Women’s health crisis

The recent headlines on Pakistan’s abysmal record in infant and neo-natal mortality should be giving policymakers a pause. Being the worst nation for new born babies in the world and one of the worst for infants under one-year-old is no small feat. In fact, Pakistan is worse than war-stricken countries like Afghanistan and extremely poor countries like Somalia and South Sudan. Let that sink in.

Poor delivery care, non-availability of trained midwives, inaccessibility of health facilities and lack of sanitation and water all contribute to such dangerously high numbers for Pakistan. But the most prominent cause for higher deaths in babies and children remains the worsening health and nutrition of mothers.

There is no doubt that malnutrition and food insecurity are prevalent across the country, but there are widening gaps in the same for women. According to a study conducted by UN women on gender inequality, the gender gap between men and women in food security is nearly 11 percent which leads to lower nutrient intake in women.

Globally, anemia is a major cause of maternal as well as infant mortality as the health of the child and its development depends on the health of the mother. Data from the Global Nutrition Index shows that 52 percent of the reproductive mothers in Pakistan are anemic. The same UN study indicates that women in Nigeria are better nourished than women living in Sindh, at the same poverty levels.

To quote other numbers: more than 60 percent of women categorized as poor do not have access to basic sanitation, while 70 percent do not have a skilled health professional available at child birth. The same statistics are even more staggering if we consider the gaps between poor and high-income households within Pakistan (See table).

A study conducted by Leveraging Agriculture for Nutrition in South Asia (LANSA) argued that women participating in agricultural labour in Pakistan were more likely to be undernourished and underweight than those that were not working. In fact, this unpaid labour led to poor health for both women and their children. Over 50 percent of the children born to women working in the fields were stunted; where the average is 44 percent.

The study argues that if women were to get paid for their work in the rural areas, it would have a positive impact on their nutrition as “women earners are known to make more pro-nutrition consumption choices”. But the problem also comes down to awareness and empowerment. The LANSA study cities arguments that there may be a strong association between nutrition and the empowering of women. Studies find that “women’s autonomy in production and women’s work in agriculture improves diet diversity and reduces the incidence of stunting”.

But in Pakistan, more than 58 percent of the women in poor households do not have a say in the matter of their health; and 98 percent of these women do not have more than six years of education. Surely, if they are not paid for their labour, they are not educated and they also do not have a say in what (how much) they feed themselves and their children, the resultant malnutrition and higher child morality make sense.

Policymakers should know that arranging for mobile clinics or providing women with clean and sanitary healthcare facilities where trained practitioners or midwives are present and where nutritional supplements are readily available could substantially help in improving maternal health and child mortality. Some provincial or aid-based funds can be directed toward these areas, plus an overall focus on sanitation and access to water.