Historical background of women health in Pakistan

The health status of women in Pakistan isdirectly linked to women's low social status. Pakistan'spoor position internationally is seen in UNDP's Gender related DevelopmentIndex (GDI) 2000, where Pakistancurrently ranks 135 out of 174 countries. On the Gender Empowerment Measurement(GEM) 1999, Pakistanranked 100 out of the 102 countries measured. In terms of health status, thefigures are galling. Some 30,000 women die each year due to complications of pregnancy,and 10 times more women develop life-long, pregnancy-related disability. Ruralwomen's health is generally poorest due to the lack of health facilities andskilled health providers. For example, the maternal mortality ratio inpredominantly rural Balochistan is 800 maternal deaths to 100,000 live births,compared to the national average of 340 per 100,000.

The untimely death or disability of awoman, a tragedy in itself, adversely affects the health of her children,household productivity and the national economy. About 25 percent of childrenare born with low birth weight due to maternal problems. Ten percent ofchildren do not reach their first birthday. High fertility, with an average ofsix children per woman, has resulted in high population growth of three percentper annum. Consequently, improving women's reproductive health through the useof contraceptives and spacing of children will not only improve women's healthbut also reduce population growth and allow women more time to pursue economicactivities.

There are also marked differences betweenthe health status of women and men in Pakistan. For example, malnutritionis a major public health problem in Pakistan that disproportionatelyaffects women and girls. More girls than boys die between the ages of 1 and 4;in fact the female mortality rate here is 12 percent higher than for boys. Thisis a direct consequence of the lower social status accorded to women and girls,who as a result tend to eat less and face additional barriers when accessinghealth care. Women, girls and infants most often die of common communicablediseases such as tuberculosis, diarrhea, pneumonia and tetanus, which couldhave been easily prevented and treated. The high prevalence of communicablediseases and malnutrition is not only related to poor living conditions, butalso to the lower social status of women and girls. In addition, because ofsocial stigma and gender norms, as many as fifty percent of women suffer fromrecurrent reproductive tract infections.

Consequently, poor women's health in Pakistan is asmuch a social as medical problem. Underlying factors here are the lack ofawareness of, and attention to, women's health needs; women's lower educationand social status; and social constraints on women and girls, including thepractice of seclusion.

Cancer

Cancer information on PakistanApproximately one in every 9 Pakistani women is likely to suffer from breastcancer which is one of the highest incidence rates in Asia.^[16]

'Pakistan Cancer Care Welfare Society'(PCCWS) is a no-profit public welfare organization registerd in Pakistan , aims to strive and raise awarenessregarding cancer in Pakistan.PCCWS founded by Abdul Wahid Chaudhary back in 2006, now has more than 200members and working to raise cancer awareness in lower Punjabat the moment. PCCWS works on monthly theme based calendar system as perpublished by American Society of Cancerand arranges lectures, seminars, presentations, campaigns all across rural andurban lower Punjab. PCCWS provides localresidents with easy, comprehensive, up-to-date cancer literature in Urdu language.

Law: which is seen as the landmark for theimprovement of women health

18^th amendment

Many Pakistanis celebrated when a smilingbut highly unpopular President Asif Ali Zardari signed the so-called 18thamendment to the country's constitution last month. The long-awaited bill,applauded for stripping the presidency of its sweeping powers, strengthenedprovincial autonomy and handed over control of key public sector services,including health, to the country's four provinces.

This development, argue health professionals, politicians,and women's rights activists, could potentially improve women's health, whichis neglected in this deeply patriarchal country, where public health carefacilities are largely inadequate or, in some areas, altogether absent.

“One of the basic benefits of devolution of health down tothe provinces is stricter control, as smaller units are better managed, andthere will be increased control when provincial capitals, rather thanIslamabad, look over programmes”, Mian Raza Rabbani, chairman of the 18thamendment committee and a senator from the ruling Pakistan Peoples Party, tellsThe Lancet.

Others tend to agree. Some Pakistani women, especially in the poorcountryside, live their entire lives, through multiple pregnancies andchildbirths, without ever seeing a doctor. In this climate, argues RozinaKarmaliani, interim dean of the school of nursing at the Aga Khan University in Karachi, devolution couldimprove access to health care. “There are a lot of access issues related towomen and child rights. The 18th amendment could improve efficiency andaccess”, she says.

Samrina Hashmi, an obstetrician and gynaecologist says:

“With the devolution of power, the power and the money will come down to thebasic levels”, says Samrina Hashmi, an obstetrician and gynaecologist based in Karachi and a member ofthe women's rights organisation Women's Action Forum. “If the provincialgovernment is giving out money to provincial centres, it will easily controlmanagement and solve problems…Controlling the employees and making them workwould be easy. Hopefully, this will bring positive change in our health-caresystem and maternal health as well.”

The health indicators of women in Pakistan areamong the worst in the world.^[2] Intra-household bias in fooddistribution leads to nutritional deficiencies among female children. Earlymarriages of girls, excessive childbearing, lack of control over their ownbodies, and a high level of illiteracy adversely affect women's health. Morethan 40 percent of the total female population are anemic^[2].

According to 1998 figures, the femaleinfant mortality rate was higher than that of male children. The maternalmortality rate is also high high, as only 20 percent of women are assisted by atrained provider during delivery.^[2] Only 9 percent of the women usedcontraceptives in 1985, however this figure has increased substantially.^[2]

Women are also at a higher risk ofcontracting HIV-AIDSand other sexually transmitted diseases (STDs) because of male dominance in sexrelations and lack of access to information.^[2]

Pakistan has taken certain initiatives in the health sectorto redress gender imbalances. The SAP was launched in 1992–1993 to accelerateimprovement in the social indicators. Closing the gender gap is the foremostobjective of the SAP. The other major initiative is the Prime Minister'sprogram of lady health workers (LHWs). Under this community-based program, 26,584LHWs in rural areas and 11,967 LHWs in urban areas have been recruited1 toprovide basic health care including family planning to women at the grassrootslevel. Other initiatives include the village-based family planning workers andextended immunization programs, nutritional and child survival, cancertreatment, and increased involvement of media in health education.