Maternal Health Issue: Gender Roles as an Obstacle

Sikan­der Ali

Like most of the crises in ser­vices deliv­ery, the qual­i­ty of health ser­vices deliv­ery is far from keep­ing mass­es safe. Mater­nal health is one of such issues. The state has been mak­ing efforts to address this issue but they are mea­ger and insuf­fi­cient. Some com­mit­ments at nation­al and inter­na­tion­al lev­el have also been made in this regard to reduce mater­nal mor­tal­i­ty and to pro­vide bet­ter facil­i­ties. Mil­len­ni­um Devel­op­ment Goals (MDG) of Unit­ed Nations is one such inter­na­tion­al com­mit­ment where­by Pak­istan shows its con­cern in con­nec­tion to mater­nal health and real­izes the sen­si­tiv­i­ty of the sub­ject. How­ev­er recent fig­ures of 2012 show that Pak­istan is los­ing 276 women per 100,000 live births which needs to be reduced to 140 on per 100,000 by 2015. Along with that, the high fer­til­i­ty rate of 4.1 also needs to be reduced to 2.1 by 2015. Sim­i­lar­ly if we cat­e­gor­i­cal­ly look at all four provinces, Balochis­tan would be found in alarm­ing con­di­tion where 785 women per 100,000 live births per­ish dur­ing the child­birth. In Khy­ber Pakhtunkhwa mater­nal mor­tal­i­ty rate is 350 per 100,000 and in Pun­jab it is 259 per 100,000 live births, while Sindh is suf­fer­ing from 314 deaths per 100,000 live births. This is no doubt a high num­ber and requires imme­di­ate atten­tion to save hun­dreds and thou­sands of lives each year.
There are mul­ti­ple fac­tors con­tribut­ing in count­ing mater­nal mor­tal­i­ties, for instance lack of con­cern by the stake­hold­ers, lack of aware­ness, polit­i­cal insta­bil­i­ty and so on. Unfor­tu­nate­ly inten­tion­al­ly or unin­ten­tion­al­ly some fun­da­men­tal caus­es behind issues such as mater­nal health are usu­al­ly ignored. Gen­der role in a giv­en soci­ety is one such fun­da­men­tal obsta­cle to meet the Mil­len­ni­um Devel­op­ment Goals.

Gen­der is pure­ly social­ly con­struct­ed where­by men and women are asso­ci­at­ed with fixed social roles and respon­si­bil­i­ties. Over gen­er­a­tion gen­der has evolved into a kind of ide­ol­o­gy. Accord­ing to it, men are respon­si­ble for out­door duties while women are asso­ci­at­ed with indoor house­hold chores and child bear­ing activ­i­ties. In under devel­oped soci­eties such as Pak­istan, socio-cul­tur­al, reli­gious and moral norms pre­scribe women to remain under the con­trol of men. Addi­tion­al­ly, men hav­ing con­trol over finan­cial and social resources make deci­sions about the repro­duc­tive rights of women. Women are not sup­posed to decide regard­ing fam­i­ly plan­ning, num­ber of chil­dren and the use of con­tra­cep­tives etc. High fer­til­i­ty, pref­er­ence for son and ear­ly mar­riages add to the vul­ner­a­bil­i­ty of women lead­ing them even­tu­al­ly to a slow death.
From ear­ly child­hood, the con­flict of respec­tive gen­der roles dis­crim­i­nates against women. This dis­crim­i­na­tion is rein­forced through the web of socio-cul­tur­al and reli­gious insti­tu­tions. Exam­ples of such atti­tude can be observed in dis­tri­b­u­tion of food, pro­vi­sion of edu­ca­tion, health and dif­fer­ences in expec­ta­tions asso­ci­at­ed with men and women.
Pak­istan is also a sig­na­to­ry in oth­er inter­na­tion­al treaties for end­ing vio­lence against women and seek­ing gen­der jus­tice. Con­ven­tion on the Elim­i­na­tion of all forms of Dis­crim­i­na­tion against Women (CEDAW), Bei­jing Plat­form for Action and Uni­ver­sal Dec­la­ra­tion of Human Rights are a few major com­mit­ments. Apart of that, at nation­al lev­el the Arti­cle 25 of the Con­sti­tu­tion of Pak­istan reserves pro­tec­tion and equal rights for all cit­i­zens irre­spec­tive of class, race or sex. Nation­al Com­mis­sion on the Sta­tus of Women has been estab­lished for the empow­er­ment of women. Despite all these com­mit­ments, the real­i­ty is too obvi­ous that it is not pos­si­ble to meet the MDG stan­dards of mater­nal health by 2015. There is an urgent need for pub­lic and pri­vate part­ner­ship in this regard, anoth­er objec­tive pre­scribed by MDGs. We need grass­roots sup­port to tack­le this issue. Edu­cat­ed men and opin­ion lead­ers could be help­ful ally in this regard. They need to be sen­si­tized about the sever­i­ty of the issues with col­lec­tive efforts of gov­ern­men­tal and non-gov­ern­men­tal insti­tu­tions.

Sikan­der Ali is a young human rights activist and researcher cur­rent­ly work­ing as a Research offi­cer at Agha Khan Uni­ver­si­ty Karachi.