Programme de Médecins du Monde pour les femmes au Pakistan

Pakistan

Emergency
1 in 13

children die before their 5th birthday

34 million

people live below the poverty line

14,000

women every year die giving birth

Humanitarian assistance and the scale of need in 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.

Doctors of the World comes to the aid of displaced people in Pakistan© Sara Farid
Doctors of the World comes to the aid of displaced people in Pakistan© Sara Farid

Our humanitarian action in Pakistan

Médecins du Monde has been working in KP since 2009, responding to emergencies and supporting facilities which provide primary healthcare to displaced people and host communities. In addition to general medical care and sexual and reproductive healthcare, since 2018 MdM has begun to provide 24-hour basic emergency obstetric and neonatal care at four healthcare facilities.

Since the beginning of the Covid-19 pandemic in 2020, the Médecins du Monde teams have developed an adapted response to provide humanitarian assistance, including in the usually hard-to-reach former tribal areas.

 

Humanitarian assistance in Pakistan despite the epidemic

MdM’s healthcare staff and those from the Ministry of Health in the province have been trained in infection prevention and control, protective measures and good hygiene practices to ensure access to care despite Covid-19. MdM has also provided health authorities with personal protective equipment, such as surgical masks and gloves, in order to equip health centres in the region, and we have installed around ten hand-washing stations. With these measures MdM has enabled nine health centres to continue to provide healthcares services in an environment that is safe for staff and patients. Five of these centres are in the former tribal areas and four are in KP, the latter having continued to provide 24-hour basic emergency obstetric and neonatal care.

The measures imposed by the authorities to slow the spread of the epidemic, including travel restrictions, also meant MdM had to cease its outreach campaigns – awareness-raising and health education sessions usually organised within communities. Nevertheless, Médecins du Monde delivered a large-scale Covid-19 information and prevention campaign in the region through the distribution of leaflets, the media and billboards.

In 2020

as part of our humanitarian action in Pakistan, we:

  • provided free basic emergency obstetric and neonatal care to 20,734 women
  • ensured 2,755 births were attended by skilled staff
  • provided 6,163 antenatal consultations

 

Awareness raising and health education workshops, especially on the vaccination of children, are held within the communities ©Lam Duc Hien
Awareness raising and health education workshops, especially on the vaccination of children, are held within the communities ©Lam Duc Hien

Our humanitarian programs in Pakistan

Improving access to family planning

Médecins du Monde has been working in Punjab since 1996 and has developed a good understanding of the health issues and challenges in this region. Since 2015, and with the aim of improving access to good sexual and reproductive healthcare (SRH) services, MdM has made family planning a particular focus of its work. Capacity-building support has been provided to family planning centres and staff from the Population Welfare Department (PWD) to ensure good quality services. Influential volunteers from the community have been trained and work alongside MdM teams to run awareness-raising sessions. These sessions are aimed at both women and men, with the intention that everyone has the opportunity to learn about and exercise their rights.

In addition, there is a focus on young people, with the development in collaboration with the PWD of a pre-marriage handbook, which is currently being trialled in the regional capital of Lahore. A coalition of local actors has also come together to advocate greater promotion of SRH rights in Punjab, especially through the endorsement of new draft legislation. However, when the country’s first cases of Covid-19 were identified in February 2020 the continuum of care was hit by further disruption. The International Planned Parenthood Federation estimated that Pakistan was one of the countries in the world where access to sexual and reproductive healthcare, including family planning, was most disrupted. This was due to the combination of lockdown measures and travel restrictions imposed by the authorities, the impact of the virus on healthcare staff and budget cuts at the Population Welfare Department.

In response to this crisis, Médecins du Monde trained PWD staff in infection prevention and control measures which meant the six supported family planning centres could reopen and a minimum service could continue. These centres also received the equivalent of three months’ supply of modern methods of family planning, including 100,000 condoms, as well as personal protective equipment to help protect against Covid-19. Social mobilisers were trained in Covid-19 prevention and how to identify gender-based violence and mental health and psychosocial problems and this facilitated large-scale public awareness-raising. Médecins du Monde also supported the PWD with 10 mobile units to provide information, raise awareness and carry out Covid-19 testing in the community. The people of Pakistan are contributing to the country’s future.

In 2020

thanks to a humanitarian action in Pakistan, the Médecins du Monde teams:

  • supported 15,973 people with health services: 8,929 people received services from mobile units, while 6,977 learnt about Covid-19 and gender-based violence
  • distributed 65,816 Covid-19 information and prevention leaflets
  • trained 65 members of Population Welfare Department staff in infection prevention and control
  • donated three months’ supply of modern methods of family planning and four months’ supply of personal protective equipment to the Population Welfare Department to help tackle Covid-19

 

 

 

our institutional support

Budget: €1,940,250
Le ministère des Affaires étrangères allemand (AAHH) soutient Médecins du Monde
History
2004
Start of intervention in Dar-ul-Aman women's shelters.
2009
35 Dar-ul-Aman shelters opened in the country.
2009
Start of intervention for victims of conflict in KP.
2015
Conclusion of intervention in the Dar-ul-Aman shelters; management transferred to the social affairs department.
2015
Launch of an SRH project in young people’s centres in Lahore.
2017
Opening of a new family planning project in Chiniot, Punjab.
2020
Developement in the context of Covid-19 of an adapted response to provide humanitarian assistance, including in the usually hard-to-reach former tribal areas

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