Case Study 2

The following case study illustrates the issue of gender preference in a Pakistani family with signs of child neglect. The case study provides a question for viewers to consider and reflect on.

Case Study 2: Gender Preference (Pakistan)

Background

Asal is a 30 year old pregnant woman who presents to hospital during her third trimester seeking midwifery care. She and her husband have 4 female children aged between 2 and 12 years. Asal, her husband and their oldest daughter are migrants from Pakistan. The family settled in New Zealand 8 years ago. Asal’s husband is currently unemployed and the family struggles financially. English is a second language. This is Asal’s 4^th pregnancy since arriving in New Zealand.

Current Pregnancy

When Asal presented to the hospital, during her antenatal assessment she received a pregnancy ultrasound scan and was advised (with an interpreter) that she was having a girl. Upon receiving this information Asal said she did not want another girl.

Asal did not attend any further follow-up antenatal appointments and was admitted when she went into premature labour. Her baby was born 5 weeks early. 

Upon delivery, Asal refused to have contact with her baby and she discharged herself without the baby. The baby needed to remain in hospital for 5 weeks. During this time Asal did not want any contact with her baby telling nurses that this was because the baby was a girl and “she did not like her baby”. Other members of her family did not visit.

A number of nurses recorded in the patient’s medical record that they were concerned about the lack of emotional care that the baby was receiving from her mother and other family members.

Asal and her family were difficult to engage and assess when staff made attempts to meet with them. The staff made provision for the availability of interpreters. Antenatal staff made the assessment that Asal was tired and overwhelmed by the birth of a 5^th child and was possibly suffering from postnatal depression. A referral was made to mental health services. Mental health services had the same difficulties engaging with Asal and her family. Follow-up postnatal visits by the midwife were also difficult.

Discharge of Baby

After 5 weeks the baby was well enough to be discharged home with her parents and siblings. A discharge meeting was held with the parents, an interpreter, mental health services and a well-child provider. It was felt at this meeting that there were no child protection concerns and that there were enough services involved to support the family in the community.

Re-admission of baby into hospital

After 2 weeks post discharge, the baby was re-admitted to hospital in a seriously malnourished and neglected state.

Child Protection Indicators and Red Flags:

• During pregnancy

1. Once the baby had been identified as a girl – it appeared that this was an unwanted baby.
2. Asal did not attend follow-up antenatal appointments.

• Postnatal

1. Asal did not want to hold or care for her baby directly after birth.
2. Asal discharged herself as soon as possible post-delivery.
3. Asal refused to have any further contact with her baby and stated she did not like her baby.
4. The baby did not receive any skin to skin contact, nurturing, emotional connection/attachment or family involvement.
5. Health professionals were concerned about the mother’s lack of emotional attachment to her baby.
6. Asal was deemed to be suffering from postnatal depression, to be shut down and was not responsive to her baby.
7. Asal had other stressors, 4 other children to care for at home, no extended family support, financial difficulties.