Underreporting of stillbirths in Pakistan: perspectives of the parents, community and healthcare providers

There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

Abstract

Background

Pakistan has the highest rate of stillbirths globally. Not much attention has been given so far to exploring the sociocultural factors hindering the reportage of stillbirths and the causes of death. Therefore, the aim of this study was to assess the perspectives of parents, communities and healthcare providers regarding the sociocultural practices and health system-related factors contributing to stillbirths and their underreporting.

Methods

This study used a qualitative approach including in-depth interviews and 14 focus group discussions to collect data from four districts of Pakistan. We conducted 285 in-depth interviews and 14 focus group discussions with health professionals – mainly active in the areas of maternal and child health – and parents who had experienced stillbirth. Constant comparative method and analytical induction method were performed to analyze the data.

Results

The results of this study show that stillbirth is frequently misclassified and, therefore, an underreported phenomenon in Pakistan. It is an outcome of sociocultural practices, such as the social meaning of stillbirth and their understanding about the conflict between cultural and medical anatomy. In addition to grief and psychological distress, it endangers the maternal identity and worth in society in contrast to the mothers of live-born children.

Conclusion

The misclassification of stillbirth, especially by healthcare providers, is a significant impediment to designing preventive strategies for stillbirth. We recommend that the reporting system for stillbirth should be aligned with the WHO definition of stillbirth to avoid its underreporting. Reporting procedures at a more administrative level need to be made uniform and simplified.

Related collections

Most cited references 17

Record: found
Abstract: found
Article: not found

Stillbirths: ending preventable deaths by 2030.

Luc de Bernis, Mary V. Kinney, William Stones … (2016)

Efforts to achieve the new worldwide goals for maternal and child survival will also prevent stillbirth and improve health and developmental outcomes. However, the number of annual stillbirths remains unchanged since 2011 and is unacceptably high: an estimated 2.6 million in 2015. Failure to consistently include global targets or indicators for stillbirth in post-2015 initiatives shows that stillbirths are hidden in the worldwide agenda. This Series paper summarises findings from previous papers in this Series, presents new analyses, and proposes specific criteria for successful integration of stillbirths into post-2015 initiatives for women's and children's health. Five priority areas to change the stillbirth trend include intentional leadership; increased voice, especially of women; implementation of integrated interventions with commensurate investment; indicators to measure effect of interventions and especially to monitor progress; and investigation into crucial knowledge gaps. The post-2015 agenda represents opportunities for all stakeholders to act together to end all preventable deaths, including stillbirths.

0 comments Cited 151 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Stillbirth in developing countries: a review of causes, risk factors and prevention strategies.

Omrana Pasha, Zoë E. McClure, Robert L Goldenberg … (2009)

To understand the rates, causes and risk factors for stillbirth in developing countries as well as the strategies that have been evaluated to reduce stillbirth. We searched the English literature for 2003-2008 for all articles related to stillbirth and perinatal mortality in developing countries and reviewed all related publications. Despite the large number of stillbirths worldwide, the topic of stillbirths in developing countries has received very little research, programmatic or policy attention. In many developing countries, almost half of the deliveries occur at home, and under-reporting of stillbirths is a significant problem. Reliable data about rates and causes are unavailable in many areas of the world. Nevertheless, of the estimated 3.2 million stillbirths that occur yearly world-wide, the vast majority occur in developing countries. Rates in many developing countries are 10-fold greater or more than in developed countries. There is not a standard international classification system that defines cause of death, nor is there agreement about the lower limits of birthweight or gestational age that define stillbirth, making comparisons of causes of stillbirth or rates over time or between sites problematic. From available data, prolonged and obstructed labour, pre-eclampsia and various infections, all without adequate treatment, appear to account for the majority of stillbirths in developing countries. Identification and treatment of maternal syphilis has been effective in reducing stillbirth risk, as has improvements in access to emergency obstetrical services and particularly caesarean section. Further research is needed to understand the causes and the best preventive strategies for stillbirth specific to geographic areas. However, based on current data, better access to appropriate obstetric care, particularly during labour and delivery and better screening and treatment of syphilis should reduce developing country stillbirth rates dramatically.

0 comments Cited 82 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: found

Is Open Access

Perceptions and experiences of using a nipple shield among parents and staff – an ethnographic study in neonatal units

Renée Flacking, Fiona Dykes (2017)

Background Preterm infants have an immature sucking behavior and the capacity to be exclusively breastfed may be reduced for a period of weeks or months, depending on gestational age. Nipple shields have been used, not only as a device to help mothers with sore nipples, but also to facilitate the infant’s latch on to the breast. However, the benefits of using nipple shields have been debated. The aim of this study was to explore perceptions and experiences of using a nipple shield among parents and staff in neonatal units in Sweden and England. Methods An ethnographic study was undertaken where observations and interviews were conducted in four neonatal units in Sweden and England. The data were analyzed using a thematic networks analysis. Result The global theme was developed and named, ‘Nipple shield in a liminal time’. This comprised of two organizing themes: ‘Relational breastfeeding’ and ‘Progression’. ‘Relational breastfeeding’ was underpinned by the basic themes, ‘good enough breast’, ‘something in between’ and ‘tranquil moment’. ‘Progression’ was underpinned by the basic themes, ‘learning quicker’, ‘short-term solution’ and ‘rescue remedy’. Although breastfeeding was seen primarily as a nutritive transaction, the relational aspects of breastfeeding were of crucial importance. These two organizing themes show the tension between acknowledging the relational aspects of breastfeeding and yet facilitating or supporting the progression of breastfeeding in the period from tube feeding or cup feeding to breastfeeding. It is a liminal time as mothers and their infants are “in between” phases and the outcome, in terms of breastfeeding, is yet to be realized. Conclusion This study demonstrates parents’ and staffs’ perceptions of the nipple shield as a short term solution to help initiation of breastfeeding but also as a barrier between the mother and infant. It is important that the mother and baby’s own particular needs are taken into account, in a person-centred way and on an ongoing basis. Furthermore, we need to emphasise the importance of the ‘relational’ whilst understanding the need for ‘progression’. Holding these in balance may be the key to appropriate use of the nipple shield.

0 comments Cited 72 times – based on 0 reviews      Review now

Bookmark

All references

Author and article information

Contributors

Muhammad Zakria Zakar: mzzakir@yahoo.com

Rubeena Zakar: rubeena499@hotmail.com

Mudasir Mustafa: mudasir.sociologist@gmail.com

Aisha Jalil: aisha5@live.com

Florian Fischer: f.fischer@uni-bielefeld.de

Journal

Journal ID (nlm-ta): BMC Pregnancy Childbirth

Journal ID (iso-abbrev): BMC Pregnancy Childbirth

Title: BMC Pregnancy and Childbirth

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2393

Publication date (Electronic): 16 July 2018

Publication date PMC-release: 16 July 2018

Publication date Collection: 2018

Volume: 18

Electronic Location Identifier: 302

Affiliations

[1 ]ISNI 0000 0001 0670 519X, GRID grid.11173.35, Department of Sociology, Institute of Social and Cultural Studies, , University of the Punjab, ; Lahore, Pakistan

[2 ]ISNI 0000 0001 0670 519X, GRID grid.11173.35, Department of Public Health, Institute of Social and Cultural Studies, , University of the Punjab, ; Lahore, Pakistan

[3 ]ISNI 0000 0001 0944 9128, GRID grid.7491.b, Department of Public Health Medicine, School of Public Health, , Bielefeld University, ; Bielefeld, Germany

Article

Publisher ID: 1924

DOI: 10.1186/s12884-018-1924-9

PMC ID: 6048905

PubMed ID: 30012104

SO-VID: 05abd439-a4de-416b-9ea3-50bc59b4c5d0

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 4 January 2018

Date accepted : 27 June 2018

Funding

Funded by: Care International

Custom metadata

ScienceOpen disciplines: Obstetrics & Gynecology

Keywords: stillbirths,pakistan,gestational health,cause of death,underreporting

Data availability:

ScienceOpen disciplines: Obstetrics & Gynecology

Keywords: stillbirths, pakistan, gestational health, cause of death, underreporting

Underreporting of stillbirths in Pakistan: perspectives of the parents, community and healthcare providers

Read this article at

Abstract

Background

Methods

Results

Conclusion

Related collections

Advocacy for Maternal and Women’s Health

Most cited references 17

Stillbirths: ending preventable deaths by 2030.

Stillbirth in developing countries: a review of causes, risk factors and prevention strategies.

Perceptions and experiences of using a nipple shield among parents and staff – an ethnographic study in neonatal units

Author and article information

Contributors

Journal

Affiliations

Article

History

Funding

Categories

Custom metadata

Comments

Comment on this article

Similar content 313

Cited by 14

Most referenced authors 717