Health

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The health status of women in Pakistan is reflected in UNDP's Gender related Development Index (GDI) 2000, where Pakistan currently ranks 135 out of 174 countries. 

In Sindh maternal health facilities and proper reproductive care is not available at the required scale. Many women, especially in rural localities, find themselves at risk due to poor provision and a lack of access to knowledge and health professionals. Low levels of maternal health and nutrition coupled with high fertility rates lead to high mortality and morbidity among mothers and also children, particularly in the rural areas. 

Maternal mortality is six to eight per thousand live births; women usually marry at a young age and on an average give birth to 6/7 children[1]. Prevalence of anemia and malnutrition indicate deficiencies in basic minerals and nutrients important for all women especially those in pregnancy. There is inadequate health-care infrastructure needed to meet the health needs of women (both) in number and in quality of service. The lack of such health care endangers the life of the mother and the child. The infant mortality for females is 105 per 1000 live births, as compared to 93 for males[2]. The estimated crude birth rate is 33 per 1000 population and 28 percent constitute mothers with more than 5 births[3]. In Sindh the fertility rates average at 6.0 births by women by the age 45-49 and more than 4,000 mothers die every year due to pregnancy related issues[4]. No doubt that the current provincial health policy has identified focused interventions to create awareness on pubic health matters need to improve public health service promotion of primary and secondary health services, but still the progress has been slow and insufficient, compared to the overwhelming population and needs of the people.

A study conducted on the effects of the interplay of formal and customary laws on women in Sindh in 2002, surveyed a sample group of women and men in both rural and urban areas in Sindh regarding their knowledge and practice of family planning. The results show that a slightly larger number of men had knowledge of family planning in comparison to women but the levels of practice were consistent among both genders. While 44% of rural and urban men were aware of family planning methods only an average of 15% practiced any form of contraception[5]. The percentage of women who had knowledge of family planning was 35% in the urban and 37% in the rural areas and an average of 14% of women practiced the known methods of contraception[6]. The disparity between the level of knowledge and the level of practice indicate a discrepancy not in the level of awareness but in the availability and access of individuals to safe and reliable contraceptives. 

There are marked differences between the health status of women and men in Sindh. For example, malnutrition is a major public health problem in Pakistan that disproportionately affects women and girls. 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 Sindh and 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.

Recommendations for Health Initiatives

A holistic approach to women’s health which includes both nutrition and health services should be adopted and special attention to be given to the needs of women and the girl at all stages of the life cycle. In view of the high risk of malnutrition and disease that women face at all the three critical stages viz., infancy and childhood, adolescent and reproductive phase, focused attention should be paid to meeting the nutritional needs of women at all stages of the life cycle. 

The reduction of infant mortality and maternal mortality, which are sensitive indicators of human development, is a priority concern. Women should have access to comprehensive, affordable and quality health care. Reproductive rights of women should be protected to enable them to exercise informed choices, reduce their vulnerability to sexual and health problems together with endemic, infectious and communicable diseases such as malaria, TB, and water borne diseases as well as hypertension and cardio-pulmonary diseases. The social, developmental and health consequences of HIV/AIDS and other sexually transmitted diseases should be tackled from a gender perspective.

To effectively meet problems of infant and maternal mortality, and early marriage the availability of good and accurate data at micro level on deaths, birth and marriages is required. Strict implementation of registration of births and deaths should be ensured and registration of marriages would be made compulsory. 

[1] “District Population Profile: Sindh, Operationalizing and Interpreting Population Census for Planning. Multidonor support Unit, Islamabad, March 2002.

[2] “District Population Profile: Sindh, Operationalizing and Interpreting Population Census for Planning. Multidonor support Unit, Islamabad, March 2002.

[3] “District Population Profile: Sindh, Operationalizing and Interpreting Population Census for Planning. Multidonor support Unit, Islamabad, March 2002.

[4] “District Population Profile: Sindh, Operationalizing and Interpreting Population Census for Planning. Multidonor support Unit, Islamabad, March 2002.

[5] “A Study of Effects of Interplay of Formal and Customary Laws on Women in Sindh.” Vol. V. Raasta Development Consultants, Karachi and The Royal Netherlands Embassy, Islamabad, 2002.Pg 13.

[6] “A Study of Effects of Interplay of Formal and Customary Laws on Women in Sindh.” Vol. V. Raasta Development Consultants, Karachi and The Royal Netherlands Embassy, Islamabad, 2002.Pg 13.

 

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