Request permissions about this article.

      Request Permissions

      Check for updates

      Qualifiers

      • research-article

      Acceptance Rates

      Overall Acceptance Rate6,199of26,314submissions,24%

    PDF Format

    View or Download as a PDF file.

    PDF

    eReader

    View online with eReader.

    eReader

    HTML Format

    View this article in HTML Format .

    View HTML Format