Gender, Poverty and Pelvic Floor Dysfunction: Unmet Needs Among Informal Sector Women Workers in Pakistan
DOI:
https://doi.org/10.64229/yafxy023Keywords:
Pelvic floor dysfunction, Informal economy, Women workers, Pakistan, Intersectionality, Social determinants of health, Gender inequality, Poverty, Health inequity, Urinary incontinence, Pelvic organ prolapseAbstract
Background: Pelvic floor dysfunction (PFD)__encompassing urinary incontinence, pelvic organ prolapse, and anorectal dysfunction__imposes a disproportionate burden on women in low- and middle-income countries (LMICs). Within Pakistan, informal sector women workers constitute one of the most structurally vulnerable populations, yet their experience of PFD remains almost entirely undocumented. This study examines the prevalence, occupational and socioeconomic correlates, and self-reported barriers to PFD care among this population, through analysis of associations between structural disadvantage and pelvic floor health outcomes. Methods: A cross-sectional, community-based survey was conducted across five informal occupational cohorts__brick kiln workers, domestic workers, street vendors, textile home pieceworkers, and agricultural labourers__recruited from peri-urban and low-income areas of Lahore and Sheikhupura districts. A total of 412 women aged 18-55 years who had ever been pregnant were enrolled using stratified purposive sampling within predefined occupational strata. Data were collected through interviewer-administered structured questionnaires incorporating validated Urdu-adapted instruments: the ICIQ-SF for urinary incontinence, the PFDI-20 for prolapse and colorectal symptoms, and the PHQ-4 for psychological distress. Multivariate logistic regression was employed to identify independent predictors of symptomatic PFD. Results: The overall prevalence of at least one PFD symptom was 68.9% (95% CI: 64.3-73.2%). Urinary incontinence was present in 46.2%, pelvic organ prolapse symptoms in 31.7%, and anorectal dysfunction in 16.3%. Significant independent predictors included grand multiparity (aOR 3.41; 95% CI 2.18-5.34), strenuous occupational posture (aOR 2.87; 95% CI 1.79-4.59), prior obstetric injury (aOR 2.64; 95% CI 1.63-4.27), daily household income below PKR 500 (aOR 2.19; 95% CI 1.38-3.47), and absence of a female gynaecologist within 10 km (aOR 1.93; 95% CI 1.22-3.06). Of those with symptomatic PFD, 84.7% had never sought formal healthcare. Conclusions: PFD affects nearly seven in ten informal sector women workers surveyed in this study, and 84.7% of those affected have never consulted a healthcare provider. These findings indicate substantial unmet need across financial, geographic, and gender-related dimensions of healthcare access, and support the case for targeted community-based and policy-level interventions.
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