'Good health means being mentally, socially, emotionally and physically fit': women's understanding of health and ill health during and after pregnancy in India and Pakistan: a qualitative study.
OBJECTIVE
To explore what women consider health and ill health to be, in general, and during and after pregnancy. Women's views on how to approach screening for mental ill health and social morbidities were also explored.


SETTINGS
Public hospitals in New Delhi, India and Islamabad, Pakistan.


PARTICIPANTS
130 women attending for routine antenatal or postnatal care at the study healthcare facilities.


INTERVENTIONS
Data collection was conducted using focus group discussions and key informant interviews. Transcribed interviews were coded by topic and grouped into categories. Thematic framework analysis identified emerging themes.


RESULTS
Women are aware that maternal health is multidimensional and linked to the health of the baby. Concepts of good health included: nutritious diet, ideal weight, absence of disease and a supportive family environment. Ill health consisted of physical symptoms and medical disease, stress/tension, domestic violence and alcohol abuse in the family. Reported barriers to routine enquiry regarding mental and social ill health included a small number of women's perceptions that these issues are 'personal', that healthcare providers do not have the time and/or cannot provide further care, even if mental or social ill health is disclosed.


CONCLUSIONS
Women have a good understanding of the comprehensive nature of health and ill health during and after pregnancy. Women report that enquiry regarding mental and social ill health is not part of routine maternity care, but most welcome such an assessment. Healthcare providers have a duty of care to deliver respectful care that meets the health needs of women in a comprehensive, integrated, holistic manner, including mental and social care. There is a need for further research to understand how to support healthcare providers to screen for all aspects of maternal morbidity (physical, mental and social); and for healthcare providers to be enabled to provide support and evidence-based care and/or referral for women if any ill health is disclosed.
['McCauley|Mary|M|0000-0003-1446-0625', 'Avais|Ayesha Rasheeda|AR|', 'Agrawal|Ritu|R|', 'Saleem|Shumaila|S|', 'Zafar|Shamsa|S|', 'van den Broek|Nynke|N|']
D000328:Adult D004644:Emotions D005195:Family Relations D005260:Female D007722:Health Knowledge, Attitudes, Practice D006304:Health Status D000070497:Healthy Lifestyle D006801:Humans D007194:India D007407:Interviews as Topic D000068097:Maternal Health D008603:Mental Health D010154:Pakistan D010809:Physical Fitness D011181:Postnatal Care D011295:Prenatal Care D036301:Qualitative Research D058992:Social Participation D014505:Urban Population D016387:Women's Health
postnatal care maternal morbidity antenatal care maternal medicine understanding of health and ill-health