Qualitative Formative Research Findings Dadu District

Transcription

Volume 1:
Qualitative Formative Research Findings - Summary
Volume 2:
Qualitative Formative Research Findings DG Khan District, Punjab
Volume 3:
Qualitative Formative Research Findings Khanewal District, Punjab
Volume 4:
Qualitative Formative Research Findings Rawalpindi District, Punjab
Volume 5:
Qualitative Formative Research Findings Buner District, NWFP
Volume 6:
Qualitative Formative Research Findings Jafferabad District, Balochistan
Volume 7:
Qualitative Formative Research Findings Sukkur District, Sindh
Volume 8:
Qualitative Formative Research Findings Dadu District, Sindh
Volume 9:
Qualitative Formative Research Findings Study II
Volume-8
Qualitative Formative
Research Findings - Dadu
July 2006
PAIMAN project is funded by the United States Agency for International Development
and implemented by JSI Research & Training Institute Inc.
in conjunction with Aga Khan University, PAVHNA, Contech International, Save the Children US,
Population Council, Johns Hopkins University/CCP, and Greenstar Social Marketing.
SUNRISE DIGITAL 051-2278515
Center for Communication Programs
The Pakistan Initiative for Mothers and Newborns (PAIMAN) is a five-year United States Agency for
International Development (USAID) funded project designed to reduce country's maternal and
neonatal mortality by making sure women have access to skilled birth attendants during childbirth
and through out the postpartum period. PAIMAN works at national, provincial and district levels to
strengthen the capacity of public and private health care providers and improve health care system
infrastructure. The PAIMAN Program is jointly implemented by John Snow Inc (JSI), the Johns
Hopkins Center for Communication programs (JHU/CCP), Agha Khan University, Contech
International, Greenstar Social Marketing, Population Council and Pakistan Voluntary Health and
Nutrition Association (PAVHNA) .
Copyright © 2006 by JHU/CCP. All rights reserved.
Published by:
PAIMAN
House 6, Street 5, F-8/3, Islamabad, Pakistan.
Author:
Dr. Arjumand Faisel
Arjumand and Associates
Editor:
Daniela Lewy
Cover Design, Layout & Printed: Sunrise Digital, Islamabad, Pakistan.
Inquiries should be directed to:
Fayyaz Ahmed Khan
Team Leader BCC
Johns Hopkins Bloomberg School of Public
Health
PAIMAN Office
House 6, Street 5
F-8/3, Islamabad, Pakistan
E-mail: [email protected]
Suruchi Sood, Ph.D.
Senior Program Evaluation Officer
Johns Hopkins Bloomberg School of Public
Health
111 Market Place
Suite # 310
Baltimore, MD 21202
E-mail: [email protected]
Disclaimer:
This study/report is made possible by the generous support of the American people through the United States Agency for
International Development (USAID). The contents are the responsibility of JSI Research & Training Institute, Inc. and do not
necessarily reflect the views of USAID or the United States Government.
contents
8.1.
District profile
8.2. Participants Characteristics
8.3. Current Maternal Health Seeking Behaviors and the Key Factors that
Facilitate or Hinder Health Seeking Practices
8.3.1 Recognition of and reaction to pregnancy
8.3.2 Health seeking behavior adopted at home
8.3.3 Perception of required health services in pregnancy, delivery and
postpartum
8.3.4 Availability of services to women and their utilization
8.3.5 Health seeking from skilled providers during current/last pregnancy,
last delivery and last postpartum
8.3.6 Knowledge about life threatening complications
8.3.7 Actions taken during obstetric emergency
8.3.8 Assistance of husbands, family members, health care providers and
community in emergency situations
8.3.9 Conclusions
8.4. Current Health Seeking Behavior for Newborns and the Key Factors
that Facilitate or Hinder these Health Seeking Practices
8.4.1 Perception of required health services for newborn
8.4.2 Availability of services for newborn and their utilization
8.4.3 Steps to ensure health of the newborn
8.4.4 Knowledge about life threatening complication in newborn
8.4.5 Actions taken for threat to life of newborn
8.4.6 Conclusions
8.5. Current Birth Preparedness and Complications Readiness Behaviors
and the Key Facilitating and Hindering Factors
8.5.1 Preparations made for birth by woman, husband and family
members
8.5.2 Hindrances in BPCR
8.5.3 Conclusions
8.6. Religious and Cultural Practices Surrounding Maternal and Neonatal
Health
8.6.1 Religious/Cultural ceremonies
8.6.2 Preferred and forbidden food items for breastfeeding mothers
8.6.3 Precautions taken during postpartum to ensure safety of mother
and newborn
8.6.4 Feeding of newborn
8.6.5 Bathing patterns
8.6.6 Presence and effects of Nazar (evil-eye)
Conclusions
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Qualitative Formative Research Findings - Dadu
ACKNOWLEDGMENTS
Arjumand and Associates (Management Team)
Dr. Arjumand Faisel
Dr. Narjis Rizvi
Dr. Naveed-I-Rahat
Wasiq Mehmood Khan
Sabeena Kausar Satti
Dr. Fauzia Waqar
Johns Hopkins Bloomberg School of Public Health (Baltimore)
Dr. Suruchi Sood
Anne Palmer
Dr. Corinne Shefner-Rogers
Daniela Lewy
Margaret Edwards
Johns Hopkins Bloomberg School of Public Health (Pakistan)
Fayyaz Ahmed Khan
Dr. Zaeem Ul Haq
Shereen Rahmat Minhas
John Snow Inc.
Dr. Theo Lippiveld
Dr. Nabeela Ali
Dr. Tahir Nadeem
Dr. Nuzhat Rafique
Dr. Iftikhar Mallah
Dr. Syed Hassan Mehdi Zaidi
Local Government Health Department Staff
EDO Health,
District Coordinator LHW Program
LHWs
National Program for Family Planning and Primary Health Care
Dr. Haroon Jahangir Khan
A special thank you for all the individuals who graciously
participated in this formative research
Study 1: From Pregnancy to Newborn Care:
Health Seeking, Birth
Preparedness/Complication Readiness,
Religious and Cultural Practices
Report - Study 1 (Volume 8)
Findings: Dadu, Sindh
In-depth Interviews (IDIs) with Married Women,
Husbands and Family Members
04
8.
Findings District Dadu (Sindh)
8.1
District Profile
8.2
Participants Characteristics
A total of 40 interviews were conducted with the distribution given in Table 8.1:
District Dadu is administratively divided into 4 talukas which include Dadu,
Mehar, Johi and Khair Pur Nathan Shah (known as K N Shah). According to
1998 Census, the population of the district was 1,688,811 with 53% males and
1
47% females and an annual growth rate of 2.65%. The medical coverage
provided by the public health sector in the district consists of 1 District
Headquarters Hospital (DHQH), 3 Taluka Headquarters Hospital (THQH), 3
Rural Health Centres (RHCs), 44 Basic Health Units (BHUs) and 2 Maternal &
Child Health Centres (MCHCs).
Table 8.1: Distribution of In-depth Interviews
Area
Number of Interviews
Currently Women with Husbands
Pregnant
Live Birth
Women
CP* LB*
Mukhi Street
Purano Dero
Makhdoum Bilawal
Phulji Village
Total
3
3
3
3
12
3
3
3
3
12
1
1
1
1
4
1
1
1
1
4
Family
Members
Male Female
1
1
1
1
4
1
1
1
1
4
Figure 1: Map of District Dadu with Sampled Areas
Note: CP= currently pregnant, LB= woman with live birth
2
1
3
4
Sampled Areas:
1.
2.
3.
4.
Mukhi Street (urban)
Purano Dero (rural)
Makhdoum Bilawal (rural)
Phulji Village (rural)
The ages of participants were: women from 20 to 40 years with the mean of 27.85
years, husbands 26 to 46 years with mean of 33.5 years, and family members 33
to 70 years with mean of 57.25 years. The living children of women and husband
participants ranged from 0 to 10; the number of sons ranged from 0 to 7, and the
number of daughters ranged from 0 to 5. The age range of the youngest child of
women participants was 4 months to 4 years and of the husbands' from 1 month to
4 years.
Several women (16 out of 24) had no schooling, few (6 out of 24) completed
grades ranging from 1 to 10, with one woman reported having completed high
school (12th grade) and another who had done graduation. One of the husbands
interviewed had no schooling while 3 had education from primary to grade 10.
Three of them had completed up to 12th grade while one had done masters.
Several (5 out of 8) of the family members had no schooling and some (3 out of 8)
had attended school up to the 10th grade.
The husbands reported working in the following occupations: teacher,
shopkeeper, agriculture, policeman, laborer and government servant. Male
family members worked in agriculture, business or retired.
Among the participants, 82% (33 out of 40) spoke Sindhi language, 17% (7)
spoke Saraiki language whereas one reported speaking Marwahri language.
8.3
Current Maternal Health Seeking Behaviors and the
Key Factors that Facilitate or Hinder Maternal Health
Seeking Practices.
Health seeking behavior and practices of an individual or family is influenced by
several factors, such as the stage at which the condition/illness is recognized,
importance given to it, whether the condition can be shared with others or not,
severity of symptoms, access to health services, behavior of and confidence in
the staff, availability of financial resources, etc. The behaviors recorded in Dadu
1. Population Census 1998, Report
06
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district, and the factors that influence them are presented below.
pregnancy care, to get supplements and for asking her to accompany them to the
hospital.
8.3.1 Recognition of and reaction to pregnancy
In general, the recognition of pregnancy is early by the women, both in urban and
rural areas. Most of the women presume that they are pregnant when their
menses are over due, especially if they have one or more associated symptoms
such as nausea, vomiting, giddiness, weakness, lethargy, headache, body ache,
lack of desire to have food, increased appetite, irritability and feeling of sinking of
heart. Some (11 out of 24) women diagnosed it mainly on the basis of symptoms,
while more than half (13 out of 24) sought help from the health care providers for
confirmation. Many of those who sought help from health care providers for
confirmation (9 out of 13) saw a doctor or got a lab test, while only one went to the
dai and others did not mention the provider. All the urban women got a urine test to
confirm their pregnancy.
A woman with live birth in Makhdoum Bilawal while describing recognition of
pregnancy stated: “First (I) got nausea, then vomiting and my menses were over
due with these symptoms I became suspicious (of pregnancy) and told my
husband who got (my) urine test done” (Sab sey pehley dil kee ajeeb kafiat shoroo
ho jatee hey yanee dil matlaney lagta hey, ultian shoroo ho jatee hen or
mahwaree naheen atee, is tarha kee alamat sey mujhey kuch shak paida hua to
phir meney apney shoher ko bataya to unhoon ney paishab test karwaya”.
Discussing the subject, a currently pregnant woman with two children in Mukhi
Street said: “(I) was vomiting, had no desire to eat anything hence went to a doctor
who got the urine test which was positive and I learnt that I was pregnant” (Ulti
lagney lage thein, kuch khaney ko dil naheen karta tha to phir meney doctor ko
dekhaya, doctor ney paishab test karwaya to who positive tha, to pata chala ke
men hamal sey hoon”.
Almost all (22 out of 24) of the women stated that they shared this news first with
their husband, with similar pattern in urban and rural areas, indicating that the
level of spousal communication is high in Dadu, both in urban and rural areas. A
currently pregnant woman in Mukhi Street said: “I told my husband as he is my life
partner and it is his right (to know)” (Meney apney shoher ko bataya kion ke who
humsafar hey or us ka haq hey). The remaining two women shared the news with
their mothers.
Next, the mother-in-law, other female members of the house (sister-in-law, aunt),
mother, sister, father-in-law, female cousins were informed. The reasons for
informing other family members were mainly due to their position in the household
(for mother-in- law especially) and for advice and care during pregnancy. In
Purano Dero, a father-in- law stated: “My daughter-in-law told her husband and
her mother-in-law about her pregnancy. She told her husband as it is his right (to
know) and to my wife as she is a woman and an elderly member of the house”
(Apney shoher or meree bevi ko meree bahu ney apney hamal ke barey men
bataya tha, shoher ko is liye ke wo us ka haq hey or meree bivi ko is liye ke who
aurat hey or ghar kee baree hey, is liye).
Two women also informed the LHWs with the purpose for seeking advice for the
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Almost all of the interviewed participants including women, husbands and family
members (except two women) reported happiness on learning about the
pregnancy; and they (women, husbands) had 0 to 10 children before the
occurrence of the current/last pregnancy. In Phulji Village, a husband who had 10
living children reported his happiness in these words: “I felt happy when I learnt
about the pregnancy of my wife. There is lot of happiness on first pregnancy and
gradually the intensity of happiness decreases but one does feel happy” (Khushi
hui thee mujhey jab mujhey meree bivi kay hamal ka pata chala tha, pehlee
martaba khushi buhat hotee hey phir ahista ahista khushi kee shidat men kame a
jatee hey magar khushi hotee hey).
A mother-in-law of Makhdoum Bilawal stating her happiness said: “(I) felt very
happy, it is evident that we will feel happy as our generation will increase” (Buhat
ziada khushi hui thee, humaree nasal barhey gee to zahir hey ke khushi to ho
gee).
The two women who expressed unhappiness on learning about the current or last
pregnancy had 7 to 10 living children. The reason for unhappiness mentioned by
one was having too many children. She belonged to Phulji Village and said: “Did
not like it at all, this is my eleventh pregnancy and I do not have any strength to
give birth” (Bilkul acha naheen laga, ab ye mera gyarwahn pait hey, mujh men
bachey paida karney kee bilkul himmat naheen hey). The other woman stated her
bad health as the reason for unhappiness.
From the above, it is clear that:
 Recognition of pregnancy is mostly early and its clinical confirmation is also
sought by several women, both in urban and rural areas.

Almost all of the women shared the news of pregnancy first with their
husbands indicating that spousal communication is high, which reflects that
women do perceive a role of husbands in the process.

There is also sharing of the news with other family members in hope of
getting their favor or support.

Very few women reported unhappiness on learning about the pregnancy
indicating some unmet need for family planning
8.3.2 Health-seeking behavior adopted at home
The participants reported behavioral changes by women and her family on
learning about the pregnancy. These are related to food intake, daily routine,
rest, etc.
Food intake: Almost all (22 out of 24) women mentioned that they increased their
food intake during pregnancy. Besides, all of the husbands and family members
had similar opinions irrespective to their rural or urban belonging. It was stated
that this care was mainly initiated by husbands, self or female family members
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especially mother-in-law and one even said that her father-in-law initiated the
increase.
The most commonly reported food items of increased intake mentioned by all
groups were fish, fruit, milk and meat. Few participants mentioned vegetables,
2
while very few mentioned increase in chicken and roti. Rarely mentioned items
3
included pulses, yogurt, rice, eggs, tamarind, coconut, butter and desi ghee. The
reason commonly mentioned for the increased intake of the preferred items was
that they provide strength and produces blood.
Table 8.2: Preferred Foods During Pregnancy
Number of Participants mentioning Preferred Foods in Pregnancy
1
2
3
4
5
6
7
8
Only some (8 out of 24) women and two family members said that there is no
forbidden food during pregnancy (none of the husbands expressed such views),
while the remaining specified foods that were forbidden to maintain health of the6
mother or the fetus. The forbidden foods, predominantly mentioned were badi
foods and included cauliflower, brinjal (eggplant), potato and spinach. This was
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followed by difficult to digest foods (channay ki daal, peas) and vegetables
including brinjal, ladyfinger and cauliflower. Fried items, sour items, stale food,
rice and ghee were mentioned rarely by the participants. The reasons given were
that foods that produced gas could cause abdominal pain and damage the fetus,
difficult to digest and stale food, fried items could cause jaundice an
Table 8.3: Forbidden Foods During Pregnancy
9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26
Fish
Fruit
Milk
Meat
Vegetable
Roti
Chicken
Eggs
Ghee
Pulses
Rice
Yoghurt
Soup
Anis
Seed
Tamarind
Apples, bananas and oranges were the most commonly consumed fruits, while a
4
5
few participants also mentioned eating pomegranate, narangi, cheekoo and
plums. The frequency of intake of fruits and milk is stated to be daily and the
increase ranged from one glass to two glasses per day, while of fish and meat was
stated to be from daily to once a month. A currently pregnant woman in Purano
Dero, while describing the increased intake said: “We cook fish or meat once a
week. I drink a glass of milk and also eat orange and plums daily” (Gosht machlee
khatey hen hum log jasey haftey men ek adh dafa pakta hey zaroor. Dhoodh ka ek
glass rozana peetee hoon or fruit jasey narange or bair rozana khati hoon).
In Mukhi Street, a husband of a currently pregnant woman said: I bring fruits for
my wife daily since she is pregnant. I also bring fish and meat for her, which she
eats once a day” (Meree bivi jab se hamla hay to us ke liye rozana ghar men fruit
ata tha, men ghar walee ke liye gosht machlee bhee ley kar ata hoon, meree bivi
rozana ek martaba khate hey).
Only one woman reported decreased intake of food during pregnancy with the
reason of lack of desire to have food. Also, another woman said that there was no
change in her food intake with no specific reason for not changing the diet.
2. Roti: Jesus bread/flat bread made of wheat
3. Desi Ghee: clarified butter
4. Narangi: a variety of orange
5. Cheeko: a fruit
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A woman with live birth in Purano Dero stated: “(she) should not eat potato and
(other) gas producing items like cauliflower and brinjal as they can cause
abdominal pain” (Aloo na khaye, badee cheezen jasey ghobee ya bangun
wagera ke aurat ke pait men dard na ho jaye).
A husband in Makhdoum Bilawal said: “(She) should not eat cauliflower and
brinjal, these are gas producing items and should avoid fried items as they can
cause jaundice” (Gobi or baingun na khaye, ye badee cheezen hen, tali hui
cheezon sey parhez karey kion ke is sey yarqan honey ka khatra hota hey).
A father in law in Mukhi Street said: “A woman can eat everything in pregnancy,
except those that take longer to digest such as spinach, potato, cauliflower etc.
She is advised to avoid these food items” (Aurat hamal men har cheez kha saktee
hey siwaye asee cheezoon ke jo hazm der sey hotee hen maslan palak, aloo,
ghobi wagera khaney sey aurat ko mana kia jata hey)
Daily routine: Most (19 out of 24) of the women reported that they decreased
their daily workload. All of the urban women (6 out of 6) decreased their daily
workload as compared to rural women (13 out of 18). The initiation of decrease
6. Badi foods: foods believe to produce gas inside the body
7. Channay ki daal: pulse of gram
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in work varied with only very few (3 out of 19) individuals reporting that they
started decreasing their workload from the first trimester and gradually reduced
it to minimum. The work decreased varied from individual to individual, but
mostly reduction was in strenuous work such as lifting of animal fodder, water
buckets, sweeping floors, washing clothes, washing dishes, cooking food,
scaling heights (stairs) and lifting heavy weights etc. Interestingly, almost all of
the women who reported decrease in the workload also said that their female
family members supported them through sharing of household work.
A currently pregnant woman in Makhdoum Bilawal stated: “During pregnancy I
do not lift weight, do not do work related to buffaloes and if unwell, also do not
do household chores. My sisters-in-law live with me and they do all the work”
(Pait ke doran wazan bilkul naheen uthatee, bhains ka kam bilkul naheen
kartee or ghar ke kam bhee agar tabiyat kharab ho to naheen kartee, meree
nanden merey sath rehtee hen to wo sara kam kar letee hain).
All husbands and family members reported that the workload has been/was
decreased during pregnancy. A husband in Mukhi Street while commenting on
this subject said: “I prohibited my wife from working when she became
pregnant i.e. from washing clothes, taking clothes to the roof for drying,
washing dishes, infact from all work and we hired a maid” (Jab meree bivi
hamla hui to hum ney us ko ghar ke kam kaj sey mana kar diya, ghar ke
kaprey dhoney sey, kaprey chat par le janey or sukhaney sey, bartan dhoney
sey hata ke har kism ke kam karney sey mana kar diya or ghar ke kam ke liye
ek masi rakh lee thee).
From the information presented above, it can be concluded that:

Positive changes in life style of pregnant women were reported by all
groups of participants.

Almost all of the women participants reported increase intake of some
type of food, with major increase in foods rich in proteins, vitamins and
calcium.

Some food items, mostly vegetables are forbidden during this period,
especially those believed to produce 'gas' or 'difficult to digest'.

Only one woman reported decrease intake of food due to pregnancy
associated symptoms such as nausea and vomiting.

Most women were also able to decrease their workload, which included all
women participants from urban areas. The participants from Dadu appear
to be relatively well off since there is not only clear reduction in workload
but reports of hiring a maid as well.

Family communication appears to be strong in Dadu with women
reporting that they informed their husbands and family members
(specially mother-in-law) about their pregnancy, reports of family
members (including in one case a father-in-law) playing a role in
increased food intake during pregnancy, and reports of adequate and
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appropriate family help on work related matters so that pregnant women
can reduce their workload.
8.3.3 Perceptions of required health services in
pregnancy, delivery, and postpartum
Pregnancy: Most (34 out of 40) of the participants believed that check up
should be done during normal pregnancy. Majority (32 out of 34) of them
reported a preference for skilled providers namely the doctor/hospital/nurse,
while rarely (2 out of 34) participants suggested seeking health services from
dai. The various purposes identified for seeking health services included:
check up of the status and position of the fetus (ultrasound), weight and blood
pressure of the mother, identification of any abnormality in the mother or fetus,
prescriptions or tablets for “strength” and tetanus toxoid vaccinations.
A currently pregnant woman in Makhdoum Bilawal said: “One must get check
up done to know the stage of pregnancy, the expected date of delivery, to
assess if the fetus is healthy or if there is any other problem, and to get
injections for strength” (Check up zaroor karwana chaye take pata chaley ke
kitney maheeney ka bacha pait men hey or kitney maheeney ke bad ho ga or
bacha sehat mand hey ya koi or masla to naheen or taqt ke injection lagwaney
chayen).
A mother-in-law in Phulji Village said: “(She) should take care of diet and rest,
get check up done from a lady doctor because if anything is going wrong then
she can handle it, and get vaccination done” (Aram or khaney ka khayal
rakhey, doctornee sey check up karwana chaye ke ager koi masla ho jaye to
doctornee sambhal letee hey or teekey lagwaney chaye).
The frequency of visits for check up was suggested by very few (4 out of 34)
and it ranged from 15 days to once in a trimester.
Only some participants (16 out of 40) mentioned about the need for getting
tetanus toxoid (TT) injections during pregnancy.
Several of the participants (25 out of 40) emphasized the need for taking good
diet during pregnancy for ensuring health of the mother and fetus.
More than half (23 out of 40) participants were of the opinion that pregnant
woman should take proper rest during this period.
Delivery: Most (32 out of 40) of the participants stated that the services of a
skilled provider (doctor/hospital/nurse) should be sought for delivery while very
few (7 out of 40) preferred dai for such services as the first choice. All urban
participants mentioned the need for seeking care from a skilled provider in
delivery.
A currently pregnant woman in Purano Dero said: “Delivery should be
conducted at the hospital, (preferably) by lady doctor at Civil Hospital so that
she can handle if there is any dangerous condition” (Delivery hospital men
karwanee chaye, civil hospital men lady doctor sey take agar koi khatrey walee
baat ho to doctornee sambhal ley).
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An educated husband in Mukhi street said: “The woman should take care that
all facilities should be available at the place where she wants the delivery to be
conducted, and it is necessary that the health provider should be trained and
experienced. Besides this, the place should have facilities for medicines and
arrangement for oxygen and blood” (Zichgi ke waqt aurat ko sehat ke hawaley
sey is baat ka khyal rakhna chaye ke jahan zichgee karwayee jaye wahan
sehat kee tamam sahulat majood ho, zichgee karwaney walee tarbiyat yafta or
tajruba kar honee zarooree hey, is ke elawa jahan zichgee ho rahee hey
wahan dawyun kee sahulat majood ho, oxygen or khoon ka bandobast
zarooree hey).
All women, family members and almost all husbands who preferred dai as the
first choice stated that in case she cannot handle then the woman should be
taken to a doctor or hospital. In Phulji Village, a father-in-law said: “The family
members will call the dai when time for delivery comes, and if she fails to
deliver then the woman will be taken to hospital”(Jab bachey kee paidaish ka
waqt aa chukka ho to ghar waley dai ko ley kar ayengey jo bacha paida
karwaye gee agar dai sey baat barh jaye tab usey hospital ley kar jaya jaye
ga).
Postpartum: Very few (5 out of 40) participants said that there is a need to
seek health services from skilled providers (doctor) during the postpartum
period. Few (9 out of 40) of the participants mentioned that the services of dai
are needed mainly for conducting massage in the postpartum period. Half of
the participants were of the opinion that services of a skilled provider
(doctor/hospital) should be sought in case of any complication.
Inference drawn from above is that:

Encouragingly, most of the participants believed that there is need for
seeking skilled health care for normal pregnancy and delivery, and majority
of them expressed the need for check up by a doctor.

The perception regarding the need for TT vaccination is low

Very few participants perceived that there is no need for seeking health
care in case of a normal postpartum period.
8.3.4 Availability of services to women and their
utilization
The health services available to women within community for pregnancy care,
delivery and postpartum care are given in Table 8.4.
Table 8.4: Services Available in the Community for Maternal Care
Purano Dero
(rural)
Dai
LHW
BHU
14
Makhdoum Bilawal
(rural)
Dai
LHW
BHU
Paramedic
Phulji Village
(rural)
Dai
LHW
BHU
Paramedic
Mukhi Street
(urban)
LHW
Private Clinics
Civil Hospital
In Pregnancy: In rural areas, the commonly available health services for
pregnant women within their community are those provided by Dai, LHWs and
BHU. LHV was posted in BHUs at Purano Dero and Makhdoum Bilawal. While,
participants from urban area mentioned availability of LHW, private clinics and
Hospital in the area.
Very few (4 out of 40) participants from rural areas mentioned utilizing the
services of the dai during pregnancy for advice and massage.
Although LHWs were available in all areas but only some (13 out of 40)
participants reported utilizing their services for antenatal care (ANC). This
included availing advice, vaccination and medicine. A currently pregnant
woman of Purano Dero said: “LHW is available and she gives some advice,
pain killers, blood cleaning tablets, and strength giving syrups” (LHW hey wo
hee kuch mashwarey detee hey, dard kee golian, khoon saf karney walee
golian aur taqat ke sharbat bhee detee hey).
The utilization of BHU services for pregnancy was mentioned only by half of
the participants in Purano Dero for TT vaccination and check up. A currently
pregnant woman in Phulji Village stating the reason for not utilizing the
services of BHU said: “This is a government facility but it has no nurse or
doctor and our men do not allow us to go there” (Yeh sarkari hospital hey
magar yahan par koi nurse ya doctornee naheen hey to humarey mard wahan
naheen janey detey).
A paramedic was also identified in Makhdoum Bilawal and is reportedly used
for treatment of minor illnesses.
In urban area, most of the participants reported utilizing the services of Civil
Hospital and private clinics (run by lady doctors or male doctors). The
reported use is for check up and lab tests (urine, blood test, x ray, ultrasound)
and they said that these facilities are used because of availability of female
staff, services (tests etc) and low cost (in case of civil hospital only).
A currently pregnant woman in Mukhi Street said: “Most of the women of the
area go to the Civil Hospital. One reason is that it has many female doctors
and the other is that it is less expensive. Besides, all facilities for testing urine,
blood, X-ray and ultrasound are available” (Yahan kee aurten ziada tar civil
hospital jatee hen, ek to wahan buhat saree lady doctors hotee hen, dosra
wahan kharcha bhee kam hota hey, aurtoon ke sarey test jasey paishab ka
test, khoon, ultrasound, x ray sab kuch yahan ho jata hey).
Delivery: In rural areas, dai was mentioned as the main available service
provider for delivery by 13 out of 18 participants. In case of non-availability of
dai/or any other provider, services of providers outside the community are
sought in these areas.
A currently pregnant woman in Makhdoum Bilawal said: “The dai of the area
conduct most of the deliveries because she comes anytime on call, besides,
she is the elder of the area” (Yahan kee dai he ziada tar deliverian karwatee
hey kion ke who har waqt bulaney par aa jatee hey or phir mohley kee massi
(bare) bhee wohee hey).
15
In urban areas, services of the Civil Hospital and private clinics are being
utilized as mentioned by the urban participants.
In Mukhi Street a currently pregnant woman opined: “All the women of the
area, either rich or poor, get the delivery conducted by doctor and there is no
question of availing the services of dai. Those who cannot afford private
doctors go to the government facilities” (sab aurten chayehn who amir hoon ya
gareeb, delivery doctor sey hee karwatee hen, dai ka yahan swal he naheen
hey han jinko private ke gunjaesh naheen hotee who sarkaree men karwa
letee hen).
Postpartum: Several participants in rural areas mentioned the availability of
the services of the dai for postpartum period. A Dai is mainly sought for check
up, conducting oil massage and prescribing medicine in this period.
In Phulji Village, a woman with live birth said: “Only one dai is available and
she comes if there is any problem in postpartum period. No other facility is
available in our area” (Sirf ek dai hey wo hee aa jatee hey chiley men agar
masla ho to, aur koi sahulat naheen hey idhar).
Participants mentioned that from Purano Dero, it takes 0.5 hour to reach Phulji
Station and 1.5 hours to Dadu City. From Makhdoum Bilawal, Dadu City is at
one hour travel distance. From Phulji Village, Phulji Station is 0.5 hour away
and Dadu City about 1.5 2 hours. From Mukhi Street, it takes 10-15 mins to
reach Dadu City, 3-4 hours to Hyderabad and Jamshoro.
Participants from rural areas mentioned that services in the facilities outside
the community are good and they are availed according to the need and
affordability. Some mentioned that these are used even for normal pregnancy
and delivery. Participants from urban area stated that they have almost all the
facilities in Dadu City and seek help from other cities like Hyderabad,
Jamshoro or Larkana only if a specific complication cannot be managed in
Dadu City.
The specific reasons mentioned for utilizing the services outside community
are:

Insufficient facilities within community. A currently pregnant
woman from Purano Dero, while describing this reason said: “Only
services at Phulji Station are available to us outside community.
Several nurses, female and male doctors are available there and most
of the women of our area go there as no doctor is available here” (Bus
Phulji Station hay, wahan bahut sai nursain, doctornian aur doctor bhi
hain, wahin jati hain yahan ki aurtain zyada tar, kyunke yahan to koi
doctor hay nahin). It is evident that as no female skilled provider is
available in the sampled Phulji area, women are forced to seek help
from outside community.

All types of facilities are available (all levels of doctors, operation
theatre, laboratory, ultrasound, medical stores, etc.). A woman with
live birth from Makhdoum Bilawal, while highlighting this reason said:
“In Dadu City, about half an hour away from our area, government and
private hospitals are present and they have all types of facilities.
These hospitals have facilities of laboratories and medical stores and
that is why many women go there” (Hamaray ilaqay se dour adhay
ghantay kay faslay par Dadu mein sarkari aur private haspatal hain,
aur wahan har tarah ki sahulat maujood hay, in haspatal mein
laboratory aur medical store ki bhi sahuilat hay, is liyae bahut si
aurtain wahan jati hain)

Perceived good quality of care. A husband in Makhdoum Bilawal
while praising the services of Civil Hospital in Dadu City said:
“Treatment is initiated soon after arrival, good care is given, doctors
and medicines are available 24-hours that is why women prefer it. We
also have confidence in it and everybody goes to Civil Hospital”
(Wahan pahonchtay hi ilaj shoro ho jata hay, dekh bhal achi hoti hay,
wahan dawaiyon ki sahulat chobees ghantay maujood hay, doctor bhi
chobees ghantay maujood hotay hain, is liyae aurtain unhi ko tarjih
deiti hain, hum ko bhi un par bahut aitimad hay, Civil Haspatal hi sab
jatay hain).

Free Services. A father-in-law in Purano Dero mentioned that
services outside community are sought, as they are free: “ Dadu City
has a government hospital which provides free treatment” (Dadu
shehar mein haspatal sarkari hay jahan muft ilaj hota hay).
In urban areas, again, the services of Civil Hospital and private clinics of
doctors are being utilized as mentioned by participants but mainly for
complications.
None of the participants mentioned utilizing the services of LHWs in
postpartum and a husband in Makhdoum Bilawal commented about them in
these words: “There is no benefit of LHW that is why women do not go to
them, but they take advice if she comes to home. However, they do not
provide any treatment” (Lady health worker sey koi faeda hey hee naheen to
aurten un key han jatee bhee nahen hen, han agar who khud ghar par aa jaen
to mashwar wagera ley letee hen magar elaj kee sahulat un sey hasal naheen
hey).
Participants in all areas stated that services outside the community are
accessible and these are given in Table 8.5
Table 8.5: Services Available Outside Community for Maternal Care
Purano Dero
(rural)
Private and
government
facilities at
Phulji Station
and Dadu
City
Makhdoum Bilawal
(rural)
Private and
government
facilities at
Phulji
Station and
Dadu City
Phulji Village
(rural)
Private and
government
facilities at
Phulji
Station and
Dadu City
Mukhi Street
(urban)
Public and
private
facilities in
Dadu City,
Hyderabad,
Jamshoro
and Larkana
Despite the positive reasons for seeking services outside of their community
mentioned by many participants, there were very few others who reported that
16
17
not all people utilize health services outside the community. Two mentioned
poverty as the reason for not accessing services outside the community, while
two women stated that their husbands do not allow them to go outside the
community.
mentioned LHW for ANC. The visits to the doctor ranged from fortnightly check
up to three visits during a pregnancy. Among family members, 4 out of 8
mentioned that the women had ANC by doctor, while two stated that she was
attended to by an LHW during pregnancy.
In brief:
According to women participants, half (12 out of 24) of them had deliveries
conducted by a doctor or in hospital. All (6 out of 6) urban women reported
this, while some rural women (6 out of 18) mentioned it. All of these were
normal deliveries, however, one woman mentioned that her previous to last
delivery was conducted by a Dai, who mismanaged the case and the newborn
died.

In rural areas, there is a distinct gap between the desired services for
pregnancy and delivery and those being obtained. Most of the
participants from rural areas perceive that care should be obtained
from skilled providers (doctors) during pregnancy and delivery,
however; only some are able to utilize them.

Health services available to rural women within their community for
pregnancy care are mainly by Dai, LHWs and BHUs. The use of
LHWs by some for pregnancy care points to the utilization of the
formal health system during pregnancy. This could serve as an entry
point for strengthening programs designed to improve demand for
MNH services. However, LHW services are not actively sought if and
when the LHW visits individuals at home they use her for giving
advice. Therefore, less than optimal utilization of LHWs is evident

Non-availability of female skilled providers in BHU is a hindrance in
seeking care from the facility.

The dai is the main available provider for deliveries in rural areas and
is most commonly utilized. The role of the dai extends from delivery to
providing various medical and non-medical types of assistance in the
postpartum period. Given this active and important role that the dai
plays it is probably important to design interventions that utilize the
services of the dai in appropriate ways rather than try to undercut her
presence in the community.

Participants presented a fairly positive picture related to the
availability of services outside their community. This positive picture
related both to the various types of services available as well as the
quality of care available. The utilization of services outside the
community however was restricted to those who can afford these
services or in emergency situations. These findings are pertinent for
messages that seek to promote local services.
8.3.5 Health seeking from skilled providers during
current/last pregnancy, last delivery and last postpartum
Participants were asked to report their personal experiences of seeking care
beyond the level of dai during pregnancy, delivery and postpartum.
A little more than half (13 out of 24) of the women participants reported
seeking antenatal care from a doctor or a hospital during current or last
pregnancy. This trend is higher in urban area (5 out of 6) as compared to rural
areas (8 out of 18).
A woman with live birth from Mukhi Street describing the antenatal check ups
said: “I go to Dr. Zarina every month for check up, who works in Civil Hospital
and also has her private clinic” (Mein doctor Zarina jo sarkari Civil Haspatal
mein hoti hay aur us ka private clinic bhi hay, us kay pas har mahinay check
up kay liyae jati thi).
Many husbands (6 out of 8) reported that their wives visited a doctor, while one
18
A woman with live birth from Purano Dero, while explaining her preference for
delivery by skilled provider said: “My delivery was conducted by Dr. Shehar
Bano and it happened with ease. Delivery should not be conducted by dai, as
doctor can handle if the fetus has breech presentation or gets stuck” (Meri
delivery doctor Shehar Bano nay karwai thi aur delivery aasani se ho gait hi,
dai se delivery nahi karwani chahiyae kyunke agar baccha ulta ya phansa hota
hay tou doctorni sambhal leyti hay).
A mother-in-law from Mukhi Street mentioning her preference for skilled
providers said: “Dai spoils the case, hence delivery should not be conducted
by her”(Dai case kharab kar deti hay, is liyae dai se delivery nahi karani
chahiyae).
Those who sought services from dai (12 out of 24 women and 2 out of 8
husbands) for delivery, preferred her care for different reasons:







They did not have any other health provider in the area
They did not have money to pay skilled providers and other expenses
involved in delivery outside the community
Family members do not like delivery to be conducted outside the
home
Dai conducts deliveries at home which is logistically convenient
Dai is easily accessible 24 hours, while facilities outside community
are 1-2 hours away
Delivery was expected to be normal
Have faith in the dai's competence
A currently pregnant woman in Phulji Village while mentioning the reasons for
the preference for Dai said: “Dadu City is faraway, it takes 1.5 to 2 hours to
reach there and one has to wait for long to get the transport, and also lot of
expenses are incurred. The men here do not care much for their wives, hence
women get the delivery done at home” (Dadu shehar ka rasta bahut hay, dairh
dou ghantay lagtay hain, sawari bhi dair se milti hay aur paisay bhi bahut
kharch hotay hain, yahan kay mard apni biwiyon ka khyal bhi nahi rakhtay tou
aurtain ghar par delivery karwati hain).
A husband in Phulji said: “In our family all deliveries have been conducted by
dai, we do not take the woman outside” (Hamaray yahan bachay dai nay paida
karwai hain, hum bahar nahi lay kar jatay).
None of the women mentioned seeking care in the normal postpartum, and
some (9 out of 24) categorically stated that they had a normal postpartum
hence there was no need. Only two women mentioned seeking care for
complications.
In brief:

Most women from urban area and some of rural areas are seeking
19
care for ANC from skilled providers (doctors).

Contrary to the desire for seeking skilled care during pregnancy, only
some women from rural areas were able to obtain it for themselves,
and even fewer women were able to obtain it for delivery. Most of the
women from urban areas had deliveries by skilled providers.

Cultural norms associated with the mobility of women appear to play a
role in seeking care outside the community with skilled providers.

Very few sought care from skilled providers for normal postpartum
of the woman” (Aurat nay munasib khoorak nahi khai ya kam karnay mein
kami nahi ki, ya araam nahi kya tou us ki zindagi ko khatra hota hay, Khoon ki
kami aur kamzoori aurat ki maut ka sabab ban sakti hay).
Delivery: Only two women and some husbands (3 out of 8) said that they do
not know of any life threatening complications during delivery.
Other participants mentioned 1 to 3 signs, and the most common was
prolonged labor followed by bleeding as seen in Table 8.7.
Table 8.7: Knowledge of Life Threatening Conditions During Delivery
Among Different Groups of Participants
8.3.6 Knowledge about maternal life threatening
complications
Conditions
Pregnancy: About 1 to 4 life threatening conditions were identified by almost
all participants, as two husbands and 1 family member did not mention any.
Bleeding was the most commonly mentioned sign as evident from Table 8.6
Table 8.6: Knowledge of Life Threatening Conditions During Pregnancy
Conditions
Bleeding
Weakness
Deficiency of blood
Abdominal Pain
High/Low Blood Pressure
Headache
Swelling of hands and feet
Bursting of water bag
Fever
Fits
Death of Fetus
Giddiness
Insufficient diet
Swelling of face
Jaundice
Diabetes
Fear
Stress
Asthma
Don’t know
Woman
(24)
Husbands
(8)
Family
Members
(8)
Total
Participants
(40)
14
10
6
6
6
2
3
4
4
4
0
2
0
0
0
0
0
0
1
0
2
2
1
0
0
0
0
0
0
0
2
0
2
0
1
0
1
1
0
2
5
0
2
2
1
3
2
0
0
0
1
0
0
1
0
1
0
0
0
1
21
12
9
8
7
5
5
4
4
4
3
2
2
1
1
1
1
1
1
3
A woman in Mukhi Street while describing life threatening conditions in
pregnancy said: “A woman's life is in danger if she is bleeding heavily, has
weakness, is discharging water (from vagina), has high blood pressure”(Khoon
zyada aa raha ho, kamzoori ho rahi ho, pani aai, blood pressure ho to aurat ki
jan ko khatra ho sakta hay).
Prolonged Labor
Bleeding
Malpositioning of fetus
High Blood Pressure
Early bursting of water bag
Delivery of placenta
before fetus
Retained Placenta
Foul smelling discharge
Dead fetus
Deficiency of blood
Fits
Don’t know
Woman
(24)
Husbands
(8)
Family
Members
(8)
Total
Participants
(40)
21
12
5
2
2
2
3
3
0
1
0
0
4
7
3
0
1
0
28
22
8
3
3
2
1
0
0
0
1
2
0
1
2
1
0
3
1
1
0
0
0
2
2
2
1
1
5
A currently pregnant woman in Purano Dero said “The woman can die if the
placenta comes out first, bleeding does not stop or the fetus gets stuck” (Agar
anwal pehlay bahar a jay ya khoon band na ho, ya bacha phans jay to aurat
mar sakti hai).
A husband in Phulji Village said: “The woman's life is in danger if she bleeds
heavily during delivery, for example 3 bottles (those that come from blood
bank). If the fetus does not come out or dies in womb, then it is also a
dangerous sign” (Zichgi kay waqt aurat ko agar khoon zyada aay to to us ki
zindagi ko khatra hota hai andazay say bahar ho to wo zyada hota hai,
andazan 3 botlain khoon ki ( blood bank wali). Bacha pait say bahar na aay ya
wanhi pait main mar jay to yai bhi khatarnaak ilamat hai aurat ki zindagi kay
liay).
Postpartum: The predominant conditions mentioned by majority of
participants were fever and bleeding. Women and family members mentioned
1-3 conditions, while husbands stated 1-2 conditions. Again, some (3 out of 8)
husbands did not mention any life threatening complications. The details are
given in Table 8.8
A husband, also from Mukhi Street, said: “The woman's life could be in danger
if she has not maintained a proper diet or has not reduced the workload or
does not take rest. Deficiency of blood and weakness could lead to the death
20
21
Table 8.8: Knowledge of Life Threatening Conditions During Postpartum
Conditions
Fever
Bleeding
Body ache
Abdominal Pain
Jaundice
Fits
Weakness
Swelling of genital tract
Don’t know
Woman
(24)
Husbands
(8)
Family
Members
(8)
Total
Participants
(40)
16
14
4
3
0
1
0
0
0
0
2
0
0
1
1
0
1
3
4
3
1
0
2
1
2
1
0
20
19
5
3
3
3
2
2
3
A currently pregnant woman from Phulji Village said: “It is evident that family
member will take me to a hospital in Dadu City if my conditions worsens” (Agar
meri tabiyat bahut kharab ho jai gi tou zahir hay ghar walay haspatal lay kar
jain gay Dadu shaher mein).
Only 5 participants mentioned seeking care from a dai during an emergency
and all of them were from rural areas.
A husband in Phulji Village said: “We call dai and if she cannot handle and
advise, then we take the woman to hospital or BHU” (dai ko bulwatay hain wo
dekhti hay, agar us se baat barhi hoti hay to wo kehti hay to lay jatay hain
haspatal ya BHU).
In brief:
A woman with live birth in Mukhi Street while explaining life threatening
conditions said: “It is life threatening if a woman has fever of 101/102, or
continuous bleeding more than half a cup per day”(Agar aurat ko bokhar ho
101/102 to yeh khatarnak hota hay, aur agar khoon band nahi ho raha hay,
bahut zyada aa raha hay, rozana aadhay cup se zyada, tou aurat ki jan ko
jhatra ho sakta hay).
A husband in Purano Dero while admitting his ignorance said: “ Life and death
is in the hands of God, I do not know what happens, the women must be know
these things ”(Zindigi aur maot khuda kay hath mein hay, ab kya hota hay
mujhey pata nahi, aurat ko hi pata ho ga).

In emergency help is reportedly mainly sought from the doctors/hospital
and it is important to note that doctor, not necessarily hospital is the first
choice for many participants.

Though a significant number of participants are seeking care from the
skilled providers in emergency and are mentioning that they take the
woman immediately on recognition of the complication but it is hard to
infer that at what stage a complication is considered to be serious
enough to take the woman to the doctor/hospital. Given the limited
knowledge of danger signs and discussions by participants suggest that
any decision in this regard is likely to be delayed.
It could be concluded that:

Knowledge of life threatening obstetric complications is limited

Though varied signs were mentioned by participants, the knowledge of
individual participants was low.

Bleeding is the predominantly recognized sign for pregnancy, prolonged
labor and bleeding for delivery, and fever and bleeding for postpartum.

Postpartum appears to be a often neglected area. On the one hand
fewer participants reported the need for skilled care during the
postpartum and at the same time fewer life threatening conditions were
mentioned for this period.

There is some evidence of fatalism whereby life and death are
considered to be based on the “Will of God” hence undercutting the
desire and need to learn more about life threatening complications and
efforts to combat these.
8.3.7 Actions taken during obstetric emergency
Most of the participants (22 out of 24 women, 5 out of 8 husbands and 7 out of
8 family members mentioned that the woman is taken to a doctor/hospital for
an obstetric complication. While some women (9 out of 24) categorically stated
that the women is taken to the hospital for emergency during delivery.
22
8.3.8 Assistance of husbands, family members, health
care providers and community in emergency
situations
Husband: All women stated that the husband plays an important role in
emergency situations. Most (21 out of 24) stated that this assistance is given
by taking the woman to the health facility, while half mentioned arranging
money and some (10 out of 24) said that he arranges for transport. Rarely
mentioned assistance was moral support (2 women) and praying (2 women).
The assistance described by husbands in descending order were arrangement
of money (6 out of 8), taking her to the health facility (4 out of 8), arrangement
of transport (3 out of 8), arrangement of blood (2), and moral support (1 out of
8).
One husband mentioned that he has no role and said: “The woman handles
any problem or complication that arises herself and she herself finds the
solution, we do not have to do anything” (Jab paraishani ya paicheedgi hoti
hay to aurat us se khud nibat leiti hay aur us ka hul bhi wo khood hi nikal leiti
hay, hamain kuch nahi karna parta hay).
Family members mentioned that husband provides assistance by taking her to
the facility (6 out of 8), arranging money (6 out of 8), arrangement of transport
23
(2 out of 8), moral support (1).
Family Members: Several women mentioned that family members can
accompany her to the health facility (14 out of 24) and pray for her (13 out of
24). Few stated that they can take her to the service provider (6 out of 24),
arrange transport (5 out of 24) and money (5 out of 24). Very Few opined (3
out of 24) that moral support can be provided by the family members in this
situation. One woman mentioned that they can bring medicines.
8.3.9 Conclusions
There is more positive maternal health seeking behavior in urban area as
compared to rural areas, both at home and health services level.
The fact that several of the participants pointed to the role of the community as
a whole in arranging for finances bodes well for the establishment of
community financial and other schemes.
Several (5 out of 8) husbands mentioned that family members take care of the
woman; some stated that they give moral support (3 out of 8); and one
mentioned that they can accompany to the hospital.
The issue of moral support at the family and community level is an important
one as it identifies an important albeit intangible role that can be carried out at
a level beyond the spousal dyad.
Family members, while describing their own role stated that they can
accompany the woman (3 out of 8), pray for her (3 out of 8), look after her (2
out of 8), inform husband (2 out of 8). One each mentioned that they can bring
dai at home or arrange transport.
The lack of clear understanding of the overall and comprehensive
responsibilities of health care providers bears consideration. Specific
interventions are needed to establish their roles and responsibilities and
communicate the same to both the providers and the beneficiaries.
Health Care Providers: Most women (19 out of 24), husbands (7 out of 8) and
family members (7 out of 8) mentioned provision of better care by health care
providers through good medicines and treatment, as their assistance. Very few
(6 out of 40) said that they could give good guidance about warning signs and
the place to seek care from in case of complication. One family member
expressed that health care providers give no assistance at all and they are
only interested in their fee.
The Table 8.9 summarizes the findings under theme 8.3
Community: Several of the women participants (13 out of 24) stated that
members of the community can provide monetary assistance. Some said that
they can assist in arranging for transport (8 out of 24), while few mentioned
that they accompany the woman to the facility (6 out of 8) and pray for her (5
out of 24). Very few also mentioned that they can provide moral support (4 out
of 24). In rare instances women said that they can advise about the doctor (2
out of 8) or arrange blood (1 out of 24).
Arrangement of money was mentioned by many husbands (6 out of 8) and
several of the family members (5 out of 8) as the assistance from community
people. Several husbands (5 out of 8) and half of the family members thought
that community can assist in an obstetric emergency through arrangement of
transport. Some husbands (3 out of 8) and one family member mentioned
arrangement of blood in case it is needed. One husband thought that
community people can accompany the woman to the service provider.
Few of the women, husbands (2 out of 8) and one family member said that no
assistance is provided by the community.
On specific questioning, 5 cases of obstetric emergencies were recalled by the
participants from the rural areas and 1 from the urban area. In 5 of these (4
rural and 1 urban), assistance was provided by the community in the form of
arrangement of money and transport, and accompanying the woman to the
hospital.
24
Table 8.9: Key Facilitating and Hindering Factors for Seeking
Maternal Health Care
Facilitating Factors
Hindering Factors
Early recognition
of pregnancy
Unmet need for
family planning
methods
Sharing of the
news with the
husband and
family members
Lack of knowledge
about proper diet
Effort to improve
diet of pregnant
women
Reliance on
traditional beliefs
about “gas
producing” and
“difficult to digest”
foods
Decreasing
workload of
pregnant women
Desire to seek
ANC
Faith in LHWs for
ANC
Effort to seek care
from skill provider
Decreased intake
of some foodstuffs
during pregnancy
Low levels of
access to TT as
well as low
perceived
importance of TT
Reliance on dai for
delivery
Recommendations
Link Maternal
health with the
Family Planning
Program
MNH program
should include a
nutrition component
based on National
Curriculum for
Nutrition
Focus on TT
Maternal health
needs to be
contextualized in
terms of pregnancy,
delivery and
postpartum care. At
this time the
postpartum aspect
is often neglected
Build on the
positive desire of
seeking skilled care
during pregnancy
and delivery to
extend it for
postpartum care
25
Free services in
some facilities
outside the
community
Perceived quality
of care
Evidence of
community
support
Lack of focus on
postpartum care
Limited availability
of skilled providers
within community
Non availability of
24-hour skilled
care in rural areas
Limited knowledge
about warning
signs of obstetric
complications
Apparent delay in
decision making to
seek medical care
(D1)
Inadequate
transport
arrangements or
non availability
(D2)
Improve
knowledge about
obstetric life
threatening
conditions
Incorporate dais in
the program
effectively by
defining their
responsibilities and
educating the
community people
about their role
Focus on
designating roles
and responsibilities
at family and
community level in
obstetric
emergencies
Explore the
possibility of
harnessing
community for
establishing
financial schemes
8.4
Current Health Seeking Behavior for Newborns and
the Key Factors that Facilitate or Hinder these Health
Seeking Practices
8.4.1 Perception of required health services for newborn
Participants identified only three required services, while the other actions
mentioned were home measures that are dealt in the next subsection. These
services are:

Vaccination, which was mentioned by 28 participants that included 23
women, 1 husband and 4 family members. A currently pregnant woman
from Makhdoum Bilawal emphasizing these two measures for newborn
said: “The newborn should be well fed, meaning that mothers milk
should be given and get vaccinations done” (Bacchay ko acha khilain
pilain, yani ma ka doodh pilana chahiyae, aur haspatal se hifazati teekay
zaroor lagwana chahiyae).

Seeking medical care from doctor for any illness was mentioned by 17
participants (10 women, 3 husbands and 4 family members)

Very few participants (1 woman and 3 husbands) stated a need for
check up by a doctor of an apparently normal newborn.
26
8.4.2 Availability of services for newborn and
their utilization
In all rural areas, the services of LHWs and BHUs are available, while the
participants of urban area also had access to Civil Hospital, and private clinics.
The services available to the people in the sampled areas are mentioned in
Table 8.10
Table 8.10: Services Available in the Community for Newborn Care
Purano Dero
(rural)
LHW
BHU
Makhdoum Bilawal
(rural)
LHW
BHU
Phulji Village
(rural)
LHW
BHU
Mukhi Street
(urban)
LHW
Private Clinics
Civil Hospital
LHWs appear to be somewhat active in all the four sampled areas, as only 1-2
participants in each area mentioned some service provided by them, which
included vaccinations, polio drops, advice for the care of the newborn and
treatment of minor illnesses. A husband in Makhdoum Bilawal while describing
the services of LHWs said: In our area, no service is available for the newborn
except LHW. She gives polio drops and vaccinates them, besides this, there is
no other benefit from them.(Hamaray ilaqay mein nai paida honay walay
bacchay kay liyae siwai LHW kay koi sahulat maujood nahi hay, LHW bacchon
ko hifazati teekay lagati hay, polio kay qatray bhi pilati hay, is kay alawa un se
aur kisi cheez ka faida nahi hay). It appears that the LHWs are playing some
role for neonatal health, which needs to be enhanced.
BHUs are being utilized for treatment of newborn illnesses in all the three
areas.
Private Clinics are being utilized for treatment of newborn illnesses in urban
area.
Participants from all rural areas mentioned that services outside their
community are accessible to them, however, in Phulji Village it was
expressed that these services are faraway and expensive, hence only used by
few people. Two participants from Purano Dero also mentioned that seeking
healthcare from outside the community is expensive and only those who can
afford it avail these services. The services identified in each area are given
Table 8.11
Table 8.11: Services Available Outside Community for Newborn Care
Purano Dero
(rural)
Private and
government
facilities at
Phulji Station
and Dadu City
Makhdoum
Bilawal (rural)
Private and
government
facilities at
Dadu City
and Phulji
Station
Phulji Village
(rural)
Private and
government
facilities at
Phulji
Station and
Dadu City
Mukhi Street
(urban)
Dadu City
27
The reasons mentioned for seeking care from outside the community:
women, 3 out of 8 husbands and 7 out of 8 family members).

inadequate services in their community.

Keeping the newborn clean was stated by 23 participants (14 women, 4
husbands and 5 family members).

poor quality of care in the BHUs located in the community. A mother8

Protection from extreme weather conditions was suggested by 19
in-law in Makhdoum Bilawal said: “We have government hospital (BHU)
participants (12 women, 4 husbands and 3 family members).
but it is useless (to go there), they just turn us back without anything or
just check for fever and give tablets which have no effect. Importance

Do not leave the newborn alone was mentioned by 7 participants (6
should be given to the newborn (Sarkari Haspatal hay magar wahan koi
women and 1 family member)
faida nahi hay, aisay hi tarkhatay hain ya bus bokhar dekh kar golian day
deitay hain unka faida bhi nahi hota, chillay kay bacchay ko tou ahmiyat
deni chahiyae).

non availability of medicines in the BHUs. A father-in-law in Phulji
Village said: “There is one government hospital (BHU) in Phulji village
that has one doctor but the medicines are available irregularly”(Phulji
gaon mein aik sarkari haspatal hay, us mein aik doctor hay, wahan bhi
dawain kabhi hoti hain tou kabhi nahi hotein).

all types of facilities are available outside, including child specialists.
A currently pregnant woman from Mukhi Street commenting about
facilities outside the community said: “Several hospitals are there where
child specialist are available. Women take the newborn there as all
facilities are available such as ultrasound, blood and urine test, and
children's wards” (Bahut saray baray hospitals hain jahan bacchon kay
doctor baithtay hain, aurtain wahan lay jati hain, kyunkay har sahulat
maujood hay, jaisay ultrasound, khoon aur paishab test, aur bacchon kay
wards).

Giving gripe water 2-3 times daily was stated by 6 participants (4
husbands and 2 family members), while honey and home remedies,
each were mentioned by 5 participants.

Five participants (3 women and 2 family members) stated, “do not let the
newborn cry”

Three women participants suggested massage of the newborn
A currently pregnant woman in Makhdoum Bilawal while describing steps to
ensure health of the newborn said: We will protect the newborn from cold in
winter and from heat in summer, give vaccinations, advise giving mothers' milk
and also for oil massage daily after bath” (Sardi mein sardi se bachain gay,
garmi mein garmi se bachain gay, aur teekay lagwain gay, ma ka doodh
pilanay ko kahain gay, aur roz nehla kar tail ki malish karain gay).
A husband from Mukhi Street while emphasizing breastfeeding as a measure
to ensure heath said: “To keep the newborn healthy it is important to
breastfeed, (as) mothers milk has lot of strength” (Bacchay ko sehatmand
good quality of care is provided by facilities outside the community. A
rakhnay kay liyae us ko ma ka doodh pilana bahut zaroori hay, ma kay doodh
husband in Makhdoum Bilawal said: “We prefer Dadu as the doctors there are
mein bahut taqat hoti hay).
experienced and 
expert and treatment by them gives immediate and
immense relief” (Hum Dadu ko hi tarjhi daitay hain kyunkay wahan kay doctor
8.4.4 Knowledge About Life Threatening Conditions in
hazrat tajrabakar aur mahir hain, jinsay ilaj karwanay se bacchay ko bahut aur
Newborn
jald faida hota hay).
Discussing personal experiences, several women (15 out of 24) and many
husbands (6 out of 8) reported that they have sought health services for the
newborn from a doctor. Most of them (14 women and 4 husbands) visited a
doctor for seeking treatment of an illness. The problems for which health care
was sought from the doctors for the newborn included fever, flu, cough,
pneumonia, diarrhea, bleeding from umbilical cord, boils.
Several participants mentioned 1 to 4 conditions that could threaten the life of
newborn. Some of the participants (16 out of 40) did not mention any life
threatening condition in newborn (however, there appears to be an interviewer
error and it seems the discussion on this topic was missed as 10 out of 12
women with live birth did not mention any condition). Predominantly stated
were high-grade fever and pneumonia/difficult breathing. The conditions
mentioned are given in Table 8.12.
8.4.3 Steps to ensure the health of the newborn
Almost all participants, except one family member, mentioned a few specific
steps to ensure the health of the newborn. These were:

Breastfeeding, which was mentioned by 33 participants (23 out of 24
8. Several village people refer to Basic Health Unit as Hospital
28
29
Table 8.12: Knowledge of Life Threatening Conditions of Newborn
Conditions
Fever
Pneumonia/difficult
breathing
Diarrhea
Improper feeding
Meningitis
Cough
Abdominal pain
Infected cord
Excessive crying
Pain in ear
Vomiting
Turning Blue
Measles
Fits
Weakness
Not mentioned/Don’t know
Woman
(24)
Husbands
(8)
Family
Members
(8)
Total
Participants
(40)
6
7
4
1
4
2
14
10
3
1
0
1
1
1
2
1
1
1
1
1
1
12
3
1
2
1
0
0
0
0
0
0
0
0
0
2
2
1
0
0
1
1
0
0
0
0
0
0
0
0
8
3
2
2
2
2
2
1
1
1
1
1
1
14
A husband in Purano Dero while describing life threatening conditions said:
“The newborn's life is threatened if s/he gets high fever or meningitis”(Bacchay
ko Agarbokhar ho jai, tez ya gardan tor bokhar, tou us ki zindagi ko khatra
hay).
A currently pregnant woman in Mukhi Street said: “A newborn could die if not
treated for abdominal or ear pain, or difficulty in breathing such as due to cold
or pneumonia” (Agar bacchay ko pait mein kan mein dard ho ya chati band ho
jai, jaisey zukam pneumonia, aur us ka ilaj na kya jai tou wo mar sakta hay).
Despite the error in recording information, it can be concluded that the
knowledge of life threatening conditions is limited among all groups of
participants. Even the two major killer diseases i.e. diarrhea and pneumonia
were mentioned by half or less than half of the currently pregnant women,
husbands and family members and other important warning signs were either
rarely mentioned or not mentioned.
Among husbands, several (5 out of 8) mentioned that in such a situation the
newborn is taken to a doctor or hospital, while one mentioned consulting LHW.
One husband from Mukhi Street stated that home remedies will be tried: “It is
necessary that the newborn is treated with home remedies instead of
medicines, as s/he cannot tolerate strong medicines” (Bacchay kay liyae
zaroori hay kay us ko dawaiyun se ilaj karwanay kay bajai us ko gharelo totkay
say hi theek kya jai, kyunkay baccha bardasht nahi kar sakta dawaiyon ki
taizee).
One husband from Purano Dero expressed his ignorance and said: “What can
I say, I don't know anything, and what is done at that time, how would I know”
(Mein kya bataon, aik to mujhey kuch pata nahi hay, phir us waqt kya kartay
hain, mujhey kya maloom).
Many family members (6 out of 8) also stated that the newborn is taken to a
doctor or hospital in case of such an emergency, except two who did not
mention any action.
Only two cases of newborn emergency were recalled by the women
participants, and in one case assistance was provided by the community. This
was in form of arranging transport and accompanying the family to the
hospital.
8.4.6 Conclusion
The only required health service for a normal newborn identified by several
participants was vaccination to prevent from several diseases. Home care
measures were advocated as steps to ensure the health of the newborn and
many mentioned breastfeeding, several suggested keeping the newborn clean,
while almost half emphasized protection from extremes of weather. But the
knowledge about life threatening conditions is limited, among all groups of
participants and some did not mention taking the newborn to doctor or hospital
even in emergency. The key facilitating and hindering factors in seeking health
care for newborn are summarized in Table 8.13.
Table 8.13: Key Facilitating and Hindering Factors in Health Seeking
Behaviors for Newborn
8.4.5 Actions taken for threat to life of Newborn
Several (14 out of 24) women participants mentioned that they prefer to take
the newborn to a doctor or hospital in life threatening situation (however,
nothing was mentioned by 9 women with live birth again and one currently
pregnant woman, again indicating some interviewer error).
A currently pregnant woman describing actions said: “(We will) get the
newborn examined by the doctor, (and) call the doctor home as newborn is not
taken out of the house in the initial 3-4 days; and still if there is no
improvement then the newborn is taken to the doctor in Phulji Station hospital”
(Usey doctor ko dekhain gay, ghar latay hain kyunkay bacchay ko shoru kay
teen char din ghar se bahar nahi nikaltay, agar phir bhi theek na ho to phir
Phulji lay jatay hain haspatal walay doctor kay pas)
30
Positive attitudes for
seeking vaccinations
Desire to seek
treatment from
skilled providers
Seeking of treatment
from skilled provider
on appearance of
symptoms by
several
Hindering Factors
Recommendations
Belief that child
should not be taken
out of home for first
40 days, and by few
for 3-4 days
Provide basic
information on care
necessary for a
neonate
immediately after
birth and also in the
first 40 days
Lack of knowledge
for check up from
skilled provider
immediately after
birth
31
Accessible services
outside community
Reliance on formal
health care system
in the form of the
LHWs by some
Low knowledge
about life threatening
conditions of
newborn
Limited availability of
skilled providers in
rural areas
Non availability of
24-hour skilled care
in rural areas
Provide information
about warning signs
in newborn
Enhance the role of
LHWs in neonatal
care
Work on improving
the services of
BHUs
Less than optimal
service utilization of
BHUs
Misconceptions
about medicines and
reliance on home
remedies
Those who had engaged in spousal communication mentioned that the issues
discussed included amount of money required, place where delivery should
take place, where to go in case of complications, who will accompany the
woman, transportation arrangements, who will give blood and moral support.
As evident from the above sentences of the participants, some preparations for
birth and complication readiness are taking place in this district.
Almost all participants (23 out of 24 women, 7 out of 8 husbands and 7 out of 8
family members) mentioned money arrangements as the primary
preparation. The amount was mentioned by 7 women, 4 husbands and 1
family member and it ranged from Rs. 1500 to Rs. 35,000, with most
mentioning from Rs. 5000 to Rs. 15,000. This indicates that the amount being
collected is enough to meet the expenses of delivery by a skilled provider or
take care of complications. Some participants mentioned that higher amounts
are arranged if it is known earlier that the delivery will have to be conducted in
a hospital.
8.5
Current Birth Preparedness and Complications
Readiness Behaviors and the Key Facilitating or
Hindering Factors
A currently pregnant woman in Mukhi Street stated: “We have collected Rs.
30,000 to 35,000 as suddenly something could go wrong, hence, my husband
has arranged money so that he does not have to ask anyone” (Hum logon ne
tees se paintees hazar rupay ikhatay kiyae hain, pata nahi kay achanak koi
garbar ho jai tou meray shohar nay paison ka intizam kar rakha hay takay
kisey se mangnay na parain).
8.5.1 Preparations made for birth by woman, husband
and family members
As part of preparation, monetary arrangements are arranged mainly through
9
savings and committee. However, if additional is required in emergency
situations, it is collected through selling of livestock and taking out loans.
Spousal Communication: A mixed picture is seen about spousal
communication and discussions regarding birth preparedness. Several women
(16 out of 24) and only some husbands (3 out of 8) mentioned that they
discussed issues related to delivery with their spouses.
All the women (6 out of 6) from urban area mentioned that they have spousal
communication and the 2 husband interviewed in the area also confirmed it. A
woman with live birth from Mukhi Street said: “(I) spoke to my husband and he
comforted me that there is nothing to worry as, God willing, delivery will
happen without any problem. (I) had registered at the hospital and money was
arranged beforehand” (Shohar se baat ki thi, us ne tasalli di thi kay paraishani
ki koi baat nahi hay, Allah karey ga khairiat se delivery ho jai gi, haspatal mein
naam pehlay se likha hua tha, aur rupay pehlay se hi alag kar kay rakhay huay
thay).
Several women (14 out of 24), some husbands (3 out of 8) and all of the family
members reported that necessary clothes and bedding are prepared for the
infant and few also mentioned these for the mother.
Ten out of 18 rural women mentioned spousal communication while only 1
husband out of 6 from rural area mentioned it. A husband from Purano Dero
justifying no spousal discussion on birth preparation said: “Elders are present
in our family, hence in their presence we younger members do not discuss
anything, whatever is discussed is discussed by them” (Hamaray ghar mein
baray maujood hain tou unki maujoodgi mein hum chotay koi baat nahi kartay
hain, jo kartay hain baray kartay hain).
Nineteen participants, several women (14 out of 24), few husbands (2 out of 8)
and some family members (3 out of 8) mentioned antenatal care as a
preparation for birth. Most urban women (5 out of 6) mentioned it as compared
to half of the rural women.
Again, 19 participants, some women (8 out of 24), many husbands (6 out of 8)
and several family members (5 out of 8) stated that the decision for the place
of delivery is done in advance. Ten of the participants mentioned hospital as
the choice, while the remaining 9 mentioned that it was decided that dai will be
called at home. A currently pregnant woman in Mukhi Street said: “We have
decided beforehand that my delivery will take place in the hospital and have
registered (myself with the hospital)” (humne pehlay se tay kar liya hay kay
meri delivery hospital mein ho gi aur naam bhi likhwaya hay).
Six participants (3 women, 2 husbands and 1 family member) mentioned that
in case of anticipated complications, the provider is discussed in advance and
9. Committee: a system of pooling a fixed amount of money every month in a group. Each
month the pooled amount is given to a person either by a random draw or to the most in
need at that time.
32
33
all of them mentioned doctor/hospital as the choice.
Only 6 out 0f 24 women and none of the family members mentioned any
arrangements for transportation. On the contrary, several husbands (5 out of
8) mentioned that arrangements for transport are made in advance but the
vehicle was not identified. A husband while describing the arrangement said:
“Many inform the transporter a day or two before or take his phone number
and call him when the need arises” (aksar aik do din pehlay sawari walay ko
bata deytay hain ya phir us ka phone number lay letain hain aur jab zaroorat
hoti hay tou usay phone kar kay bula laytay hain).
Only 5 husband participants mentioned prior discussions about arrangement
of blood. These arrangements included identification of donors and also place
for purchasing blood. A husband in Mukhi Street said: “(We) make
arrangements for the blood also, the person whose group meets with that of
the woman is made to stay at the hospital where delivery is taking place”
(Khoon kay bandobast ki bhi tyari kartay hain, jis ka khoon aurat kay khoon se
milta hay tou us ko us din zichgi ki jagah haspatal mein maujood rakhtay hain).
Almost all (22 out of 24) of the women participants mentioned that service
providers helped them in preparation for birth or complication readiness by
providing good care and advice during pregnancy. The care and advice
provided by them included guidance for ANC, diet and rest; medicines for
gaining strength; information about date of delivery, warning signs of
pregnancy, actions if complications occur and preparing clothes for the infant.
Most of these providers were doctors. Two women expressed the opinion that
service providers do not provide any help whatsoever.
Several husbands (5 out of 8) and many family members (6 out of 8) stated
that useful advice is given by doctor.
It can be concluded that discussions about BPCR between wife and husband
and with other family members is fairly good. The key activities taking place
are collection of money, preparation of clothes and bedding for the infant,
antenatal care, selection of place of delivery, arrangement of transport, and
arrangement of blood. The extent to which such discussions can occur in a
systematic and coordinated manner the more successful the BPCR practices
among families would be.
husbands and many (6 out of 8) family members mentioned money as the
major hindering factor in undertaking BPCR practices. However, only some
gave examples of desired actions in case they did have the money. These
actions included: antenatal care from doctor, arrangement of transport,
delivery by doctor or in a hospital and better diet.
A currently pregnant woman from Mukhi Street said: “Everybody wants that
there daughter-in-law or wife remains safe during pregnancy or delivery. That
is why they take her to hospital, feed good food, but the shortage of money
hinders these activities” (har koi chahta hay kay unki bahu ya biwi hamal kay
doran ya delivery kay waqt mahfooz rahey, issey wajah se haspatal lay kar
jatay hain, acha khana khilatain hain, magar paisay ki kami ye sub karnay se
roak sakti hay).
Only some women (11 out of 24) and half husbands and several family
members (5 out of 8) mentioned the non availability of transport in their area,
as a major hurdle at the time of delivery and dealing with the maternal or
newborn emergency. These were mentioned both by urban and rural
participants. A husband from Purano Dero said: “We face hurdles in arranging
transport in our area, It is difficult to find the transport on time when the woman
has to be taken to the city”(Hamaray ilaqay mein sawari kay bandobast mein
rukawat paish aati hay, yahan se agar aurat ko shehar lay jaya jai to barwaqt
sawari mushkil se milti hay).
Some women participants (7 out of 24) and few family members (2 out of 8)
mentioned non availability of the service provider at the facilities as a
significant hindrance. A currently pregnant woman from Mukhi Street said: “If
the doctor is not available at the place where the woman has registered than
the case could get spoiled” (Jahan naam likhwaya hay wahan doctor maujood
na ho tou phir case kharaab ho sakta hay).
Few women (5 out of 24) and family members (2 out of 8) mentioned that
distance from the closest health facility as a hindering factor.
Very few women (3 out of 8), few husbands (2 out of 8) and one family
member mentioned that arrangement of blood could become a hindrance.
Very few women (4 out of 24) mentioned bad roads can also become a
hindrance as it becomes difficult to reach to the health provider on time.
The money being collected is mostly enough to meet the expenses of delivery
by a skilled provider or meet expenditures for complications. Some of this
might have to do with the fact that the participants in this specific sample
appear to be relatively well off.
Very few (3 out of 24) women and one family member referred the noncooperative attitude of husbands and family members as a hurdle in
preparation.
The help from service providers is sought for a variety of actions and is
appreciated. Hence provider related roles and responsibilities can be further
clarified and easily strengthened.
Rarely mentioned hindrances are living in a nuclear family (2 out of 24
women) and absence of husband at the time of obstetric emergency (2 out of
24 women). One family member also expressed lack of knowledge as a
hindering factor.
8.5.2
Hindrances in BPCR
Almost all women (22 out of 24), many husbands (6 out of 8) and all family
members pointed out hindrances in BPCR. Many women (18 out of 24), half
34
35
8.5.3
family members and the participants are entertained with the lunch or dinner.
Conclusions for BPCR:
10
The key facilitating and hindering factors for BPCR and the recommendations
are summarized in Table 8.14
Table 8.14: Key Facilitating and Hindering Factors for BPCR
Spousal
communication as
well as discussions
with family members
about birth
preparation.
Collection of money
for delivery and
complications
Decision making for
place of delivery and
attending provider
Efforts to make
arrangement for
transport
Support from family
members
Good care in
pregnancy by
service providers
Hindering Factors
Recommendations
Not enough money
to prepare for BPCR
Introduction at
home level of
specific topics that
merit discussion at
the spousal level
Lack of perception
that ANC is part of
birth preparation by
some
Limited skilled
female staff in rural
areas
Distance from the
facilities, bad roads
and non-availability
of transport can
cause delay.
Non availability of
service providers at
the facilities
Prior arrangements
for blood by few
Living in nuclear
family
Absence of husband
Lack of knowledge
about the required
actions for BPCR
Introduce
innovative
messages and
materials that
address the real
and perceived
issues related to
the lack of money
as a hindrance to
BPCR
Consider schemes
related to making
transport available
at community level
Advocacy at the
policy level
regarding provider
staffing at the local
level
Clarify roles and
responsibilities of
HCPs and
communicate the
same to both the
providers and
beneficiaries
8.6
Religious and Cultural Practices Surrounding
Maternal and Neonatal Health
8.6.1 Religious/cultural ceremonies
Religious/cultural ceremonies and taboos during pregnancy: Most (21 out
of 24) of the women participants (except one) mentioned that no cultural
ceremonies are performed during pregnancy. The remaining three mentioned
a ceremony named Ghoud Bharayi in the last trimester of the pregnancy. In
this ceremony, people are invited; seven different fruit items are put in the lap
of the pregnant woman; she is given beautiful, new clothes by her parents or
36
Few (5 out of 24) women stated that they take a vow (Mannat man'na) for safe
delivery. For taking vow, they visit a shrine and if the delivery takes place
11
12
safely then a ceremony is held to fulfill the mannat. In this ceremony, Khatum
of Holy Quran is held and sweets are distributed among children or send these
to Mosque for people. In Phulji Village, a currently pregnant woman said: “The
woman take mannat at the place of saints or shrines so that her delivery takes
place safely, as due to the influence (of their blessings) she remains normal”
(Aurat piroon mazaroon par mannat mantee hey take us kee delivery khariat
sey ho jaye kion ke jis mazar ya pir kee mannat mane jatee hey to us pir kee
waja sey aurat ka pait theek rehta hey). It should be noted that many are
against visiting shrine and saints during pregnancy and in case a woman
belonging to this group desire to make a mannat then she sends somebody
13
else in her place. Two women also mentioned the mannat of Das Bibiyan for
safe delivery. In this ceremony, for seven Thursdays, a story is recited among
the group of women and then on the seventh Thursday, sweets are distributed
among the participants.
Only two women said that they hold a religious ceremony of “Khatum” in which
Holy Quran is read by the Moulvi of the mosque in 7th or 8th month of
pregnancy, the Moulvi is asked for praying for the safety of woman and is
given money so that he could buy sweets and distribute or keep this money for
14
the upkeep of mosque. Some (10 out of 24) women said that two Surah of the
Holy Quran are recited during the period of pregnancy, which are Surah Yasin
and Surah Marium for facilitation in delivery or having a normal delivery, and
15
Dum water of these Surah is taken by the women. Few (5 out of 24) of the
women said that they recite the Holy Quran and say their prayers regularly
during this period for the above stated reasons. In Makhdoum Bilawal, a
woman with live birth said: “For nine months, the Holy Quran is read and
16
namaz is offered, and also the water with Dum of Surah Marium is drunk to
facilitate delivery and for safety” (Quran Sharif parhtee hey or namaz or Surah
Marium ka pane dum kar ke petee hey purey no maheeney tak take delivery
men asanee ho or khariate rahey).
17
Two women also mentioned that they recite Durood Sharif and Ayatul kursi
during this period.
Many (6 out of 8) of the husbands and all of the family members stated that no
cultural or religious ceremonies are performed during pregnancy. Two
10. Mannat Man'na: People make a commitment at the shrine that if, by the blessings of the
buried saint, their desire is fulfilled then they will make offerings. These offerings vary and
could be, for example, feeding 100 people at the shrine or holding celebrations at home.
11. Mannat: Vow
12. Khatum of Holy Quran: A group of people gathers to recite different verses of the Holy
Quran and hence read the entire Quran in one sitting.
13. Das Bibiyan: Ten pious women
14. Surah from Quran: Chapters from Quran
15. Dum water: Verses from Holy Quran are read and the breath blown over water in a
container, which is then used for drinking.
16. Namaz: Prayer
17. Durood: Recitation of specific holy verses
37
husbands mentioned ceremony of Goud Bharayi (cultural ceremony) and
Khatum of the Holy Quran (religious ceremony). None of the husbands and
some (3 out of 8) family members pointed out that Surah from the Holy Quran
are recited. These included Surah Marium, Surah Yasin, Alhamd sharif, and
Names of Allah are also chanted. Among the family members who described
various Surah, two said that Surah Marium is recited and Dum water is given
to the pregnant woman in her ninth month for facilitation in delivery.
Several taboos were mentioned by the participants during the discussions
which included persons, places and occasions which pregnant women should
strictly avoid. Some (11 out of 24) women pointed out various places that
should not be visited during pregnancy, which included shrine, graveyard,
walking under trees and deserted places. Some (11 out of 24) women
mentioned occasions that a pregnant woman should not attend, and these
were funerals and weddings. Very few (3 out of 24) women mentioned
18
19
persons should not be met during pregnancy and these were Pirs and Faqirs.
The reason for applying all these inhibitions is that they have bad effect on
20
mother and fetus, could lead to miscarriage, she could be the victim of Saya or
overpowered by evil spirits. Few (5 out of 24) women did not carry such
beliefs.
In Purano Dero, a woman with live birth stated: “Pregnant women is told not to
go under a tree and to funerals so that they do not get any bad influence”
(Darakht ke neecehy na jaye, mayyat men na jaye, pait walee aurat ko mana
kartey hen ke aurat ya bachey ko kuch ho n ajye”
A currently pregnant woman in Makhdoum Bilawal said: “Pregnant women are
not allowed to go to the houses where death has taken place recently and also
not visiting shrines, as it is believed that the fetus dries up in the womb” (Mayat
waley gharoon mein hamal ko naheen janey detey or mazaroon par bhee
naheen janey detey, kehtey hen ke bacha sookh jata hey, pait ke under).
Many (6 out of 8) husbands also mentioned places that should not be visited,
which included graveyard, shrines, and where blood of an animal has dropped.
Two husbands also mentioned persons that should not be met during this
period which included people who have already been over powered by the evil
spirits. Three husbands stated that funeral ceremonies should be avoided by
pregnant woman. The reasons for these inhibitions were mentioned as over
powering of the woman by the evil spirits, miscarriage, weak baby and bad
effects on fetus. Only one husband did not mention any such belief.
Many (6 out of 8) family members also mentioned the need to avoid the
persons listed above, half also mentioned the two occasions stated above and
few gave similar responses about the places to be avoided.
Around the time of delivery: Few (6 out of 24) women participants
mentioned religious practices around the time of delivery while none among
them pointed out any cultural ceremony at that time. All of the above women
18. Pir: Saint who have several hundred followers
19. Faqir: A person who is perceived to have given up all worldly things in pursuit of God
20. Saya: effect of evil spirits
38
mentioned Khatum (recitation of Holy Quran by family members or females of
the community) of the Holy Quran at the time of taking the woman to the place
of delivery.
A currently pregnant woman in Mukhi Street stated: “Quran Khwani (recitation
of the Holy Quran in a group) should be held in home at the time when woman
goes in to labor. Women are called from the neighborhood to recite the Holy
Quran and this leads to delivery without difficulty” (Jis waqt aurat delivery ke
liye jaye to us waqt ghar men Quran Khwani karwayee jaye, mohaley sey
aurtoon ko bulwaya jata hey Quran parheney ke liye to aurat kee delivery
bager mushkil ke hotee hey).
Only two husbands mentioned any religious practice at the time of delivery,
21
among them, one said they say nafal prayer while the other mentioned Khatum
of the Holy Quran. Others did not mention any cultural or religious ceremony at
this time.
None of the family members mentioned any such ceremony or practice at the
time of delivery.
In postpartum: Many (17 out of 24) women, some (3 out of 8) family members
but none of the husbands said that women in postpartum are not allowed to go
outside of the house for a period of 7 to 21 days. Few (6 out of 24) women,
some (3 out 8) of the husbands and two of the family members also identified
places, occasions and persons that should be avoided by a woman during the
postpartum period. These were similar to those mentioned for pregnancy
except two husbands who mentioned that the woman in postpartum cannot go
to her parents and people having contagious diseases. The reasons for such
prohibitions included: she is napak (not clean), could be over powered by evil
spirits, could get hawa and fall victim to Saya.22
A husband in Phulji Village while describing these prohibitions said: “It is a
tradition among Baloch people that we do not allow the women to visit
graveyard during pregnancy or in postpartum so that she may not get affected
by any evil spirit; and also not to any saint's shrine so that she or the baby is
23
not affected by jinns. She is also prohibited to go to houses where death has
occurred, where people have dangerous diseases that can be contracted”
(Hum balochoon men ye rawaj hey ke aurat ko hamal ke waqt ya zichgi ke bad
kabrustan men naheen janey detey hen is liye ke aurat par kisi badrooh ka
asar na parey or na hee kisee buzurgane din ke mazaroon par janey detey
hen ye is liye ke aurat ya bachey par jinnat ka asar na ho, aurat ko aisee jaga
janey sey bhee mana kartey hen jahan mayyat ho gayee ho, aisey afrad jink o
koi khatarnak bemaree ho gayee ho, lagney walee bemari”
21. Nafal Prayers: Namaz offered at will and not linked to the five daily Namaz which are
mandatory.
22. Hawa: Air. Some believed that air drought?? Not sure what air drought means. is not
good for women in postpartum and can cause harm. Various harmful effects are perceived
such as getting pneumonia or even becoming mad.
23. Jinn: A spirit able to appear in human and animal forms and to posses' humans. Belief in
bad effects of Jinn is part of religious faith. Holy Quran confirms their existence and informs
the believer that they can give harm to them, which could include ill health
39
In Makhdoum Bilawal, a mother-in-law said: “A woman in postpartum is not
allowed to go out of the house for 21 days either for any reason be it as happy
or sad event or her illness. Doctor is called at home but she is not allowed to
go” (Chiley walee aurat ko bilkul naheen nikleney detey 21 din tak chahey
khushi ho ya ghume ya bemare ho jaey, doctor ko ghar bulawa letey hen
magar baher naheen janey detey).
Almost all women (23 out of 24), all husbands and family members mentioned
the cultural ceremony of “Chatti” in postpartum period. Mostly this ceremony is
held either on 6th or 7th day of the birth. In this ceremony, relatives and
neighbors are invited for a feast in which a name is given to the newborn;
newborn and mother wear new clothes; the newborn is given a gold ring or a
black thread (to ward off evil eye); singing, drum beating and dancing is held;
rice is cooked in large quantity mixed with the meat of a slaughtered goat and
sweets (or sweet rice) are distributed.
Several (27 out of 40) of the participants said that such ceremony is celebrated
more on the birth of a male child instead of a girl child. Few (8 out of 40) said
that no such difference is made while celebrating the birth of a male or female
child while the rest (5 out of 40) did not mention anything in this regard.
In Purano Dero, a currently pregnant woman said: “What celebration is to be
done for a girl child, nobody feels happy on having a girl, as God gives us so
we have to accept her” (bus larkion sey kia khushi karnee, wasey bhee yahan
ke logoon ka pait bhara hota hey larkion sey (yanee yahan larkion par bilkul
khushi naheen hotee) bus Allah dey dey to lenee partee hey).
In summary, while there are few reported cultural and religious practices the
recitation of specific verses from Holy Quran that correspond to specific times
during the pregnancy and delivery appear to be popular. It is apparent that the
delivery is given importance as Khatum is being arranged especially at that
time. Women are also encouraged to avoid certain people, places and
occasions, some of which has important program connotations. This
underscores the need for using mass media where available and/or relying on
individual interpersonal communication through the grass root workers who
visits home, especially LHWs, as women are restricted to move out during
postpartum.
8.6.2 Preferred and forbidden food items for
breastfeeding mothers
Table 8.15: Preferred Foods for Mothers During Postpartum
Foods
Number of Participants Who Specified Different Preferred Foods
1
2
3
4
5
6
7
8
9 10 11 12 13 14 15
30
Milk
Ghee
Fruit
Meat
Fish
Roti
Chicken
Vegetable
Lassi 24
Pulses
Rice
Dry Fruit
Among forbidden foods, women participants mainly mentioned difficult to
digest food items like channay ki daal, beef, potato, chickpeas, cauliflower,
spinach and guava and badi foods (cauliflower, pulses, lady finger, potato).
Very few women mentioned red chilies not to be taken by the breast feeding 25
woman followed by rarely mentioned items including garam foods, cold foods,
sour items, rice and stale food.
Most of the above stated items are believed to cause abdominal pain to the
newborn that is being breastfed, could cause diarrhea or lead to the newborn
falling ill.
Among husbands, two mentioned badi food including cauliflower and brinjal
while among others, two said that fried items should be avoided by breast
feeding woman, one mentioned rice and another red chilies. Half of the
husbands did not know of any such prohibitions and did not mention any such
items.
Some (3 out of 8) family members mentioned hard to digest food items
including potato, cauliflower, channay ki daal, peas and spinach to be avoided
by the breast-feeding woman because they could cause abdominal pain in her
and the newborn. One said that eating red chilies could lead to jaundice.
Others did not mention any such food items.
The collective information given by all participants is given in Table 8.16.
Milk was the predominant preferred food for mothers among participants,
followed by desi ghee, fruit, meat, fish, roti, chicken and vegetables. Other
items were also mentioned but rarely. The details are given in Table 8.15
24. Lassi: yoghurt based drink
25. Cold foods: foods that are believed to have cold effects in the body
40
41
Table 8.16: Forbidden Foods for Mothers During Postpartum
Food
Number of Participants Who Specified Different Forbidden Foods
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
Cauliflower
Potato
Pulses
Red
Chillies
Beef
Fried
items
Rice
Brinjal
Peas
Lady
finger
Spinach
Radish
Guava
Cold items
Stale food
8.6.3 Precautions taken during postpartum to ensure
safety of mother and newborn
Several precautions were mentioned by the participants and they are
mentioned in Table 8.17 and 8.18
murghi ke shorbey men aslee ghee daal kar roti choori kar ke khilatey hen,
garam dhoodh pilatey hein).
A husband in Phulji Village said: “During postpartum, the woman is not allowed
to work, (and) care is taken of her diet and rest so that she may not face any
problem. In feeds, she is given soft and strength giving items, besides, dai is
called everyday for oil massage on abdomen, while the newborn is massaged
with kneaded flour and olive oil by the mother or any other elderly woman of
the house. Besides this the newborn is kept warm by wrapping him/her in
warm cloth, and the mother and newborn are prohibited from going out for 40
days” (waqt mein aurat ko kam karney sey mana kartey hen, us kee khorak or
araam ka khayal rakhtey hen ta ke aurat ko koi takleef na ho, khorak men
aurat ko naram or taqt walee cheezen khilatey hen, is ke ilawa dai ko har roz
bulwatey hen, who aurat ko tail sey massage kartee hey pait par, jab ke
bachey ko ma ya ghar kee koi baree atey ko gondh kar us men sarsoon ka tail
mila key malish kee jatee hey, is ke ilawa bachey ko garam rakhney ke liye
usey kisi garam kaprey men lapaita jata hey, ma or bachey par chalees din tak
ghar sey baher nikalney par pabandee hey).
Table 8.18: Precautions Taken To Ensure Safety of Newborn
Precautions during
postpartum for safety
of newborn
Table 8.17: Precautions Taken During Postpartum To Ensure Safety of
Mother
Women
(12)
Husbands
(8)
Family
members
(8)
Total
40
Breastfeeding
Do not take outside home
(range 7 to 40 days)
13
8
5
4
4
7
22
19
Precautions during
postpartum for safety
of mother
Women
(12)
Husbands
(8)
Family
members
(8)
Total
40
Cleanliness
Protect from hot & cold
Don’t leave alone
11
8
8
1
3
0
2
1
2
13
12
10
Take good diet
Do not go out (range 7 to
40 days)
Take rest
Don’t leave her alone
Avoid much work/no
work
14
6
6
4
6
5
26
15
Vaccination
Place iron stuff with the
newborn
2
5
2
0
4
1
8
6
0
0
5
3
0
4
2
2
1
13
10
9
Restriction in meeting a
woman with periods
5
8
8
4
3
1
1
5
1
2
0
3
Protect from hot & cold
Cleanliness
Seek care from doctor in
illness
Arrangement of separate
room
6
4
1
0
0
1
1
2
1
7
6
3
Oil massage (sometimes
mixed with flour)
Seek care from doctor in
illness
Tightly wrapped in clothes
0
0
2
2
1
0
0
1
2
0
1
3
Place black mark (til) on
the newborn
Restriction to meet a
woman with periods or is
pregnant
1
0
1
2
Massage by dai
Take supplements
Place iron stuff with her
0
0
1
1
1
0
1
0
0
2
1
1
A currently pregnant woman from Purano Dero stated: “Mother is given good
food, for example clarified butter and pieces of roti are put in the chicken curry
and fed and warm milk is given to drink” (Ma ko acha khana khilatey hen jasey
42
In Makhdoum Bilawal, a woman with live birth said: “Take care of the
cleanliness of newborn, s/he should be immediately placed in a dry place (if
becomes wet) by passing urine, mother should breastfeed and get
vaccinations done, and should be immediately taken to a doctor, if God
forbids, the newborn falls sick” (Bachey kee safayee ka khayal rakhna chaye
agar paishab kardey to foran sookhe jaga par letaye, ma apna dhoodh pilaye
or teekey lagwaye or bacha agar khuda na khawsta bemar ho jaye to doctor
ke pass foran ley kar jana chaye).
43
8.6.4 Feeding of newborn
Almost all (36 out of 40) of the participants mentioned breast milk as the first
item of the intake by the newborn while some (3 out of 8) husbands and one
26
family member mentioned “Duka”, a traditional food for the newborn as first
27
intake. Duka is stated to be composed of butter, cardamom, saunf, baree
28
elaichee (another type of cardamom) and ginger. The reason for giving Duka
was mentioned as it cleans the stomach, avoids diarrhea and
gives strength to
29
the newborn. This is something probably equivalent to “ghutti” as mentioned in
other six districts, but it appears to be not a common practice. A currently
pregnant woman in Makhdoum Bilawal, describing the first feed said: “Mother's
milk is fed as advised by the lady doctor, but if the milk does not flow then
other milk is given. There is no tradition of giving honey or ghutti” (Ma ka
dhoodh hee pilatey hen, bus lady doctor ney kaha hey, han agar dhoodh na
aye to phir ooper ka dhoodh pilatey hen, shehid ya ghutti ka rawaj naheen
hey). Two women said that if mother's milk does not flow in time then either
goat milk or formula milk is given to the newborn as the first intake.
A husband stating the importance of mother's milk said in Mukhi Street: “The
newborn is fed mother's milk as it has more energy then anything else”
(Bachey ko ma ka dhoodh pilaya jata hey, is men sab cheezoon sey ziada taqt
hotee hey).
Besides breast milk, very few (5 out of 40) participants said that they give
honey to the newborn as first intake because it cleans stomach, keeps the
newborn warm and helps prevent flu and fever.
Discussing the first feed of mother's milk, most women (20 out of 24), many
family members (6 out of 8) and only one husband mentioned that it should be
given within the first hour of birth. One each among women, husbands and
family members said that it should be given within 2-4 hours. Two women and
2 husbands mentioned that it is given on third day. The main reason given for
delayed initiation of breastfeeding is that milk flows from the breast after
sometime. One husband and a woman did not give response.
A currently pregnant woman in Purano Dero stated: “Mother's milk is fed within
an hour and then 4-5 times within 24 hours” (Ghantey ke under pilatey hen ma
ka dhoodh or phir 24 ghantoon men 4 sey 5 martaba pilatey hen).
Once initiated, the feeding of breast milk has been mentioned frequently by
most of the participants. Many (18 out of 24) of the women, family members (6
out of 8) and one of the husbands stated that the newborn should be fed on
demand, while very few (4 out of 24) women, many husbands (6 out of 8) and
two family members mentioned that feeding should be done 2-5 times a day.
The remaining (one woman, one husband) said that it should be done 8-12
times a day.
26. Duka: a traditional food for the newborn as first intake composed of butter, cardamom,
saunf, baree elaichee (another type of cardamom) and ginger
27. Saunf: Anis seed
28. Baree elaichee: a type of cardamom
29. Ghutti: mixture given as a ritual first food to newborn and later to soothe the infants
44
In conclusion, the initiation of breastfeeding, feeding of colostrums and feeding
patterns are generally good.
8.6.5 Bathing patterns
Almost all (23 out of 24) women, all family members and almost all husbands
were in favor of giving a bath to the newborn immediately within the first hour
after birth. The remaining woman felt that it should be done within 24 hours
while one husband did not know about it.
In the following days, the frequency of bathing for newborn was mostly stated
to be daily by the three groups, especially in summer where very few thought
that it should be done on every 2nd or third day.
Most (20 out of 24) women and some (3 out of 8) family members were of the
opinion that the mother should take her first bath on the sixth or seventh day.
Three women and one husband mentioned that it should be within 24 hours.
Some husbands (3 out of 8) and two family members mentioned that the
woman should take her first bath after 21 days. While two husbands and two
family members said that first bath should be taken by her on 8th day or after.
Only one women and one family member said that it should be done on 3rd
day. One husband even mentioned after 40 days.
The frequency of bathing of women in postpartum was mentioned by several
(15 out of 24) of the women and half of the family members said that the
woman in postpartum then take bath whenever she desires. Few (6 out of 24)
women, half of the husbands and some (3 out of 8) family members mentioned
daily bath. Two woman said that first bath is taken on 6th day, then on 9th day
and then on 11th day. One woman said that bath should be taken 2-3 times in
the whole postpartum period while two husbands and one family member
mentioned that it should be done twice a week.
It is evident that the first bath of the mother is delayed and there is no clear cut
patterns associated with frequency of bathing of the mother in the postpartum
period. The neonate is often bathed fairly quickly post delivery. Given the
worries associated with “cold” things it is possible that appropriate precautions
are taken to ensure that an optimal body temperature for the neonate is
maintained during the bath. However, what precautions are taken is not clear
and merit further review.
8.6.6 Presence and effects of Nazar (evil-eye)
Most (35 out of 40) of the participants from the three groups, both from urban
and rural areas, believed that nazar exists. Among these participants, many
(31 out of 40) said it affects pregnant woman and woman in postpartum while
most mentioned (33 out of 40) mentioned nazar affecting the newborn
negatively.
Pregnant women: Most of the women (21 out of 24), several (5 out of 8) of
the husbands and family members expressed that nazar has bad effects. The
effect mentioned by all was some kind of illness or the lack of effectiveness of
45
medicines. Variable symptoms were reported that includes lethargy,
headache, fever, and body ache. A woman with live birth in Purano Dero
stated: “A pregnant women can get evil-eye if she is looking beautiful, then she
fells sick, becomes lethargic (and) gets fever” (Nazar lag saktee hey pait walee
ko bhee, agar aurat khubsurat lag rahee ho to nazar lag jatee hey to phir
bemar ho jatee hey, susti ho jatee hey, bukhar ho jata hey).
Women in postpartum: Many (17 out of 24) of the women, several husbands
and family members (5 out of 8 each) stated that women could get illnesses as
a result of nazar in postpartum. These participants mentioned different
symptoms which include headache, fever, weakness, body aches, lethargy
and no effects of medicine. A currently pregnant woman in Mukhi Street said:
“A woman can get affect of evil-eye in postpartum if she looks healthy, then
she will remain sick, headache will start and fever will not go away” (Agar aurat
chiley men sehat mand lagey gee to usey nazar lag saktee hey, phir bemar
rahey gee, sar men dard shoro ho jaye ga, bukhar naheen jaye ga).
Newborn: All of the women (24 out of 24), half of the husbands and several
family members (5 out of 8) believed that the newborn could be affected by the
evil-eye. They said the newborn falls sick because of nazar. The symptoms
mentioned were: newborn cries a lot, stops taking milk and becomes weak.
Measures to protect mother and newborn from Nazar: The measures
mentioned to protect
mother and newborn from nazar are:
30
 Putting tawiz
in
neck
31
 Putting til mostly behind the ears, cheeks or neck
 The mother and newborn should not be left alone
 Placing a black thread in the neck
 Mother should avoid non-family members
 Keep a knife or iron item in the bed
 Recite Surah Yasin
Measures to overcome Nazar in mothers and newborn: Some specific
measures to overcome the effects of nazar were mentioned by all groups of
participants:










32


and is later thrown out
Money or chicken is rotated over the head of the affected and is given to a
deserving or needy person
Dum of Surah Yasin recited by mother-in-law
8.6.6
Conclusion
Some cultural beliefs and practices have positive effects on health, others
have negative effects, while some have neither. The Table 8.19 gives a
summary.
Table 8.19: Positive and Negative Cultural Practices
Positive Practices
Negative Practices
Recommendations
Surah of the Holy
Quran is recited during
pregnancy and delivery
for gaining Allah's
blessings. Hence give
psychological comfort
and strength
Preferential treatment
for male child
Focus on nutrition as an
intervention Early
initiation of
breastfeeding
Milk is given to
breastfeeding mothers
and efforts to give good
diet to mother during
pregnancy and
postpartum
Forbidding mothers
from healthy foods
during pregnancy and
postpartum
The importance of
giving newborn
colostrums should be
stressed
Breastfeeding the infant,
early initiation and
frequent feeding
Restricting the mother
and newborn from going
outside of the house
during postpartum
Might consider
addressing preference
for male children as an
overarching social norm
Protecting mother and
newborn from the
severity of weather
Delayed and infrequent
bathing of the mother in
the postpartum
Optimal and appropriate
bathing patterns for
mothers need to be
promoted and
established
Restricting mother from
undertaking heavy work
Symptoms in mother
like lethargy, headache,
fever, body ache, etc
are related to Nazar .
This could lead to
delayed medical
intervention
Work on highlighting that
measures to overcome
nazar should
simultaneously be
carried out with medical
interventions
33
Dum from Moulvi
Tawiz for the neck
Collect soil from the path traversed by the person who inflicted nazar and
burn it in fire
Treat the affected with smoke of red chilies or salt
Thread tied around a cup full of milk is burned. If the thread burns then it is
believed that person is effected by nazar
A thread is obtained from the one who inflicted nazar, this thread is taken
to the Moulvi for dum and later it is worn by the woman or newborn
Using Dum water
Putting black mark
A glass of water is rotated clock wise and anti clock wise for seven times
Regular bathing of the
newborn
30. Tawiz: amulet
31. Til: a black mark
32. Dum: verses from Holy Quran are read and then the breath air is blown over the individual
or water, which is then used for drinking
33. Moulvi: Imam of the mosque
46
47

Qualitative Formative Research Findings Dadu District

Transcription

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