BackgroundUptake of family planning services in Pakistan has remained slow over the past decade despite a rapid increase in availability and awareness, indicating that social barriers may be preventing uptake. Social barriers such as opposition by family members have largely been studied qualitatively; there is a lack of quantitative evidence about the effect of different family members’ opposition on women’s intention to use contraceptives. The objective of this study was to quantitatively evaluate the effect of family members’ opposition to family planning on intention to use contraception amongst poor women in Pakistan who have physical access to family planning services.MethodsAn unmatched case control study (nested within a larger cohort study) was conducted in two public hospitals in Karachi, Pakistan. Univariable and multivariable logistic regression analyses were conducted to compare risk factors between women that were not intending to use any contraceptive methods in the future (cases) and women that were planning to use contraceptive methods (controls).Results248 cases and 496 controls were included in the study. Negative contraceptive intent was associated with no knowledge of contraception (AOR = 3.79 [2.43-5.90]; p < 0.001), husband’s opposition (AOR = 21.87 [13.21-36.21]; p < 0.001) and mother-in-law’s opposition (AOR = 4.06 [1.77-9.30]; p < 0.001).ConclusionsThis study is the first to quantitatively assess the effect of opposition by different family members on women’s contraceptive intent in Pakistan. Our results indicate that of all family members, husband’s opposition has the strongest effect on women’s intention to use contraception, even when the women have knowledge of and physical access to family planning services.

Background Pakistan stands along top ten countries responsible for two-third of global child mortality burden. To improve Child Mortality (CM) estimates in Pakistan, there is an exigent need to understand the in-depth reasoning behind mortalities. In Pakistan, the data on cause-ofdeath (CoD) for a large number of child mortalities in Pakistan is either not available or not suitable for use. Pakistan uses an alternative technique called Verbal autopsy (VA). Since VA only determines the biological cause of death (BCoD), and does not capture multitude of other modifiable social, cultural and health system determinants, it has a limited importance. Such non-biological determinants are captured by another technique i.e. Social Autopsy (SA). Objective By integrating VA with SA, extended set of mortality related determinants will be explored, in addition to strengthening death notification coverage and assigning CoD in such missed out mortalities. Method Under the working group of Health Advocacy Council for Women and Children (HACWC) in collaboration with Child Registry of Pakistan (CROP), mixed method (QUAN-QUAL) interventional study will be carried out in urban-slums of Karachi city using VASA-integrated under-five mortality investigative technique. Parents of dead children will be interviewed. Second stage of study will be followed by qualitative interviews with different cadres of stakeholders. Expected Outcomes By focusing the specific determinants related to case-management and care-seeking process (identified by The Pathway to Survival Framework-TPtoSF) an in-depth understanding of related determinants can be achieved, which will help in crafting potential interventions required to limit the barriers that increase the chances of CM in developing nations.

Over the last two decades, obstetric fistula has rightly gained some prominence as a public health issue. It has been a rocky road, with each step along the path bringing positives and negatives: one step forward, two steps back. Thankfully the end result has been overwhelmingly positive.The increased awareness of obstetric fistula first led to an increase in the availability of funds to help women with the condition, which in turn led to more people performing fistula surgery. All good. However, a small group of people took, and still take, advantage of the funds and perform surgery without adequate training, leading to unnecessary breakdowns and complications, which ultimately increases the suffering of these women, rather than decreases it. In response, FIGO (the International Federation of Gynecology and Obstetrics) founded a standardized global fistula training program that enables many surgeons to be trained in the latest techniques and thousands of women with obstetric fistula to access quality surgery.The surgical community has looked more closely at the outcomes of fistula repair and exciting new techniques have been developed to improve continence rates with a closed fistula and ways to improve sexual health. Twenty years ago, ongoing incontinence rates despite fistula closure were often overlooked and categorized as too difficult to rectify. We are now getting many more of these most severely injured women fully continent thanks to some exciting developments, but there is still much room for improvement. Likewise, novel techniques of vaginal reconstruction have also enabled women to resume a sexual life.The Millennium Development Goals sought to decrease maternal death and disability. Although we've seen a two-thirds reduction in maternal deaths in Africa and Southeast Asia-the areas where obstetric fistulae occur in greatest numbers-more needs to be done. We hope that the Sustainable Development Goals will continue to make improvements to maternal health and indirectly to obstetric fistula.In December 2018, the UN General Assembly made a call to end fistula by 2030, eliminating obstetric fistula within a decade. Soon after the announcement an initial planning meeting was held with members of the International Society of Obstetric Fistula Surgeons (ISOFS) and the plans to achieve this continue to evolve. This is indeed a noble and ambitious task and we hope that it will propel positive action; however, action needs to be directed. All too often we have seen wealthy donors wanting to help by giving expensive equipment that has wasted millions of dollars investing in high-tech ideas when the problems and solutions are far more basic. The overwhelming and daily frustrations such as having water, gloves, medicines, and sutures available in hospitals, and educating communities on women delivering in a hospital, either at no cost or greatly subsidized, need to be funded first. These basics are what eradicated fistula from highresource countries over 100 years ago, not expensive, complicated systems and techn...

Background: Disorders related to hypertension in pregnancy, mainly Pre-eclampsia (PE), and Eclampsia, are the major causes of fetal and maternal morbidity and mortality. The placenta's ischemic blood supply leads to its endothelial dysfunction and reduced glutathione bioavailability involved in its pathogenesis. This study explored maternal serum Glutathione's level and changes and found out its association with fetal growth in pregnancy-induced hypertensive disorders. Methodology: A Multicenter, case-control study was conducted on 240 pregnant females. The investigational group included 180 pregnant females having blood pressure above 140/90 mmHg. The Investigational group was divided into different groups, i.e. Pregnancy-induced hypertension (PIH) group, PE group, and Eclamptic group. 60 normotensive pregnant females were kept in control. The blood samples were obtained to analyze serum Glutathione (GSH) through ELIZA (enzyme-linked immunosorbent assay), while urine samples were obtained for confirmation of the PE status. Fetal well-being and signs of growth restriction were observed using ultrasound. Results: A significant reduction was elucidated in serum glutathione, biparietal diameter, and femur length among all experimental groups p < 0.001. However, no significant difference was observed in the abdominal circumference p=0.122 and Fetal weight p=0.51. A significantly inversely proportional relation was found between serum glutathione and gestational age, fetal weight as well as head circumference in all four groups control (r =-.305 p=0.018) PIH (r =-.618 p =0.000), PE (r=-.707 p=0.000) and Eclampsia (r=-.661 p=0.000). Conclusion:It is to conclude that the fetus's growth was markedly affected by reduced Glutathione in hypertensive disorders of pregnancy with the progression of the disease.

Study was an interview-based cross-sectional survey with an objective of investigating if there are any social or cultural factors present in rural areas, which makes it difficult for women living in these communities to seek proper health care services. The subjects of this study were rural women who came to receive treatment for their gestation and related complications at Koohi Goth Hospital in Karachi, Pakistan. The variables that were explored included the level of education, socioeconomic status, social/family support, and level of awareness regarding proper birth care. Data collection included interviewing these women who were admitted to the outpatient department (O.P.D.) of the hospital and asking them questions concerning these variables. Much of the participants who were included for the study were conceiving for the 3rd and 4th time and they were in 3rd week of gestational period. The result of this study showed that women living in the rural areas were less educated due to their low socioeconomic status. Disproportionate number of women claimed that learning about maternal health and related issues were never included in education they received.