Socio-Cultural Discourse on Female Reproductive Rights (A Case Study of Pothohar Village, District Attock) Dissertation submitted as fulfillment of the award of the degree Doctor of Philosophy in Anthropology at the Quaid-i-Azam University, Islamabad BY Aneela Sultana Department of Anthropology Quaid-i-Azam University, Islamabad, Pakistan 2017 i Socio-Cultural Discourse on Female Reproductive Rights (A Case Study of Pothohar Village, District Attock) Summited By: - Aneela Sultana Ph.D. Scholar, Department of Anthropology Quaid-i-Azam University, Islamabad Supervisor: - Prof. Dr. Hafeez-ur-Rehman Department of Anthropology Quaid-i-Azam University, Islamabad Department of Anthropology Quaid-i-Azam University, Islamabad, Pakistan 2017 ii Dedicated to the dreams of my loving father iii ACKNOWLEDGEMENTS First of all I would like to thank Allah, All Mighty, the most Beneficent and Merciful, Who by His Grace bestowed me with the ability, courage and means to complete this piece of work. It would not have been possible without His blessings and approval. Great acknowledgement is extended to my thesis supervisor Prof. Dr. Hafeez-ur-Rehman whose guidance, support and encouragement made it possible for me to complete the arduous process of writing this dissertation. He enabled me to think critically about my work and his insightful comments and valuable feedback helped me to review my work again and again. I deeply appreciate his help and support through tough times, personal and professional, during this entire journey. I would like to thank my foreign referees Dr. Werbner and Dr. Spooner for their comments and appreciation that helped me to proofread my work. Enormous thanks goes to Dr. Saadia Abid, Incharge Department of anthropology and Dr. Waheed Chaudhry for all their kindness and cooperation. I am also thankful to other Faculty Members and Colleagues of Anthropology Department for their cooperation and encouragement. I would like to acknowledge the support that I received from other staff members Rafique Sahib, Mr. Khalid Tanveer, Sajjad, Basir, Aftab and Shahzada Aftab. I am deeply indebted to my family, especially my parents for their unconditional support, continuous prayers and love. I would never be able to thank them enough for investing in my life and bringing me close to my dreams. It is difficult to express in words how much they have contributed to make me the kind of woman I aspire to be, their unwavering support has helped me to become what I am today and I owe my every success to them. I also appreciate the contributions of my husband Imran Aslam and other family members in the completion of this task. My heartfelt gratitude goes to my sincere friend Dr. Sadia Saeed for her moral support throughout this dissertation writing. Last but not the least, I am also profoundly thankful to my key informants and host family who assisted me during my data collection. Their enthusiasm, kindness and interest in the subject made it a pleasure to work with them. Undoubtedly, they deserve a special mention. I owe heartfelt thanks to my maid Ruqayya for her help, limitless encouragement and above all for showing real curiosity about finalizing my dissertation. Shortly, I want to thank all my well-wishers who understand me, pray for me and encourage me whenever I accomplish any goal. Aneela Sultana iv ACRONYMS AAA American Anthropological Association BHU Basic Health Units CEDAW Convention on the Elimination of All Forms of Discrimination Against Women CPR Contraceptive Prevalence Rate FPAP Family Planning Association of Pakistan FWCW Fourth World Conference on Women IUD Intrauterine Device ICPD International Conference on Population and Development ICESCR International Covenant on Economic, Social and Cultural Rights ICCPR The International Covenant on Civil and Political Rights ICASC International Campaign on Abortion, Sterilization and Contraception LHW Lady Health Workers LHV Lady Health Visitor MMR Maternal Mortality Rate MNCH Maternal, Neonatal and Child Health NGO Non-governmental organization NIPS National Institute of Population Studies PHC Primary Health Care PDHS Pakistan Demographic and Health Surveys TV Television UN United Nations UNDP United Nations Development Programme UNFPA United Nations Population Fund UNICEF United Nations International Children's Emergency Fund WHO World Health Organization WPPA World Population Programme of Action. v ABSTRACT This thesis mainly explores the association between the socio-cultural context and women‘s perception and practice of their reproductive rights. Meeting reproductive needs of rural women living in a traditional culture of Pakistan is no less than a challenge where sexuality is a taboo subject. There is little known about the sexual and reproductive practices and behaviour of women. The issues pertaining to female‘s reproductive rights remain unacknowledged at the policy level and lack implementation. Studies that were conducted In Pakistan before had mostly focused on the issues of maternal health from the service delivery aspect and very few attempts have been made to empirically assess linkages between socio-cultural factors and Reproductive Rights. In order to have a clear picture of the state of females reproductive rights, this study was conducted in village Choha Shah Ghareeb of District Attock, in the Province of Punjab with the prime objective to understand the perception and practices of reproductive rights among females of the reproductive age group (15-49 years). The study employed anthropological methods including participant observation, in-depth interviews, illness narratives to provide a comprehensive analysis of reproductive with an emic perspective. The study explored their participation in Fertility Decision Making and utilization of reproductive health services such as antenatal care, delivery and postnatal care. Furthermore, it investigated those traditional practices which affect female‘s reproductive rights such as early marriages, inability to access modern health care facilities, nutritional taboos, consequences of infertility, son preferences and unsafe induce abortion etc. The study elaborated key aspects linked to the notion of female sexuality and fertility. The findings show that socio-cultural norms inhibit discussion related to sexuality and reproductive health and young girls‘ receive little information about puberty prior to menarche which becomes the foundation for their incapacity to safeguard their future reproductive health. Marriage is considered a religious duty and an inevitable act. Field findings reflect the importance of marriage to protect the honor of women and also for the formation of a family unit. The right to marry and form a family was more recognized vi in terms of parental responsibility and obligation to arrange timely marriage of their children. Among married women interviewed in this study, 45% were asked to give their opinion in spouse selection and more than one third of respondents were married to their cousins. Women were also aware of their right to seek divorce yet the majority of them (47%) disagreed and urged the necessity to avoid dissolution of marriage due to the fear of social disgrace, family pressure, being separated from children and due to the limited opportunities to marry again. Sexuality for married women is an area of compromise, obligation, and lack of control. Sexual obedience is considered an essential characteristic of a good and successful wife. The majority of the respondents agreed that they would never like to refuse their husbands and perceived sex as a ‗wife‘s duty & religious obligation‖. Furthermore, good women are expected to be ignorant and passive in sexual matters and sexual subservience is used as a strategy to gain love and respect from their husbands and also to secure their present and future well-being. Women‘s understanding of their reproductive health comes from their socialization pattern, configuration of gender roles and sense of motherhood and identity based on their norms and traditions. Women placed safe motherhood as an important element of their expressed meaning of reproductive rights and strongly emphasized their right to have good reproductive health care particularly during pregnancy and post-partum period. But practically, the majority of them considered conception and the act of giving birth as ‗natural‘ and received antenatal care mostly in case having some health problem. There was a clear preference for home delivery and hospitals were chosen in case of emergency or health risk or in the absence of family member to assist home delivery. Women perceived childlessness as a curse because children strengthened the marital bond and raised their status in the family. Having a quick pregnancy meant compliance with social norms and family expectations. Successful childbearing gives them respect and decision making authority in reproductive matters. Women also discussed the deteriorating effect of excessive births for their reproductive health and the majority of vii them acknowledged their right to space births and determine family size. Many women mentioned their limited decision making authority with regards to keeping their family size smaller and also accepted the covert use of contraceptives and induced abortion without consent of their husbands in case of having closely spaced pregnancies, health concerns, or under extreme economic misery etc. The majority of women had knowledge of modern contraceptives and apart from them they also knew and practiced traditional