Intended for healthcare professionals


Pakistan lags behind in reproductive health

BMJ 1998; 317 doi: (Published 05 December 1998) Cite this as: BMJ 1998;317:1546
  1. Claire Wallerstein
  1. Manila

    New figures illustrate how discrimination starts from birth for women in Pakistan, where mortality among children aged under 4 is 66% higher in girls than in boys.

    A recent seminar on population development in Karachi found that large swaths of Pakistani society still attach enormous importance to the wellbeing of their male children while considering daughters to be a shameful burden.

    Delegates at the follow up to the 1994 international conference on population development in Cairo were told that Pakistan could soon suffer serious social and economic repercussions if steps are not taken to change traditional male and religious attitudes towards women and family planning.

    The cash strapped country was also criticised for its paltry investment in preventive health care and education--even its poorest, smallest neighbours in South Asia, such as Nepal and Bhutan, spend 10 times more on these sectors.

    The conference heard how one woman in 38 dies during pregnancy or childbirth in Pakistan, compared with a regional average of one in 230. Up to 13% of these deaths are the result of unsafe abortions.

    Infant mortality in Pakistan is 95 per 1000 live births, while mortality for children under five is 136 per 1000 live births. Nearly 25% of all children are born underweight. The adult literacy rate is around 50% for men but only 26% for women, which makes the task of those trying to raise awareness of the importance of reproductive health even more difficult.

    A representative from the United Nations Population Fund, François Farah, said that new efforts to address Pakistan's problems had begun in the five years since the Cairo conference. Cairo recommendations, however--such as reproductive health services being made available at grassroots level through the general health delivery system--were basically moot in Pakistan, where 45% of the population still has no access to any form of health service.

    With the largest section of the country's population now aged between five and 20, Mr Farah warned of the potential for a huge population explosion unless concrete progress was made. He said the bulk of the country's health budget was still being spent on curative treatments instead of information campaigns, which could be more effective in the long run.

    Field workers related how they had initially faced hostility from religious leaders and family matriarchs, who prevented them from speaking about reproductive health with young women. Some progress was, however, now being made by getting male members of the communities to cooperate, they said.

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    Health workers face hostility when they want to discuss contraceptio