Addressing disparities in maternal health care in Pakistan: gender, class and exclusion

Background: After more than two decades of the Safe Motherhood Initiative and Millennium Development Goals aimed at reducing maternal mortality, women continue to die in childbirth at unacceptably high rates in Pakistan. While an extensive literature describes various programmatic strategies, it neglects the rigorous analysis of the reasons these strategies have been unsuccessful, especially for women living at the economic and social margins of society. A critical gap in current knowledge is a detailed understanding of the root causes of disparities in maternal health care, and in particular, how gender and class influence policy formulation and the design and delivery of maternal health care services. Taking Pakistan as a case study, this research builds upon two distinct yet interlinked conceptual approaches to understanding the phenomenon of inequity in access to maternal health care: social exclusion and health systems as social institutions. Methods/Design: This four year project consists of two interrelated modules that focus on two distinct groups of participants: (1) poor, disadvantaged women and men and (2) policy makers, program managers and health service providers. Module one will employ critical ethnography to understand the key axes of social exclusion as related to gender, class and zaat and how they affect women’s experiences of using maternal health care. Through health care setting observations, interviews and document review, Module two will assess policy design and delivery of maternal health services. Discussion: This research will provide theoretical advances to enhance understanding of the power dynamics of gender and class that may underlie poor women’s marginalization from health care systems in Pakistan. It will also provide empirical evidence to support formulation of maternal health care policies and health care system practices aimed at reducing disparities in maternal health care in Pakistan. Lastly, it will enhance inter-disciplinary research capacity in the emerging field of social exclusion and maternal health and help reduce social inequities and achieve the Millennium Development Goal No. 5

It’s not the size, it’s the relationship: from ‘small states’ to asymmetry

Debate about the definition of “small state” has produced more fragmentation than consensus, even as the literature has demonstrated its subjects’ roles in joining international organizations propagating norms, executing creative diplomacy, influencing allies, avoiding and joining conflicts, and building peace. However, work on small states has struggled to identify commonalities in these states’ international relations, to cumulate knowledge, or to impact broader IR theory. This paper advocates a changed conceptual and definitional framework. Analysis of “small states” should pivot to examine the dynamics of the asymmetrical relationships in which these states are engaged. Instead of seeking an overall metric for size as the relevant variable—falling victim in a different way Dahl’s “lump-of-power fallacy,” we can recognize the multifaceted, variegated nature of power, whether in war or peacetime

New Forms of Development: Branding Innovative Ideas and Bidding for Foreign Aid in the Maternal and Child Health Service in Nepal

Nepal has been receiving foreign aid since the early 1950s. Currently, the country’s health care systemis heavily dependent on aid, even for the provision of basic health services to its people. Globally, the mechanismfor the dispersal of foreign aid is becoming increasingly complex. Numerous stakeholders are involved at variouslevels: donors, intermediary organisations, project-implementing partners and the beneficiaries, engaging not onlyin Nepal but also globally. To illustrate how branding and bidding occurs, and to discuss how this process hasbecome increasingly vital in securing foreign aid to run MCH activities in Nepal

Graduate Student Perceptions of College of Education Culture and Climate

This study queried graduate student perceptions of, and experiences with harassment and discrimination in a college of education (COE). The study employed inclusive sampling, targeting all graduate students enrolled in COE classes from fall 2000 to summer 2006. One hundred and ninety-three surveys were completed and returned (12% response rate). While findings revealed relatively low incidences of harassment (26 incidents or 13.5%) and discrimination (27 incidents or 14%) within the COE; with oral remarks, in terms of insensitive or disparaging comments, perpetrated by faculty and students, within COE classrooms, the most frequent form of harassment/discrimination observed and/or experienced; this study contributes yet another example of data-driven evidence regarding the ongoing need in higher education settings for organizations and individuals to act with intentionality and purpose to ameliorate persistent harassment and discrimination.</jats:p