The health of the nation is going through a crisis. The whole healthcare system is based on short-term planning. We are one of the unhealthiest nations with a very poor healthcare system and health indicators in the world. Similarly, the status of women’s health in Pakistan is not bright. The health of women is rarely considered an important issue because women as a gender have little respect in the community. Let’s discuss some important factors of Women’s Health in Pakistan.
Women’s Health in Pakistan
Women’s health in Pakistan is not up to the mark. In the name of culture, tradition, and religion they were never given equal status in society. A system that is based on gender inequality will not adopt policies for the well-being of women who are poor, powerless, and pregnant (most of the time without their consent) and weak as a class.
It is also disturbing to note that religious political parties and traditional political parties with lethal images have little time for women and their issues. Our assemblies and political institutes have a great number of women but most of them are not interested in those issues related to women’s health and their rights.
In Pakistan, we are losing three women per hour because of pregnancy-associated complications. More than 23,000 young women die every year in Pakistan which gives a maternal mortality rate of 340/per 100,000 pregnancies. A recent study has suggested that there is a small drop in the maternal death rate.
312,000 women suffer every year from pregnancy-related complications. Vesicovaginal Fistula (VVF), Recto-vaginal Fistula (RVF), Depression, Chronic Pelvic Pain, Loss of Uterus, Infertility, and Pelvic Inflammatory Diseases are the major complications faced by our women, which make their lives miserable. All these conditions are preventable and no women should suffer because of these conditions.
More than eighty percent of women are delivered at home in the presence of unskilled birth attendants. In the majority of secondary and tertiary healthcare centers, emergency obstetrical care is not available on a twenty-four-hour basis.
Hemorrhage, hypertension, and infection are the three major and direct causes of maternal death in our country. Four delays of pregnancy are the major contributory factor to cause women’s death and pregnancy-related morbidity in Pakistan.
We have more than seventy-five thousand villages all over the country without a proper road network. People living in mountains, forest areas, and small islands have no access to centers with EmOC available.
The majority of our Basic Health Units (BHUS) and Rural Health Centers (RHCs) are not functional With the exception of very few facilities, EmOC is not available on a twenty-four-hour basis in tertiary care centers.
Anemia in Women
Anemia in women is very common in the low socio-economical class. Anemia during pregnancy is associated with maternal death and morbidity. Iron-deficient nutrition is responsible for anemia. Lack of proper sewerage system and clean water is a cause of worm infestation which causes iron deficiency, and anemia in women living in city slums and rural areas.
Four Delays in Pregnancy
- Delay in Decision: When the decision is delayed to consult the doctor and healthcare center in case of obstetrical emergency.
- Delay in Transportation: When the delay occurs because of unavailability of transport and absence of roads, (bad terrain, river, sea, and forest) and communication.
- Delay in Emergency Care: When the delay occurs at secondary and tertiary healthcare centers because of the non-availability of doctors, midwives, anesthetists, operation theatre staff, drugs, oxygen, blood, electricity, and water.
- Delay in Recognition of Post-natal Complications: When the delay occurs in recognition of complications occurring post-natally.
The majority of private hospitals and maternity homes are expensive and are not providing proper obstetrical care to women as per international standards.
Very few private setups are providing free care to needy women. A very small number of hospitals and maternity homes are operating with international standards of care. As these facilities are extremely expensive, very few people can afford their services.
A girl child is not enjoying all rights in Pakistan. From the time of conception till her adolescence she remains under threat. It is not that uncommon to find families seeking termination of pregnancy based on ultrasonic confirmation of gender in early pregnancy.
Backstreet termination of pregnancy of a female fetus is a major cause of morbidity. The girl child infant mortality rate is higher than the male child infant mortality.
The girl child has no equal opportunity in society. They have limited opportunities for primary and secondary education. They have less access to playgrounds, social functions, and other community activities as compared to their male partner.
A large number of girl children are forced to marry without consideration of their consent, liking, and disliking. Often girl children are sold, bartered, and given as compensation to resolve family and tribal feuds. Girls are also given “blood- money” to settle crimes such as murder and are exploited sexually and physically.
A huge number of the girl child are living under threat and need help. It is also disturbing to note that traditions like VANA, SWARA, WATTA SATTA, DUNDEE, KARO KARI, and other kinds of activities are directed at girl children.
Un-safe induced abortion is a major cause of women suffering in Pakistan. Health professionals are not well-sensitized about the care of women with induced abortion and miscarriage. Medical students, nurses, midwives, and health workers should be sensitized about this major health-related issue by a change in curriculum.
The majority of menopausal women have no access to healthcare in Pakistan.
Poor menopausal women living in rural areas and city slums face problems associated with osteoporosis. Routine screening for age-related diseases is not available.
They also cannot afford hormone replacement therapy, if required. Menopausal women living in rural areas face extreme difficulties in carrying out their routine activities with a prolapsed uterus and urological problem (incontinence).
Menopausal elderly women have also limited access to health facilities. They are victims of quackery as they often receive unscientific treatment from dais and quacks because of economic reasons.
Cancers of Women
Breast, cervical, ovarian, and colon cancers are the leading causes of women’s death in Pakistan. The Department of Health has no screening program to prevent breast, ovarian colon, and cervical cancer in the country. Very few trained surgeons are available to deal with early and advanced cancers of women. Chemotherapy is extremely expensive and it is not possible for poor women to afford this kind of expensive therapy.
Radiation therapy is available free of cost in government hospitals but they are overcrowded with patients. The overburdened staff is not able to provide quality treatment to every woman.
Women in Community and Violence against Women
Women are facing extreme social conditions in Pakistan. They are not well represented in the judiciary, bureaucracy, assemblies, and armed forces. The private, multinational and national corporate sector is hostile toward women.
Violence against women is a national phenomenon. Men are killing women in the name of honor and family traditions. Prevalent traditions, such as Karokari, Vana, Swara, and Dundee, have reduced women’s status in society.
Domestic violence is common and there is no help available to those women who are victims of this kind of sub-human treatment. Acid burning, gang rape, and the slavery of women are deep-rooted problems in our society. According to a report in 2017, 5,733 incidences were reported in which women were tortured and humiliated. The exact figure is not known.
Some NGOs like Women’s Action Forum, War Against Rape, Aurat Foundation, and Shirkat Gah are helping women but their resources are limited and they need government support to deal with these kinds of problems.
In the health sector, the government is receiving a huge amount of grants, loans, and help from donor agencies (UNICEF, UNFPA, WHO, UNDP, USAID, DIFID, ADBP, CIDA, SIDA, and many others) to improve women’s health care in Pakistan.
Unfortunately, the government has failed in proper utilization of this funding because of a lack of political will and non-understanding of the existing healthcare system in the country. It is also noticeable that the lack of merit in the utilization of these funds is responsible for the non-utilization and improper spending of this budget.
The country needs massive investment in the production of competent midwives, activation of BHUS, RHCs, and maternity homes, and availability of EmOC in secondary and tertiary care centers. There is no shortcut to reducing maternal death and morbidity rate. A long term planning is required to bring durable change.
The country also needs a good road network in rural and urban areas. Moreover, good ambulance (Flying) services are required to provide access to women in need living in far-flung areas of the country.
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