Inequities and Status Consumption of Maternal Health Care Use in Punjab, Pakistan

Use of maternal health services in Pakistan is characterized by vast inequities between the rich and poor. With 70% of services provided by the for-profit private sector, health care is becoming a commodity. To explore if maternal health care use was a symbol of high status, a 10-month village ethnography was conducted in Punjab, Pakistan. The Han et al.’s (2010) model of status consumption was used to understand how wealth level and need for status explained the observed patterns of usage that were sharply fragmented along social class lines. The highest class used the free public sector services, and did not loudly exhibit their use. Their social capital ensured they received acceptable quality care in a system traditionally understood as abusive and exclusionary. The better-off middle class used a private sector midwife and loudly constructed this as a symbol of wealth and status. The poorer middle classes felt social pressure to use the afore-mentioned midwife despite not having the financial means to do so. The poorest class used the public-sector services, and if they found it too abusive, avoided use altogether. In conclusion, when private health care is introduced in highly hierarchical societies, its uptake is susceptible to status consumption and creation of inequities.