Under Water: Women’s Access to Reproductive Health Care in Pakistan

“[She] went into labor in her eighth month and had to give birth without any medical aid, assisted just by myself and a few other women who could get there.”

– Woman affected by the Pakistan flood

This woman’s frightening experience amidst the floods in Pakistan illustrates that, even in emergencies, women will continue to deliver babies and communities will desperately need reproductive health services.

An estimated 14 million people have been affected by the recent flooding in Pakistan. This woman’s friend is one of approximately 52,500 that will deliver in the next three months. She was lucky that she was not one of the more than 9,000 women who will need a surgical obstetric intervention. As the waters continue to rise, an estimated 1.5 million women of reproductive age will need services such as emergency obstetric care, family planning, and clinical response to sexual violence. Despite the obvious reproductive health needs among women and girls in emergencies, reproductive health care is often overlooked in crisis situations.

Morbidity and mortality for women were tragically high even before the monsoons. Crises put women and girls at even greater risk of unintended pregnancies – often a death sentence in a country where the maternal mortality ratio can be as high as 673/100,000. Basic, low-cost reproductive health services save lives in emergencies. Access to emergency obstetrical care is essential to reducing maternal deaths, and simply providing contraceptives to the women who want them can reduce the maternal mortality rate by up to 40 percent. When the rains fell in Pakistan, 30 percent of Pakistani women were using contraceptives, and these women should be able to access and continue to use contraceptives during the floods.

Even when services are available, seeking aid is especially difficult for women and girls in Pakistan where cultural norms often place shame on receiving medical care from males. The restricted mobility of women and proscriptions against male-female interactions have widened the rift between women and access to care, especially in a highly patriarchal society. Finances, reluctance to bring a woman to a hospital, a male’s absence from the house, and inadequate referral services are all barriers to seeking care.

Gender roles have created a stark difference between men and women in accessing health care, especially since there are not many women health providers. In one province, before the flood, 2/3 of the basic health units did not have any female staff and almost half did not have a labor room. The inaccessibility amounts to women dying – this province has the highest maternal mortality ratios (673/100,000). But difficulties are not confined to one province; 61 percent of women in Pakistan give birth without a skilled birth attendant. The flooding will only make the female-oriented health facilities and skilled birth attendants less accessible.

The situation seems bleak, but feasible solutions exist. Pakistan’s non-governmental organizations and the ministry of health were on the ground providing reproductive health services before the flood and should be supported. Local actors are best suited to provide culturally appropriate care and we applaud their efforts. Additionally, JSI‘s Astarte Project, on behalf of the Reproductive Health Response in Crisis (RHRC) Consortium, has supported efforts by local NGOs to respond to reproductive health needs in emergencies. Working with these local groups, those involved with the relief response should also include the Minimum Initial Service Package of Services (MISP) for reproductive health which includes:

  • Access to emergency obstetric care
  • Clean delivery kits
  • Standard precautions to avoid HIV infection
  • Clinical care to survivors of sexual violence
  • Contraceptive supplies meet demand
  • Planning for comprehensive family planning services when the situation stabilizes

Finally, more work can be done to strengthen the efforts to support a cadre of female community-based workers to reach the women who are unable to access health care services otherwise. Reaching more women and girls with female workers will help ensure that they get the care they need, especially in emergencies. This is particularly true for adolescent girls who are even less likely to seek care in the context of Pakistan’s prevailing social norms.

Providing reproductive health services in emergencies and during recovery can save lives. As we work towards achieving the Millennium Development Goals, the global community cannot ignore crisis-affected areas, many of which lag behind in reducing maternal deaths and achieving universal access to reproductive health. Pakistan should be at the top of our list. Today, we have the opportunity to demonstrate how the provision of reproductive health services is essential in rebuilding communities when the flood waters recede.


This post was originally published by The Global Health Magazine blog on August 25, 2010

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