Political, Social, Economic and Cultural Barriers to advance SRHR in South Asia

1. Presentation by Suhail Safdar, Secretary, Ministry of Women Development, Government of PakistanBangkok, July 28, 2005 Political, Social, Economic and Cultural Barriers to advance SRHR in South Asia

2. “As world population hits 6.5 billion, the largest group of young women ever is entering their child bearing years. Most are in developing countries and many are born into poverty”

3. Outline of the Presentation • Basic demographics (Global view) • Regional view (South Asia) • Political, Social, Cultural & Economic Barriers • Steps to be taken to remove these barriers • Women of Pakistan • Government of Pakistan’s initiatives

4. Proportions of Younger and Older Women, Selected World Regions Percent of female population Source: PRB, Women of Our World 2005

5. Births per Woman (Total Fertility Rate), Trends in Selected Regions Source: PRB, Women of Our World 2005

6. REGIONAL VIEW (South Asia)

7. POLITICAL BARRIERS • Not enough women in the legislatures • Not allowed to contest elections • Not allowed to vote • Patriarchal/ feudal systems • Gender violence restricts women’s participation in society

8. Social and Cultural Barriers • Illiteracy and lack of Education • Early marriage and frequent pregnancies • Desire to produce a male hier • Lack of reproductive and health rights • Harmful traditional practises and customs • Lack of proper healthcare because of poverty

9. ECONOMIC BARRIERS • No access to land and resources • No land ownership rights • Unable to work because of domestic issues • No financial credit available because of lack of education • Tough working environment and unequal remuneration

10. STEPS TO BE TAKEN • Investments in Girls education • The right of women to participate in political life (In Pakistan, 33% women at Local level and 21% in the Parliament) • Politicians and celebrities to make public statements and take a leadership role in promoting gender equality • Highlight the role of SRHR in achieving the Millennium Development Goals. • Hold workshops, Seminars and Debates. • Involve the religious groups, Ulema and Scholars in the Reproductive health debate.

11. Quran and Family Planning • Sura Bakara, Ayat 233 ‘’ The Mothers shall suck to their offspring for two whole years, If the father desires, To complete the term. But he shall bear the cost of the food and clothing on equitable terms A burden laid on it Greater than it can bear No mother shall be treated unfairly on account of her child, Nor father on account of his child An heir shall be chargeable In the same way If they both decide on weaning,’’

12. Pakistani Women at a Statistical Glance • Population 71.376 million • Life Expectancy 63.8 years (64.1 years for men) • Fertility Rate 4.07 • Maternal Mortality Rate 350 – 400 per 100,000 live births • Literacy Rate 41.8% • Labour Force Participation Rate (Refined) 16.80% • Ratio of girls to boys in primary education 0.55 • Female share of non agri. wage employment 8% • Women in Federal Govt. 4.20%

13. Gender Related Indices Gender Empowerment Measure (GEM) Pakistan Ranks at 64 out of 175 Listed Countries (UNDP Human Development Report, 2004) Gender-related Development Index (GDI) Pakistan Ranks at 120 out of 175 Listed Countries (UNDP Human Development Report, 2004)

14. CURRENT SITUATION • 68% rural women most vulnerable, poor and voiceless – lack assets, access to services, options and economic opportunities. • Of 32% urban women, majority live in slums or katchi abadis or just above poverty line – lack basic needs and economic options. • Both rural and urban women suffer socio-cultural gender biases, inequalities, injustice. • PRSP focuses on poor and vulnerable, asset creation and human capital. • MDGs1-2,4-7 are integrally linked to MDG #3 that discusses gender equality &women’s empowerment.

15. Formulate and develop women sensitive policies. • Announcement of National Reproductive Health Policy 2000, and National Health Policy 2001 announced. Gender dimension incorporated. • National Policy for Development & Empowerment of Women 2002, affirms government’s health policy.

16. ACTIONS TAKEN BY M/O WOMEN DEVELOPMENT TO ADDRESS SRHR Gender & MDGs • Five years assessment of achievement of MDGs in Pakistan highlights weak areas such as: • Maternal mortality • Literacy • Sanitation • Access to safe drinking water

17. NATIONAL PLAN OF ACTION (NPA)FOR WOMEN • THE NPA FORMULATION PROCESS CULMINATED ON 14TH AUGUST, 1998 WHEN THE PRIME MINISTER ANNOUNCED THE PLAN. • 184 ACTIONS • BROAD CATEGORIES OF ACTIONS: • POLICY ORIENTED 59 • LEGISLATIVE 25 • FINANCIAL ACTIONS 100 184

18. Women Health and RH • Numerous health indicators related to women are far from being impressive, such as:- • Maternal mortality rate is 350/100,000 live births, perhaps more. • 15 doctors and only 2.1 nurses for 10,000 population. • GNP expenditure for health services is less than 1%. • 20,000 women die of pregnancy and child related causes annually.

19. Women Health and RH • NPA implementation. • Forward looking National Health Policy. • Health for all concept. • Removing gender disparities. • Special focus on women and girl health. • Treats health sector investment as part of Government’s poverty alleviation plan. • Best practices. • National Programme for Family Planning and Primary Health. • Expanded Programme of immunisation. • The Lady Health Workers scheme – now nearly 100,000 LHWs providing door to door service.

20. Improve Quality of Care. • Strengthening of district based health systems in progress. • District health information systems established. • Baby friendly hospital initiative extended to community and private sector. • As a follow up to ICPD: • Reproductive health package introduced. • Gender sensitization incorporated in the basic and refresher courses run by training institutes. • Women Health Project launched in 2000 – focus on improving health, nutrition and social status of women and girls by developing women friendly health systems in 20 districts of Pakistan. Reproductive health including emergency obstetric care being expanded.

21. Improve Women’s Access to Health Services. • Easy access to health care services through LHWs. National Programme for Family Planning and Primary Health Care focusing exclusively on women, through a network of Lady Health Workers who provide services for family planning, maternal and child health immunization, nutrition and treatment of minor ailments. • Other government run health programmes include: • Expanded Programme of Immunisation, National AIDS Control Programme, Malaria Control Programme, T.B. Control Programme, National Hepatitis B Immunization Programme, Cancer Treatment Programme, Anaemia Control Programme, Vitamin A Deficiency Control Programme. • Network of clinics established by private sector organizations to provide family planning services. • EPI coverage at 77% for children and 50% for expectant mothers. • 88% TBAs trained. • 100% LHWs trained. • Women promoted to important supervisory positions in the AIDS Prevention and Control Programme. Increased proportion of women employed in the health sectors as doctors and nurses.

22. Strengthen Women’s Participation in Decision-making regarding their health / reproductive choices • Information sessions in girls’ schools about reproductive health issues arranged by the AIDS Control Programme. • Health messages (MoH) on various issues, telecasted on national television networks including for ORS, breast-feeding, immunization of expectant mothers, nutrition, family planning, HIV/AIDS. • Training of Women Councilors about community problems including health /reproductive issues

23. PAKISTAN’S COMMITMENTS TO HIV/AIDS, RH, AT RECENT INTERNATIONAL CONFERENCES • Islamabad Declaration (Celebrating Beijing plus 10- Fifth South Asia Ministerial Conference 3-5 May- Islamabad) – Hosted by MOWD • Islamabad Plan of Action ( Gender Mainstreaming Conference- March 28-30, 2005- Islamabad)- Hosted by MOWD • Islamabad Declaration on Population andDevelopment (International Ulema Conference on Population and Development, 4-6 May, 2005- Islamabad) – Religious Scholars from 26 countries participated

24. Thank You