The role of social geography on Lady Health Workers' mobility and effectiveness in Pakistan
The role of social geography on Lady Health Workers' mobility and effectiveness in Pakistan
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DOI：
10.1016/j.socscimed.2013.05.007
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发表时间：
2013-08-01
影响因子：
5.4
通讯作者：
Ayyalasomayajula, Bharati
中科院分区：
文献类型：
--
作者：
Mumtaz, Zubia;Salway, Sarah;Ayyalasomayajula, Bharati
巴基斯坦女性保健工作者（LHW）方案在男权隔离规范限制妇女利用保健设施的情况下提供上门生殖保健服务。该方案没有达到最佳效果，特别是在提高避孕药具使用水平方面。一个原因可能是LHWs面临着同样的流动性限制，这使得任命他们成为必要。过去的研究记录了性别规范和大家庭（biradari）关系对农村妇女流动模式的影响。本研究探讨了这些社会文化因素是否以及如何影响LHWs的家访率。2009-2010年，在旁遮普邦一个地区的21个村庄进行了一项混合方法研究。对21名妇女保健工作者进行了社会测绘练习，以确定和调查803名育龄妇女。将调查数据和地图联系起来，直观地描述了LHWs的访问模式。我们与21名社工和27名社区成员进行了深入访谈。LHW的biradari成员报告LHW访问的几率要高出两倍，并且对他们提供的避孕药具感到满意的可能性要高出两倍。定性数据表明，妇女保健员的流动导致担任这一角色的妇女地位的丧失。进入没有血缘关系的男性占据的空间尤其可耻。以种姓为基础的村庄等级制度进一步阻碍了比拉达里边界之外的访问。为了回应这些规范的禁令，卫生工作者采取了减少家访次数和避免探访非比拉达里家庭的策略。研究结果表明，LHW的表现受到性别和biradari/种姓等级制度的制约。此外，由于LHWs往往是贫穷和低种姓的人，同时他们的大家庭成员中有可能拥有相似的社会经济环境，因此该计划可能会通过一种意想不到的途径，以不同的方式向较贫穷的家庭提供医疗保健服务。(C) 2013年作者。Elsevier Ltd.出版。版权所有。
The Pakistan Lady Health Worker (LHW) program provides door-step reproductive health services in a context where patriarchal norms of seclusion constrain women's access to health care facilities. The program has not achieved optimal functioning, particularly in relation to raising levels of contraceptive use. One reason may be that the LHWs face the same mobility constraints that necessitated their appointment. Past research has documented the influence of gendered norms and extended family (biradari) relationships on rural women's mobility patterns. This study explores whether and how these socio-cultural factors also impact LHWs' home-visit rates. A mixed-method study was conducted across 21 villages in one district of Punjab in 2009-2010. Social mapping exercises with 21 LHWs were used to identify and survey 803 women of reproductive age. The survey data and maps were linked to visually delineate the LHWs' visitation patterns. In-depth interviews were conducted with 21 LHWs and 27 community members. Members of a LHW's biradari had two times higher odds of reporting a visit by their LHW and were twice as likely to be satisfied with their supply of contraceptives. Qualitative data showed that LHWs mobility led to a loss of status of women performing this role. Movement into space occupied by unrelated males was particularly shameful. Caste-based village hierarchies further discouraged visits beyond biradari boundaries. In response to these normative proscriptions, LHWs adopted strategies to reduce the amount of home visiting undertaken and to avoid visits to non-biradari homes. The findings suggest that LHW performance is constrained by both gender and biradari/caste-based hierarchies. Further, since LHWs tended to be poor and low caste, and at the same time preferentially visited, co-members of their extended family who are likely to share similar socioeconomic circumstances, the program may be differentially providing health care services to poorer households, albeit through an unintended route. (C) 2013 The Authors. Published by Elsevier Ltd. All rights reserved.