Pakistan

Pakistan is ranked 152 out of 189 countries by the Index of Human Development (IHD) and the country invests very little in its health sector – just 3.2% of GDP. The public health system is extremely fragile, especially in rural areas that have suffered multiple crises, such as armed conflict and natural disasters. The services provided are inadequate and there is a lack of qualified medical staff, equipment and essential medicines.

The situation is particularly concerning in the region of Khyber-Pakhtunkhwa (KP), especially in the former tribal areas on the border with Afghanistan. According to UNHCR, in 2020 Pakistan was host to around 1.4 million Afghan refugees and 100,000 internally displaced persons and 58% of these refugees were in KP.

The key challenges for medical assistance in Pakistan

The local healthcare system is particularly fragile and struggles to cope with influxes of displaced persons, while the care available for the host communities is already of poor quality. Although almost all those who were internally displaced have now returned to the former tribal areas, they have been confronted with infrastructure that is damaged or destroyed and limited access to health services.

Only one in five women have access to modern methods of contraception

As is often the case, women and children are among the first affected as sexual and reproductive and reproductive healthcare is the most neglected. Too many women die during pregnancy or while giving birth, due to haemorrhages, infections or preeclampsia (a serious complication resulting from pregnancy-induced hypertension). In Khyber-Pakhtunkhwa, only one in five women have access to modern methods of contraception. Too many children die from asphyxia at birth or from diarrhoea or pneumonia during their first years of life.

Breaking down sexual taboos: a priority for Médecins du Monde

Women and girls in Pakistan face numerous barriers – economic, social and cultural – in accessing comprehensive sexual and reproductive healthcare (SRH) services and exercising their rights and freedoms in relation to control over their own bodies, sexuality and family life. While progress is evident in urban areas, acceptance of the right to SRH remains limited in rural areas where socio-cultural norms are more deep rooted.

In KP, women cannot travel alone and they usually need permission from their husband or mother-in-law to attend healthcare facilities. Very few female medical staff, particularly doctors, are employed in this region. Women have many pregnancies, with one of the highest fertility rates in the country. The concept of family planning is very poorly understood and accepted by the community and 40% of births are not attended by qualified medical staff.

A weakening access for women and girls to family planning

In Punjab, the most populous province in Pakistan with over 110 million people, cultural and religious practices and the lack of public investment in sexual and reproductive healthcare is weakening access for women and girls to family planning. Yet this is a major public health and demographic issue for the province. A quarter of the population is aged between 9 and 19 and 8% of 15-19-year-olds are already mothers or are pregnant with their first child. There is therefore tremendous need for sexual and reproductive health advice and care, but these are topics social workers struggle to tackle.

Improving access to good comprehensive sexual and reproductive health services, including family planning, is therefore a real challenge for Pakistan.