Health is a basic human right. According to WHO, this right includes access to timely, acceptable, and affordable healthcare of appropriate quality. But in a developing country like Pakistan, access to quality healthcare seems to be a far cry. For a major chunk of the population, simply accessing healthcare services is an issue; let alone quality. It is no secret that Pakistan’s public healthcare system is inadequate and inefficient with poor infrastructure, non-functioning primary health centers, low quality service delivery and medical facilities in secondary and tertiary hospitals, inadequate medicines, insufficient nurses and paramedical staff and absence of emergency services. Unaffordablity, geographic remoteness and lack of transportation facilities also contribute to the problem.
Accessibility however, becomes an even greater issue when it comes to Pakistani women. Good health is a pre-requisite for human development and for the progress of a nation. But women, almost 50 percent of the population, are further deprived of this basic right owing to the social and cultural barriers. According to the Asian Development Bank, the health indicators of women in Pakistan are among the worst in the world. The country’s maternal and infant mortality rate is the highest within the south Asian region with maternal mortality estimated to be 276 deaths per 100,000 live births. Moreover, more than 40 percent of women are anemic here.
The health of a woman becomes crucial when she is responsible for taking care of the whole family. An unhealthy woman will not only mother unhealthy children but will be unable to fulfill her roles as a mother, wife and daughter-in-law. “Families form a society. If she is ill, the society will be ill. If she is healthy, she will do well for her family and society”, says Rabia Haji, director advocacy at Aurat Foundation.
Other than child birth, women have various health issues like UTIs, vaginal infections and breast cancer, etc that go unnoticed because of the social and cultural approach to women and their health. It is a deploring fact that even in the 21st century, women cannot take decision about their health, do not or cannot visit a doctor unless accompanied by someone from home, hesitate discussing gynae issues and lack financial independence. When accessibility is not an issue in such terms, seeking treatment from a male doctor remains out of question. “As a result, they just suffer”, says Rabia.
A 2008 study published in the Journal of Ayub Medical College Abbottabad says, women’s inability to travel alone as and when they wish is viewed as an important barrier to improving their health. According to Myra Imran, a journalist who writes on gender-based issues in a leading newspaper of Pakistan, their health gets greatly compromised. Myra frequently comes across such incidents while working for her stories. She did a story once in which a woman waited all day for her husband to come and take her to the doctor or even up to three days. “It depends when he has time to take her and does not even allow her to travel alone or in a private van”.
Contrastingly, Dr Shershah Syed, ex-President Society of Obstetrician & Gynecology believes family role is not the main issue. Inadequate or lack of health facilities are the reason for poor health of women. “If free emergency services are available and the woman is aware of it then no one can stop her from seeking treatment”. When people were provided with a health facility in areas of Sindh, they came when required. A study conducted in Punjab and KPK by Ayub Medical College showed that necessary emergency obstetric care is only provided in 60 of the 170 public health facilities in 19 districts across the provinces and 59 percent of facilities located in Punjab do not provide these important services.
Dr Asad Hafeez, DG Ministry of Health realizes there is lack of service providers in far flung and rural areas. He however, ensures that the government is working on a National Action Plan to bridge the supply and demand gap. “We are also working on an acceleratory program for achieving MDGs regarding maternal and new born mortality”. He is hopeful that the health sector would be in a better situation in the coming years. Reflecting on the past 20 years, the situation is better now. Infant Mortality rate in 1990 was more than 110 deaths per 1000 live births and now it is 60. Maternal mortality rate was 500 deaths per 100, 000 live births and now it has reduced considerably.
However, Roshaneh Zafar, founder of NGO Kashf Foundation, while addressing a seminar said women in Pakistan’s rural and urban areas still depended on their families and husbands to exercise their reproductive rights and visit hospitals for vital treatments. The 2008 study further says that in such a conservative society, women understandably feel uncomfortable discussing reproductive health issues with male doctors and prefer to be seen by women doctors for gynecological and obstetric consultations. Thus the absence of female doctors makes many otherwise accessible health facilities unacceptable socially, hence inaccessible, depriving these women of their human rights to equality of treatment and dignity. Sometimes, women are given partial access to get treatment. Rabia says if it is a fertility issue, then she is allowed to seek treatment even from a male doctor. But in other gynae-related cases, she is not. Alas, women do not have a right on their own bodies. The male and other members of the family are insensitive to the health issues of women, lack of awareness being one of the reasons. “Some husbands are afraid that if they allow their wives to visit a doctor they will seek help for family planning”, explains Rabia.
Seeking treatment from a male doctor is not just the issue of rural settings; even educated families do not allow interaction with male physicians. Sharing another experience, Myra says she once came across a woman who at the time of delivery took anesthesia from a male doctor. When she came home, her husband snatched the baby from her and did not speak to her. He was angry at her for not refusing to take the injection from a male doctor. Before going for the surgery, he had warned her that she should inform the staff that no male person should touch her. “She spent so many days trying to seek pardon from her husband”, says Myra. Ironically, women try to seek forgiveness even when it is not their fault. They have to go through such pressures to survive.
Seeking treatment from a male physician is more of a cultural issue rather than religious. Dr Talib-ur-Rehman, an Islamic scholar says, “the Shariah allows women to get treatment from a male doctor when a woman doctor is not available in town”.
In certain cases, women themselves are responsible for their appalling state. According to UNFPA, 65 percent women are illiterate in the country. Rabia says such women are unaware about their rights so cannot be blamed for it. But an educated woman is responsible for being negligent. Moreover, a woman who has a say at home, for instance the mother-in-law, should play her part when her son tries to impose unnecessary restrictions. Unfortunately, this rarely happens. “We lack sufficient role models and leaders among women. They do not make an effort to bring a change when they can”, laments Myra.
Dr Shershah directly puts the blame at the government for failing to provide basic health facility to the people. “Women’s health is not a priority for them. It is high time they realize this”. In a report called ‘Health of Women in Pakistan’, he says a country has no future with a huge population of uneducated, unhealthy and battered women. The government and civil society should immediately take actions to rectify the present situation on emergency basis.
Women issues should be considered specifically when making health policies. Talking about the priorities of the government, Dr Asad says that health definitely is a priority but realistically the country is passing through a highly critical stage. “On one hand we are suffering from terrorism and on the other we lack resources. We need to understand the other problems and challenges which exist in the country right now”.
Well, health not being a priority of the state is not a recent issue. Every government has had a share in this. Things would probably have not been so bad if it was realized much earlier. Dr Asad is probably right in saying that political priority cannot be made by politicians. It is made by the masses. “If masses demand health facilities and vote for it, why would not the government provide them?” Health is not included in the agenda of political parties. Or not as it should be. People should wake up and vote for their right to health.
Nevertheless, Myra believes half of the problem can get solved if we try to change the peoples’ mind-sets. Realizing the importance of getting treatment from proper health facility is imperative. Once this is recognized, men would definitely take their female members to a good health facility even if it means going to another city.