Access to healthcare

March 7, 2021

A lack of local access to health care, combined with the patriarchal restrictions on women’s movement, can mean a death sentence for rural women in particular

Any discussion on healthcare must be made as inclusive as possible. Dialogue with gender minorities and differently abled communities is a minimum requirement on any strategic plan for improvements. Healthcare policies must also address the workplace issues of harassment and discrimination faced by healthcare workers, be they doctors, nurses or lady health workers.

Patriarchal societal structures deprive women and minorities of knowledge about their rights to healthcare, consent and autonomy over their own bodies and available healthcare options. Even many women who are aware of the options, are not empowered to make their decisions on their own. Almost half of the women and girls in Pakistan aged 15-49 report having no say in these choices. This lack of education regarding diseases has led to the number of HIV positive cases doubling and a 369 percent increase in deaths between 2010 and 2018 in Pakistan. This increase is likely an underreported figure as there is a severe lack of testing. These worrying numbers are directly linked to a lack of knowledge about the spread of HIV, with people reusing syringes, engaging in unsafe sexual practices and undergoing unhygienic medical procedures. This obliviousness regarding means of infection, leads to HIV-positive people feeling like pariahs in their communities and families, as they are physically shunned by others who fear contracting the disease.

The health budget has been consistently underfunded by the state. The health expenditure was a measly 1.1 percent of the GDP in the fiscal years 2018-2019. This is a disappointingly low figure for a country that has failed to eliminate preventable diseases like polio and tuberculosis, and has an alarming rural-urban divide in health care access. There are 14.5 physicians per 10,000 population in urban areas and 3.6 in rural areas. In its manifesto, Aurat March has demanded redress for this divide and for the health budget to be increased to 5 percent.

Lack of local access to healthcare, combined with the patriarchal restrictions on women’s movement, can mean a death sentence for rural women in particular. Around 70 percent of women classified as poor do not have access to a skilled healthcare professional when giving birth. A viable solution here is the Lady Health Worker Programme, which is holding up the frontlines of our healthcare system. Unfortunately, these women do thankless work without compensation and face physical and verbal abuse from the very communities they are trying to serve due to the gendered nature of their work. Shouldering an undue burden of Pakistani healthcare, they have to deal with pay discrimination and salary delays. How long can we keep relying on their significant contributions in providing women support with birth control, childbirth and necessary abortions, without providing them a safe environment to work in? The Aurat March manifesto, lists clear demands for the reinstatement of the National Programme for Family Planning and an immediate end to the violence faced by these essential workers. The state must take this demand seriously and urgently, as LHWs will also prove crucial in the rollout of the Covid-19 vaccine. The rural population will require educational campaigns on the benefits of getting the shots. They will also require mobile health units and LHWs to improve their physical access to it.

The stigma around mental health and its feminisation – using terms like “hysterical” – is a long-running issue. Post-partum and gynaecological related depressions are often underestimated and ignored. Research has shown that trauma can be inherited through our genes – violence experienced by one suffering body can lead to distress for future generations. In a country where nearly 2 million girls were married before the age of 18, undergoing forced conversion and subjected to karo kari, watta satta, marital abuse and rape – what kind of mental health can we expect for the survivors and their offspring? We posit that the state must recognise the mental trauma that follows these violent acts and assign resources for the psychological rehabilitation of survivors, and train first responders in psycho-social care. Moreover, mental health should be made part of gynaecological care.

The feminist movement hopes to use the spotlight shone on the healthcare system during the Covid-19 pandemic to centre the needs of women and marginalised communities, and prevent the violence inflicted on women’s bodies every day due to systemic neglect and discrimination.

The writer is a   feminist and the editor-in-chief at Culturico

Woman's access to healthcare in Pakistan