IDRC supports Shirkat Gah to improve women’s reproductive rights in Pakistan
Pakistan has faced political instability and increased economic hardship over the last few decades, which has contributed to deteriorating health services and infrastructure — with women and the poor bearing the brunt of the burden.
For the past four years, an IDRC-supported project with the Pakistan-based Shirkat Gah- Women’s Resource Centre has been raising awareness around women’s reproductive health with evidence-based advocacy in districts in all four of Pakistan’s provinces. Shirkat Gah identified various challenges in women’s access to reproductive healthcare services, including the availability of service providers, equipment, and infrastructure; the attainability of a particular facility for women; and affordability. Numerous multi-stakeholder forums were held at the district level to support discussion and reflection among community members (represented by civil society organizations) and to elect executive members of the local government to improve governance in the health sector.
In a region known for its gender inequities, many women and girls in Pakistan face marriage before the legal age, limited access to education, and restricted mobility due to social norms that denounce women’s interactions with unrelated men. Cultural barriers such as these, combined with a health system that fails to overcome all the obstacles blocking women’s access to healthcare, have left women’s health and reproductive rights in a precarious state. In the province of Baluchistan, the maternal mortality rate in some districts such as Jaffarabad is dire — as high as 785 per 100,000 live births. The country faces a steep climb to meet the UN’s Sustainable Development Goal target of lowering maternal deaths to below 70 for every 100,000 live births by 2030.
A significant challenge facing Pakistan’s health system is the separation of family planning and reproductive health services from primary healthcare services. By advocating for the amalgamation of family planning and reproductive health with primary care services, this project promoted a model to improve the grossly inadequate services that cater to women’s needs. “Women often die en route to hospitals because many birthing centres aren’t equipped to handle more complicated cases,” said Noor Memon, who works for a local partner of Shirkat Gah in Jaffarabad.
To overcome these and other challenges, mediation was necessary to build a bridge between service providers and citizens. A major success story in this regard in the Khyber Pakhtunkhwa province emerged from a national level multi-stakeholder meeting. Motivated by the meeting’s discussions, a member of the Mardan district council mobilized fellow councillors to move a resolution to improve healthcare delivery at the level of local basic health units, which serve primary healthcare needs. Council members endorsed the resolution and went a step further to demand that their district government Chair allocate funds for health unit improvements across the district. The assembly responded by allocating 200,000 Pakistani rupees each (approximately CA$2,500) to 47 basic health units in the district — a significant decision given that there was previously no specific allocation of district funds for local health facilities. This injection of finances helped local basic health units install solar panels, build separate toilets for women and girls, arrange for clean drinking water, provide electricity fittings, and repair the hospital access road. The assembly is also introducing an e-health program that will help to monitor all of the district’s basic health units on a regular basis.
Another key objective was to build the advocacy skills of community members to enhance participation and community accountability. Health literacy was identified as a major challenge, so Shirkat Gah rolled out a series of capacity building events for civil society organizations to mobilize local government representatives and the media. The accountability and advocacy training included engaging with both traditional and social media to extend the reach of health messages across a range of audiences.
Noor Memon was one of two local partners who successfully secured airtime on a local FM radio program to raise awareness about women’s reproductive health and the need for discourse to identify women’s healthcare needs. In addition to her radio interview, Memon’s advocacy efforts helped to establish 10 “health clubs” to share information with women about their sexual and reproductive health, and she set up a WhatsApp group to connect civil society with local government to facilitate advocacy and action.
In addition to studying issues of availability, attainability, and affordability, Shirkat Gah tapped into measures the state is taking to provide health and reproductive services for women. As the project comes to a close, findings generated from the field will be used for evidence-based advocacy and policy change at the district, provincial, and national level. The project’s focus on advocacy, education, and awareness is intended to lower the maternal mortality rate and strengthen health system governance for women’s reproductive health and rights in Pakistan, in part by ensuring accountability for government and service providers.