Following our critical report on research from Bangladesh, which failed to engage with the influence of fathers on attendance at antenatal appointments, another study from Pakistan follows the same pattern.

The researchers investigated barriers to attending antenatal clinics among rural and urban Pakistani women. They interviewed only women and professionals and asked only questions about barriers, not facilitators.

Some women said that their husbands and mothers-in-law were unsupportive, but no data was collected about when these individuals were supportive. Nor did the study explore what difference it makes if family members are better informed.

The study says that health workers claimed the main barrier was husbands and mothers in law. But we have reported here several studies that find that the opinions of health workers are not reliable. A study in Burkina Faso found that husbands are rather similar to the women in what they want. We have reported on similar findings in Ethiopia and Uganda.

The Pakistan study goes on to propose a rather harsh recommendation: an “intervention” to “influence the behaviour of husbands and/or mothers in law”. There is a risk in this approach: if it led to a disrespectful approach to families, it would be likely to be experienced by the woman as disrespectful to herself.

All research into factors influencing antenatal attendance has to recognise that family influences are critical and that they are easily changed by information delivered to families.

Nisar YB Aurangzeb B, Dibley M & Alam A (2016), Qualitative exploration of facilitating factors and barriers to use of antenatal care services by pregnant women in urban and rural settings in Pakistan, BMC Pregnancy and Childbirth 16

Photo: Asian Development Bank. Creative Commons.