Chair: Dr. Talib Lashari, Executive Coordinator, The Network for Consumer Protection, Islamabad, Pakistan
Discussant: Dr. Saadia M. Malik, Executive Director, Mahbub-ul-Haq Human Development Center (HDC), Islamabad, Pakistan
Panel Organizer: Dr. Shafqat Shehzad, Research Fellow, SDPI, Islamabad, Pakistan
Dr. Sakuntala Narasimhan, Author/Resource Person, Bangalore, India, presenting her paper titled “Strategies to Support Women in Rural Health Practices: Some Innovative Experiments from India” shared the experiences of successful interventions of using South Asian culture of traditional songs to spread information and create awareness on health and other important issues among the illiterate poor village women. The interventions were carried out in four states of India where voluntary organizations, activists and groups effectively used tunes of the traditional songs with substituted words to spread the key messages and information. According to her, generations-old familiarity of rural women with traditional cultural songs and the substitution of words with key messages tremendously helped illiterate women to learn, repeat, remember and practice the new ideas to overcome their problems related to health, gender, violence, nutrition, hygiene, alcohol, sanitation, etc. Sharing several interesting and exemplary case studies besides singing some of the substituted songs in cultural tunes of Indian languages, she said that the infant mortality rate (IMR) and maternal mortality rate (MMR) have gone down by 50% while life birth rate have dropped from 110% to 65% in Andhra Pardesh alone.
The innovative method produced far reaching effective results compared to so many contemporary methods of spreading information such as printing materials and traditional state-funded schemes including community health clinics and paramedics, she pointed out. She said that substantial improvements took place in the conditions of women in Karnatka and Gujrat not only in dealing with the health issues but also for their empowerment, self-help growth, micro-finance, decision-making, capacity-building, networking and mobilization.
Dr. Mufiza Farid from the Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan, in her presentation titled “Magnitude and Dynamics of Physical Violence: Evidence from a Low Income Country” identified physical abuse by intimate partner as most common form of violence against women in marital life as well as during pregnancy. Sharing the details of a facility-based group survey carried out over a period of three months on 500 hundred pregnant women in tertiary care hospitals of Karachi providing care to lower and low-middle socio-economic strata; she lamented that magnitude and dynamics of physical abuse represents a serious social, medical and legal problem for women. She pointed out that is more harmful during pregnancy because it significantly impacts the pregnancy outcomes including an additional threat to fetus as well. Urging the need for further research on this subject and a restrain for the generalization of her study, she said that statistical analysis of the data shows nearly 28% women experienced physical violence during marital life while 13% during index pregnancy. She further stated that social parity and household conflicts are commonly involved in the abuse, However, social support is very protective against it adding a number of factors at individual level relationships, and at the community and society level that lead to the phenomenon. She cautioned that physical abuse increases the risk of both fatal and non-fatal outcomes ranging from homicide, suicide, maternal and AIDS related deaths to physical, mental, reproductive, sexual and injurious health behaviors. She recommended screening for abuse as an integral part of standardized antenatal care, counseling for spouse support and family planning at antenatal center and more population based studies in order to advocate screening at antennal care and a plan of action for careful patient assessment, referrals, provider education and community awareness.
Dr. Shafqat Shahzad, Research Fellow, Sustainable Development Policy Institute, Islamabad, Pakistan, presenting her paper titled “Sustainable Solutions for Improving Mothers’ Health in Pakistan” shared a detailed insight into the alarming situation of reproductive and maternal health care in Pakistan. She noted that maternal mortality rate (MMR) remains very high while mother’s health is neglected due to multiplicity of factors involving social, cultural, economic, and political reasons. She shared results of her research study jointly conducted with Ms Nabila Zaka of UNICEF in the 61 districts of four provinces of Pakistan. According to her, despite so many efforts and country’s international commitments, expecting mothers suffer risk of dying due to obstetric obligations and poor people spend more on health services out of their pockets while expenditures on health remains low and a huge supply-gap in the provision of health services exists. However, the results of study as well as international experiences show the strategies of Emergency Obstetric Care (EmOC) have the potential to reduce the MMR as it declined from 186 to 166 and obstetric case fraternity rate decreased from 0.7% to 0.6% from 2003 to 2006 in 11 selected districts. She identified perceived cost of health care as a major barrier to improve the utilization of this facility during pregnancy underlining the need to measure economic and financial cost and translation of burden of maternal deaths into economic terms to allocate resources and reduce financial barriers. She urged inclusion of expecting mothers into social protection strategy and more assistance and social protection for 12% chronically poor clients.
Dr. Shafqat Shehzad recommended a set of sustainable solutions based on evidences collected from 11 districts of the four provinces which included provision of EmOC facility, adoption of integrated policies, community participation, skilled birth attendants, realistic budgets for projected cases for obstructed emergencies, provision of pre-packaged delivery and c-sections kits, lifting of mandatory condition of showing ID card to access services especially in life threatening acute conditions, support of poor women from Bait-ul-Maal and social security funds, possible use of voucher schemes to reimburse transport and medicine expenses of complicated clients, reduction of financial barriers to access life saving maternal health services and initiate NGOs partnership mechanisms.
Discussion
Dr. Saadia M. Malik, Executive Director, Mahbub-ul-Haq Human Development Center (HDC), Islamabad, Pakistan, considered all the three papers extremely important in highlighting the health situations of two vulnerable groups—women and children—adding that these two groups represent a very dismal state in South Asia and that some of the indicators are even lower than some Sub-Saharan countries of South Africa. She said MMR has increased from 410 per hundred thousand to 530 per hundred thousand over the past 10 years and around 50% children under the age of five remained malnourished and more than one-third of the total world maternal deaths occur in South Asia, according to the UN Human Development Report.
Appreciating the paper and singing ability of Dr. Sakuntala Narasimhan, she said her paper effectively highlighted the role of culture in creating awareness among illiterate masses. The rich and diverse culture of South Asia can be harnessed and replicated to lead the development goals in Pakistan suggesting that the use of religion could also effectively contribute in the development process. However, she emphasized for more specific data and evidences on the effectiveness of interventions and to support the argument while talking of technical details of the paper.
She also appreciated Dr. Mufiza Farid’s paper saying that the extent of violence against women in South Asia is much higher than any other region of the world and despite lack of credible data at the country level, around 50% women experience violence in their marital life in South Asia and almost 70% to 90% in Pakistan, according to the Human Rights Watch. Talking of technical details, she sought clarification in the association and effects of independent variables on the spousal abuse besides some information on the socio-economic characteristics and family structure of the respondents.
Commenting on Dr. Shafqat Shahzad’s paper, she said it effectively underlines the significance of social safety nets particularly in health sector fearing that without those social safety nets in place, Pakistan would not be able to meet the millennium development goals for reducing the high MMR. However, she sought more information on criteria of selection of districts in addition to reasons for recommending EmOC facility as a best strategy.
Following the clarifications from the panelists in response to the comments of the discussant, a number of issues were discussed which included effective role of increased awareness in improving health care services and other issues in India, need to use religion as a tool to spread information and education, counseling at the family planning centers, different ways of creating motivation towards certain causes, duration and sustainability of the improvement women’s conditions in India, confidentiality aspects of women counseling, out-sourcing of health services, causes of violence, working conditions and skill levels of lady health workers.
At the end, Dr. Talib Lashari, Executive Coordinator, The Network for Consumer Protection, Islamabad, Pakistan, appreciated all the three papers especially that of Dr. Sakuntala Narasimhan adding that this kind of research and interventions are very useful and valuable addition in the policy discourse for the policy makers and health managers in Pakistan to achieve the targets of the millennium development goals by 2015.
Reported by Faisal Gorchani and Kamila Shahana
| Email Article |  |
Print Article | |
Next Article |
PDF Format
