Historical background of women health in Pakistan

The health status of women in Pakistan is directly linked to women's low social status. Pakistan's poor position internationally is seen in UNDP's Gender related Development Index (GDI) 2000, where Pakistan currently ranks 135 out of 174 countries. On the Gender Empowerment Measurement (GEM) 1999, Pakistan ranked 100 out of the 102 countries measured. In terms of health status, the figures 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. Rural women's health is generally poorest due to the lack of health facilities and skilled health providers. For example, the maternal mortality ratio in predominantly 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 a woman, a tragedy in itself, adversely affects the health of her children, household productivity and the national economy. About 25 percent of children are born with low birth weight due to maternal problems. Ten percent of children do not reach their first birthday. High fertility, with an average of six children per woman, has resulted in high population growth of three percent per annum. Consequently, improving women's reproductive health through the use of contraceptives and spacing of children will not only improve women's health but also reduce population growth and allow women more time to pursue economic activities.

There are also marked differences between the health status of women and men in Pakistan. For example, malnutrition is a major public health problem in Pakistan that disproportionately affects 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. This is 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 accessing health care. Women, girls and infants most often die of common communicable diseases such as tuberculosis, diarrhea, pneumonia and tetanus, which could have been easily prevented and treated. The high prevalence of communicable diseases and malnutrition is not only related to poor living conditions, but also to the lower social status of women and girls. In addition, because of social stigma and gender norms, as many as fifty percent of women suffer from recurrent reproductive tract infections.

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

Cancer

Cancer information on Pakistan Approximately one in every 9 Pakistani women is likely to suffer from breast cancer 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 awareness regarding cancer in Pakistan. PCCWS founded by Abdul Wahid Chaudhary back in 2006, now has more than 200 members and working to raise cancer awareness in lower Punjab at the moment. PCCWS works on monthly theme based calendar system as per published by American Society of Cancer and arranges lectures, seminars, presentations, campaigns all across rural and urban lower Punjab. PCCWS provides local residents with easy, comprehensive, up-to-date cancer literature in Urdu language.

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

18^th amendment

Many Pakistanis celebrated when a smiling but highly unpopular President Asif Ali Zardari signed the so-called 18th amendment to the country's constitution last month. The long-awaited bill, applauded for stripping the presidency of its sweeping powers, strengthened provincial 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, which is neglected in this deeply patriarchal country, where public health care facilities are largely inadequate or, in some areas, altogether absent.

“One of the basic benefits of devolution of health down to the provinces is stricter control, as smaller units are better managed, and there will be increased control when provincial capitals, rather than Islamabad, look over programmes”, Mian Raza Rabbani, chairman of the 18th amendment committee and a senator from the ruling Pakistan Peoples Party, tells The Lancet.

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

Samrina Hashmi, an obstetrician and gynaecologist says:

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

The health indicators of women in Pakistan are among the worst in the world.^[2] Intra-household bias in food distribution leads to nutritional deficiencies among female children. Early marriages of girls, excessive childbearing, lack of control over their own bodies, and a high level of illiteracy adversely affect women's health. More than 40 percent of the total female population are anemic^[2].

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

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

Pakistan has taken certain initiatives in the health sector to redress gender imbalances. The SAP was launched in 1992–1993 to accelerate improvement in the social indicators. Closing the gender gap is the foremost objective of the SAP. The other major initiative is the Prime Minister's program of lady health workers (LHWs). Under this community-based program, 26,584 LHWs in rural areas and 11,967 LHWs in urban areas have been recruited1 to provide basic health care including family planning to women at the grassroots level. Other initiatives include the village-based family planning workers and extended immunization programs, nutritional and child survival, cancer treatment, and increased involvement of media in health education.