© 2016 Marina Bakanova
Abstract: The article analyzes gender and socio-psychological factors which influence the emergence of iron-deficiency anemia among women in South Asia (using the example of Pakistan). The author suggests some possible ways of solving this problem, including the need to study cultural and gender differences of people in the area, since these differences can significantly affect lifestyle habits and compliance to medical treatment.
Key words: medical anthropology, sociology, psychology, organization of medical care, public health, South Asia, Pakistan, traditional society.
Relevance of research
Iron-deficiency anemia is an acute problem of contemporary population of South Asia, particularly widespread among women. More the 90% of them suffer from this disease (some in latent stage), and it is hardly treated by routine methods of therapy. Treatment provided in accordance with international, European or North-American standards does not have significant effect on South Asian women.
This research is relevant for two reasons. Firstly, many immigrants from South Asia are coming to Europe and North America these days. These migration waves bring their distinct cultural trends. They create their own enclaves adhering to their own traditions and culture. These should be taken into consideration to provide them effective medical care. Secondly, there have been an increase in natural and man-made disasters in South Asia recently, and many rescue teams come from Europe and America to provide medical care to victims. These doctors often times have different cultural background and training, and may not treat locals effectively.
The population of South Asia (which includes India, Pakistan, Nepal, Bhutan, Bangladesh, Sri Lanka, and in some cases Afghanistan) is peculiar in that it still upholds cast and tribal systems; elements of medieval and Victorian style. It is also characterized by multi-national and multi-religious make-up. It is important to understand how these features influence provision of healthcare and treatment of patients.
The drugs which are currently used to treat and prevent iron-deficiency anemia in South Asia are consistent with international standards and criteria. However, their efficiency is low, and, according to our hypothesis, the reasons for that lie in the plane of cultural differences.
Results and discussion of the research
In toto, we have analyzed 13 socio-psychological factors which influence the occurrence and treatment of iron-deficiency anemia in this group.
The most significant role was attributed to 7 of these factors. In 100% of cases women do not go through preventive medical examination; most people go to see a doctor only after the onset of symptoms. There are also no blood banks. Few American pharmaceutical companies store blood products, but they are very costly. Lack of preventive check-ups leads to the fact that iron-deficiency anemia in latent or light stage is barely possible to identify, so it’s often discovered when a patient visits a doctor for some other condition.
In 92.22% of cases the women of reproductive age are coming from large families; note that for the previous generation of women it was normal to have 10-15 children. This means that the health of our participants was compromised in intrauterine period or at the early age.
In addition, in 100% of cases locals use alternative medicine and a system of prayers and incantations which differ according to the region. As a result, the state of health temporarily improves (as a suggestion effect), but the disease progresses.
In 99.84% of cases boys were observed to be in a more privileged position than girls (in the rest of the families there were no male kids or they died at early age).
In general, it is worth addressing in more detail the issue of gender priority which is characteristic of most countries of South Asia. For European or Russian society, gender inequality is a remnant of the past, but in South Asia it is sad reality. So, in 90-95% of cases boys receive a better and more balanced diet; in 90-100% of cases they study in prestigious schools and receive better (of higher level) education than girls. 80-85% of boys have received more timely and better treatment; in 60-65% of cases they were bought more expensive drugs. Especially strong this gender inequality is noticeable in families with minimum boys (1-2 sons) and in poor families with low level of education (or without it).
In 94.05% of cases pressure from the husband’s side of the family was observed. In South Asia in most cases a young wife moves to her husband’s home after the wedding and lives with his family. Since that time, all questions about her health, the need to consult a doctor, and take medication will not be decided by herself, or even by her husband, but by her mother-in-law and other women who are “older than her by status.” An exception is possible only when she visits her old family and goes to the hospital with her mother or other blood relatives; the second case is when a family has very high income and good education and lives according to the European model. Even the so-called “closely related” or “cross-cousin” marriages do not guarantee that the bride will be treated well in the husband’s family. For this reason, many women go to hospital only in difficult situations (noted in 53.62% cases). The same reasons stand for the fact that in 29.92% of cases prescribed drugs are simply not purchased or fully consumed.
In 98.11% of cases it is common to quickly conceive a child (if possible immediately after marriage) and give birth to several children one by one (at the moment, the most popular model is a family with 3-5 children; if there are no boys, women give birth until the son is born) with minimum intervals of 1-3 years. Thus, even if at the beginning of her reproductive cycle a woman was in a state of latent iron-deficiency anemia or suffered a mild degree, by the end of the cycle she often finds herself in a state of severe anemia, especially if no treatment was provided.
The somewhat less important are other factors. 74.22% of women have a low level of education or do not have it at all. In a more or less stable fashion, girls started to attend schools only from the beginning of the XXI century. Thus, they can not fully appreciate the scientific and medical justification for the necessity of taking medications, and even get aware of this problem. The explanation considering education level of the patient should be provided.
In 71.58% of cases the additional cause of iron-deficiency anemia is cesarean section, many of which are conducted without proper justification. They cause more blood loss (compared with normal births), which is not compensated for later on, but, on the contrary, is aggravated during lactation or subsequent pregnancy (in my practice the shortest period between cesarean section and a new pregnancy became 1 month).
66.28% of women have average income which affects their diets and drugs’ purchase. The best diet in a family (containing more meat) goes to males.
A peculiar variant of treatment of the iron-deficiency anemia in Pakistan is transfusion of whole fresh blood. It is an elitist, costly procedure. De-facto, civilized world abandoned it long time ago. This variant of treatment is used in 39.73% cases, generally to prepare a woman with severe anemia before c/section, or when post-operative severe blood loss takes place. A donor in such situations becomes a close relative with the same blood group who is tested for hepatitis B and C, for HIV and for compatibility. Of course, under local conditions it is impossible to accurately check the blood for viruses and often blood transfused in this way is the source of infection.
According to the research, the following factors have the greatest impact on the development of iron-deficiency anemia among South Asian women: lack of prevention; absence of blood banks; treatment with alternative methods; large families of the last generation; gender priorities; influence of the husband’s family on the possibility of receiving medication; short interval between pregnancies. At the level of individual hospital, only the last two of them can be adjusted. The rest can be changed thanks to changes in state policy and cultural (gender) behavior.
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