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How is coronavirus affecting family planning efforts in Pakistan

Obstacles to family planning

July 12, 2020

On World Population Day, a look at how the pandemic is affecting family planning efforts in Pakistan, where the healthcare system is already buckling under pressure

Photo courtesy: UNICEF

For Nusrat Bibi, short-term contraception methods had been the preferred choice, which she used to get from the healthcare centre near her village close to Renala Khurd in the Punjab. But as the Covid-19 pandemic struck, the resulting overload of information, misinformation and conspiracy theories made her choice difficult. “People say that if we go to hospitals, doctors will inject us with coronavirus. Also, I cannot go repeatedly to get condoms or pills. My only option now is to go for a method that provides me protection for a longer period,” says the 33-years old mother of six. She turned to Abeeda Shehbaz, a community midwife (CMW) in her neighbourhood, who has set up a makeshift clinic at her home as women in the village are now unable to go out for their medical needs, due to fear of contracting the virus and also due to a lack of mobility and finances. Nusrat now has a contraceptive implant that is placed under her skin in the upper arm, releasing the hormone progesterone into the blood stream, and providing safe prevention of pregnancy for the next three years.

While the pandemic has affected every aspect of healthcare ecosystems globally, it is relevant to observe on World Population Day how it is affecting family planning (FP) efforts, particularly in populous nations where the healthcare systems are already buckling under pressure. Population experts predict that by 2030, Pakistan’s population will swell up to 245 million, making it the fourth most populous nation in the world. According to the latest Pakistan Demographic and Health Survey (DHS) only 34 percent of currently married women are using a contraceptive method. In the year 2019 the modern contraception prevalence rate (mCPR) in Pakistan was recorded to be just 17.7 percent, according to FP2020. It is estimated that some 3,522,000 unintended pregnancies, 1,409,700 unsafe abortions, and 3,830 maternal deaths were averted due to this mCPR. A 1.5 percent decline in the number of women using modern contraceptives during Covid-19 may negatively impact some 1,263,000 women.

Dr Azra Ahsan, a gynecologist and obstetrician with a special focus on family planning and maternal health, confirms that women are avoiding visiting healthcare facilities and hospitals for deliveries or FP as they are scared of contracting Covid. “Many helplines have emerged as there are very few patients coming to outpatient departments (OPDs). This also might be due to lockdown and lack of public transport,” she says. With less than usual women coming to hospitals for deliveries, the opportunity of post-partum family planning (PPFP) is also lost.

“It is true that due to the pandemic, all healthcare facilities have been impacted adversely, including antenatal, postnatal, and FP initiatives,” says Dr Muhammad Imran, the Okara district coordinator for the Government of Punjab’s Integrated Reproductive, Maternal, Newborn & Child Health and Nutrition Programme (IRMNCHNP). Not just FP, even the nutritional status of would-be or new mothers has suffered due to the financial crunch people are going though, adds Dr Imran.

This is why the work of lady health workers (LHWs) and CMWs like Abeeda is critical. To tackle this challenge, government departments and organisations are going the extra mile and providing special trainings to them. “We are training LHWs and concerned healthcare persons about the SOPs regarding how to stay safe themselves, create awareness among communities, and simultaneously ensure continuity of activities related to FP and maternal health,” says Dr Imran.

“Now we mostly counsel them or follow up on their progress via phone or WhatsApp messages. If someone is in need of an examination physically or needs to have a procedure done, we call them to the small facilities in our homes,” says Abeeda, a Lady Health Worker (LHW).

According to Abeeda, service providers like her were initially confused, as a lot of their work is centred on one-on-one counselling as well as conducting awareness sessions in communities. “However, virtual training by Naya Qadam helped us, as did the personal protective equipment (PPE) like masks, protective gear and sanitisers they provided to us. Now we mostly counsel them or follow up on their progress via phone or WhatsApp messages. If someone is in need of an examination physically or needs to have a procedure done, we call them to the small facilities in our homes,” says Abeeda. Naya Qadam is a project led by Pathfinder International with five partners aimed at high-quality FP programming, working in three districts of the Punjab and seven districts of Sindh. During the pandemic, organisations like these, working hand in hand with the government, are critical.

One of the concerns is the protection and safety of the healthcare staff. This, along with addressing the fast-growing stigma around Covid-19, is a key challenge, according to Dr Tabinda Sarosh, Pathfinder’s country director in Pakistan. “Communities might lose faith in health facilities and are afraid that they might end up acquiring the infection from the facility. Providers are also in a state of insecurity, as well as inundated with work. This is bound to reflect on the quality of their work, and also take away time and energies from FP counselling and services,” she says, adding that FP services are still not declared as essential health services by the provincial governments. “A policy-level assertion is much needed to motivate and set up compliance frameworks for the time to come. While some FP-RH Covid-19 framework has been developed by the governments, implementation and monitoring is a long way to go,” she says.

Another obstacle is that supply of commodities essential for continuity of FP services has been hampered due to the pandemic. “Our biggest problem is the shortage of medicines and products we need for FP,” says Haseena Soomro, a lady health supervisor (LHS) from Shaikh Zaid Colony, Larkana. “Our work has decreased by 50 percent due to this pandemic. I have to convince both LHWs and the communities that if the SOPs are in place, we can still do the needful.”

Dr Sarosh echoes the concern, saying that long acting methods that women were using could soon go out of stock if expedited procurement plans are not put in place. For this, her organisation, along with the public sector, has expedited the response for commodity security to ensure continuity in FP services in the areas where they work.

Judging by the importance of LHWs and CMWs in this scenario, the need of the hour is a gender-equitable response to Covid-19, especially in the sphere of FP. As Dr Sarosh says, “Women, as it is, are a marginalised community in Pakistan, and FP as per DHS is in a stagnant state. Add to that the emergence of the pandemic and the disruption of services. This scenario calls for ensuring that women are at the centre of the policies that are being developed or implemented and their growing needs need to be responded to.”


The writer is a freelance journalist with a focus on human rights, gender and peace-building. She works in the field of Corporate Communications­

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The case of female home-based workers during COVID-19

June 14, 2020

Perhaps the worst-hit during the lockdown are workers in the informal sector. Among them, the women have taken a harder financial blow even than the men

For Farhana Naz, the biggest worry right now is that monsoon rains will start in July, and the roof of her house drips, but she has no money to buy her medicines, leave alone get her roof repaired. “I am a widow with one daughter, the sole bread-winner of my family. Apart from some philanthropists who gave us ration, I have no one to look towards for help,” says Naz, a home-based worker (HBW) from a shanty neighbourhood in Orangi Town, Karachi. Women in her area, she says, are not just unemployed but also too scared to step out of the house even to go to the doctor or a hospital if they are sick. “Coronavirus is a disaster; it has spread in my area. We have no food, no money and no work is coming our way,” she says. “We are waiting for all this to be over”.

In wake of the Covid-19 pandemic, Pakistan’s economy has suffered badly. The lockdown has disproportionately affected Pakistan’s small-wage earners. Out of them, workers in the informal sector are perhaps the worst hit. Among them, the women have taken a harder financial blow even than the men.

According to Iftikhar Ahmad, a comparative labour law expert and founder of the Centre for Labour Research, the total employed labour force in Pakistan is 62 million of which 24 million are in agriculture while 38 million are working in the non-agriculture sector. “The informal sector includes those enterprises which do not fall under the jurisdiction of labour law. Combine the informal sector (27 million) with the agriculture sector (24 million) and you get the ‘unprotected sector’ (51 million),” he says. The unprotected sector consists of all workers who do not enjoy the protection of labour law and where workers are not registered with the social protection institutions,” says Ahmed, adding that data regarding HBWs is based on International Labour Organization (ILO) reports which mention the number of HBW in Pakistan to be around 12 million.

“Pakistan’s informal economy comprises 74 percent of it, with a majority of women working invisibly as home workers, domestic workers, contract workers in factories, and labour in rural economy,” says Ume Laila Azhar, executive director of Homenet Pakistan, a network of organizations formed to raise awareness about the working conditions of female HBWs. Azhar adds that HBWs who are subcontracted by national and international supply chains report that they have not received orders for work or regular orders have not been renewed for months since the onset of Covid-19.

Four months ago, Fozia Bibi and the 80 other women from her neighbourhood she is a community leader for, were working and supporting their families. Post-Covid-19 and lockdown, there is no work, and no earning for the 80 households from Baldia Town, Saeedabad, in Karachi. From earning Rs 15,000 to Rs 20,000 ($90- $120) a month, Bibi, a single mother supporting her three children, is now earning nothing. “I had a routine. I had a life. The lockdown and coronavirus changed everything,” says Bibi who made a living by doing miscellaneous work for garment factories.

With the wages of HBWs having dwindled, their dependents too are suffering. “In my area, almost all women are working to support their families. Some are widowed or divorced. Others have husbands who cannot work because of illnesses. Many have husbands who are drug addicts. All these families are affected in a way we could not have imagined,” she says.

“Developing countries may not have the budget or the resources to afford balloon payment to workers of the informal economy. The workers themselves don’t have enough money to prepare for crisis either.”

“While male workers could still make it to the limited work opportunities, it was impossible for female workers to leave home because of closure of transport. During the lock down, some employers were operating secretly. Male workers were preferred on account of better mobility. There is also pressure on female workers from their families to not go out in situations of crisis,” says Zulfiqar Shah, the Pakistan Institute of Labour Education and Research (PILER) joint director, adding that because of disruptions in supply chains, work opportunities of HBWs have declined.

“Even when females are working with formal sector enterprises, they are working mostly without appointment letters or formal employment contractors. Hence, they were the first victims,” says Ahmad.

Azhar says that female workers from all sectors in the informal economy have been affected. Giving the example of the garment and textile sector in Karachi, she says that the industry and local markets are closed, the consumers are opting for just basic utilities instead of purchasing clothes, and the international market demand has declined. “In Pakistan where millions of women do piecework for national and international brands, work began to fall off in February as fears of the virus spread. Since many of the raw materials these workers rely on come from other countries, they were unable to get supplies early on in the global crisis or had to pay more for inputs. This affected those who produced garments as well as those who assembled electronics, games and other products,” says Azhar. Many HBWs were unable to stock raw materials before lockdowns began. “They might not have had time, storage space, or available cash to do so. This prevented them from using this time in isolation to amass products that they might sell once the lockdown was over.”

Relying mostly on philanthropists for rations that would help them get by these very lean months, some of them tried their hand at self-help. As a community leader, Fozia Bibi had introduced the idea of putting in some spare money in what can be called a collective community fund, for rainy days. Even if very small amounts were added, the savings helped this group of women buy rations for those in dire need for the initial weeks of the lockdown. But now all petty savings have run dry.

“The informal economy is particularly strong in developing countries,” Ndaya Beltchika, Lead Technical Specialist, Gender and Social Inclusion for IFAD (International Fund for Agricultural Development), said recently while addressing journalists from various countries. “Developing countries may not have the budget or the resources to afford balloon payment to workers of the informal economy. The workers themselves don’t have enough money to prepare for crisis either.” Beltchika suggested that the governments could repurpose some investments in order to come up with plans that can at least provide basic necessities to these vulnerable citizens.

“There should be an unemployment fund for women who have lost jobs. They should be paid from this fund till normalcy returns,” suggests Shah.

The solution, according to Ahmad, is making social protection a fundamental right. “The state can initiate contributory social protection schemes for all workers, irrespective of their employment status or type of sector they are engaged in (formal or informal),” he says, adding that provision of social protection, especially when it is financed by contributions by the beneficiaries in the form of premiums, is not that costly since not everyone is accessing benefits at the same moment. “Covid-19 is an extraordinary situation and drained resources from even the best-funded social protection systems. Therefore, it depends more on the will of the state rather than on financial resources.”

https://www.thenews.com.pk/tns/detail/671633-the-case-of-home-based-workers?fbclid=IwAR17VIJL73UZwjZBm3GaJfvZ6tJ1RW60HZwi-HSLbTtsr9fLfxs1c6JYqRs

NON-FICTION: MAESTRO ON MAESTRO

Poetry has textures and feeling. And the greats of poetry have lent textures to their words that are felt the moment you hold their compilations in your hand, or read those oft-quoted lines in moments of inner silence. Faiz Ahmed Faiz’s imagery is almost silken, even when he uses difficult and piercing words such as nashtar [lancet]. Mirza Asadullah Khan Ghalib’s words, on the other hand, are faintly granular, subtle yet abrasive, and layered — as are the ideas behind his words laden with deeper meaning, Farsi derivatives and a timelessness exclusive only to Ghalib. Perhaps this unique texture of his poetry is where Ghalib crosses paths with the texture of the art of Syed Sadequain Ahmed Naqvi.

The work in focus for review is a collection of 47 folders weighing almost five kilogrammes — heavy not just in terms of its physical volume. There is a lot to take in, as it features 43 of the 50 paintings that make up Sadequain’s ‘Ghalib’ series. Titled Ghalib: Call of Angel, this collection was compiled and published as a commemoration of Ghalib’s 150th death anniversary. It has a distinct texture, perhaps by deliberate design of the compilers — the folders are separate and individually complete, yet are bound by thematic cohesion. This allows the reader the choice to pick up one and reflect on it for a day, or days, or pick an irresistible one after the other and turn it into a marathon of reading a choicest selection. The paper is hard and heavy, yet smooth — suited to the texture of Ghalib’s poetry — and solid enough to carry the weight of Sadequain’s artistic renditions.

Compiled and authored by Sibtain Naqvi, the book has been published by Mutbuaat-i-Irfani and this is the sixth book that the publishing house has produced. All six books have centred on the life, times and works of Sadequain. The translation of poetry has been done by none other than the renowned Ghalib translator Dr Sarfaraz K. Niazi.

A compilation of Sadequain’s artistic interpretations of Mirza Ghalib’s poetry delights

The third folio has a sketch of Ghalib’s person by Sadequain, alongside the famous poem Allama Muhammad Iqbal wrote, lauding the prowess of Ghalib. As Iqbal accepts in a line from the poem:

Lutf-i-goyai mein teri humsari mumkin nahin

[Matching you in literary elegance is not possible]

Images from the book
Images from the book

The fourth folio is a brief write-up in Urdu by Faiz Ahmed Faiz, where the inimitable Faiz explains why Sadequain deserves to translate Ghalib into his art, and in the last line gives a testimonial to both Ghalib and Sadequain by saying, “Ghalib ke ashaar ki musawwari Sadequain ke fann ka haqq hai” [An artistic rendition of Ghalib’s poetry is the due right of Sadequain’s art].

This fourth folio is perhaps the only one where a painting of Sadequain is by another artist, Haider Ali.

The fifth and sixth folios include calligraphies of Ghalib’s poetry by Sadequain. It seems Sadequain put his heart into these particular calligraphic renditions, very aware of the power of what he was depicting.

There onwards, it is Sadequain’s artistic depictions of selections from Ghalib’s poetic works. The selections — from both Ghalib’s poetry and the complementing art of Sadequain — are matched so judiciously that it seems like a careful slice from the work of these two has been selected and married in a way so as to give a taste of the many facets of their work. Some of the couplets seem to have touched Sadequain so deeply that they have elicited not one, but two works of art from him, as if the artist felt one was not enough to do justice to it. The compiler and author has dealt with this sensitively and the result is a book that is unmissable by lovers of Ghalib and Sadequain.

In folder 13, the words have the timelessness so typical of Ghalib, where he expresses the dilemma of one trying to walk the tight rope of balancing between love and mundane worldly concerns:

Go main raha raheen-i-sitam-ha-i-rozgar
Lekin tere khayaal se ghaafil nahin raha

[Though I remained involved in managing the tyrannies of living, I was, however, never oblivious of your thought and memory]

Possibly, Faiz was inspired by the sentiment when he wrote “Kuchh ishq kiya kuchh kaam kiya…” [I loved a little and also did some work]. Juxtaposed opposite this verse is an oil-on-canvas painting which Sadequain created in 1969, showing a man bent under the weight of earning a living by carrying heavy wood logs, yet having enough strength to have kept alive an element of romance in him, holding a flower close enough to breathe in its aroma.

Another example of one of the verses where Ghalib wrote about man’s existential condition spanning over the past, present and future is in folio number 27:

Sab kahan, kuchh lala-o-gul mein numayaan ho gaeen
Khaak mein kya sooratein hongi ke pinhaan ho gaeen

[Not all, only a few have become evident as tulips and roses What images may lie in the dirt that remain hidden from us?]

Sadequain, a great in his own right, calls himself “Banda-i-Mirza Asadaullah Khan Ghalib” [follower/servant of Mirza Asadullah Khan Ghalib] in the 47th folder, the striking and fitting Addendum, where the right-hand side presents a black-and-white photograph of Sadequain showering flowers on the grave of Ghalib alongside Zaheen Naqvi, who was then the secretary of the Ghalib Academy in Delhi. The left-hand side of the folio has what are perhaps scribblings of Sadequain as he calligraphs impromptu some of his favourite lines (not couplets) from Ghalib’s poetry, ending the page with giving himself many self-proclaimed titles, the last two being Baykal and Baychayn, both almost synonyms, meaning uneasy and restless.

Such was the temperament of the works of Sadequain — peace within restlessness, order within chaos, faces defined by his typical sharp, angled strokes, but the overall impact made whole by some softer maestro strokes. This contradiction is perhaps one other similarity between Ghalib and Sadequain, then. While much of Ghalib’s poetry is clearly inspired by the love of the Beloved, he was a man who simultaneously gave in to human temptations — gambling and consumption of alcohol being the most well known. As Naqvi writes in the introduction about him, Ghalib was “equally at ease at the king’s court or the gambler’s den, he was aware of both his poetic genius and his disreputable ways. Rather than put people off, it is this disrepute or badnaami that endears him to the general masses. The man on the street loves a flawed genius.”

The reviewer is a Karachi-based journalist, editor and media trainer; human-centric feature stories and long form write-ups are her niche

Ghalib: Call of Angel
By Sibtain Naqvi
Mutbuaat-i-Irfani, Karachi
ISBN: 978-969792700
188pp.

Published in Dawn, Books & Authors, July 5th, 2020

https://www.dawn.com/news/1566957?fbclid=IwAR330X7T01cAlyH4EEk4vO0g2gWmls_sFzrOL6tjOkdTMgKc2pucF72vIdg

#CovidDiaries: The learning curve

Farahnaz Zahidi

April 5, 2020

Reflections on living in times of coronavirus

Plan B: I’m trying to organize a work-related trip. The work plan is made. The invites are sent out. The participants have confirmed. But I have a nagging feeling that this might be postponed. I’m still attending meetings, still going out to meet family and friends. As a journalist, it is my default setting. Wuhan is in my news alerts. Till now, people are thinking it is something limited to China. “We are safe” is the global sentiment. But news has started circulating about the prevalence increasing. I’m late to the party, but I have now learnt its name: COVID-19. Three days later, we are onto Plan B: Postpone all meetings and interviews indefinitely. My feature stories will now have to rely on phone-based interviews, unless unavoidable. PSL matches also have a Plan B now: play in the stadium but have no live audience. My Quran classes are indefinitely called off. The world is in Plan B mode. Or Plan C.

Change: News of transmission through zaireen (pilgrims) returning from Iran via Taftan is creating ripples of panic. The first case in Karachi has surfaced, yet Karachiites are still chilling. Everything seems normal, except that the grocery stores are unusually crowded; bulk shopping is the first sign of collective panic. The prospect of not just hunger, but the idea that we may not get to eat what we like when we like, is causing the panic in upper-tier Pakistanis. At a lower social rung, daily wagers are hoping for just basic needs being met. Business is slow. Dollar is rising. Financial hawks are buying shares. Schools are shutting down. There is news that they are not allowing tawaaf around the Ka’aba. Husband is praying at home on a Friday. I am not prepared for this. But it’s happening.

Behind the mask: Masks are not available in any pharmacy. They have put up print-out posters outside: “Sorry, masks not available”. Husband manages to get locally made masks for us. They are flimsy and clearly made in a hurry. I still feel very grateful to have one. It is my passport to going out although I’m not sure it actually protects me. I am nagging my house help to wash her hands. Her response is a quizzical look. Two days later, she has been initiated to the idea of an invisible killer called “Corona”. She is washing her hands regularly now, but not obsessively, unlike me. My hands are sore from repeated washing. I have a variety of sanitizers now. A few days later, she has left for her village. The fear is permeating all strata. This is getting real.

It isn’t easy living in semi-isolation. Life has lost its spontaneity.

Physical Distancing: I am getting hundreds of Whatsapp messages daily. I try to read them, thinking there might be something useful. I give up soon. Although there are some useful things hidden in the multitudes of forwards, most of them are either conspiracy theories, or videos of patients in Italy, or badly written clearly fake news snippets. I feel worse every time I read any of them. The memes sometimes help me feel better, and sometimes sound insensitive. I don’t know any longer what to feel. Sad? Scared? Anxious? The only messages that make sense are from charity organizations or individuals helping alleviate people’s miseries by distributing ration, asking if I want to contribute. Charity is Pakistan’s saving grace. The best messages are personalized ones – someone asking how I’m doing, or sending prayers. The rest are all white noise. Daughter gives a brilliant suggestion: we call one person every day. I’ve started calling friends and relatives. It’s good talking to people one-on-one after ages. I prefer “physical distancing” to “social distancing”.

The cough: I wake up with a cough. I have body ache. I am so scared, my heart skips a beat, and I can’t breathe. I have checked my fever a dozen times. People I actually know, abroad, have told me they have coronavirus. The killer has a face now. I’ve been at home for more than a week, except a stroll outside the house after dinner on a deserted street since the lock down. No happy motorcyclists whoosh past anymore. Leave alone eating out, even riders cannot be seen on the streets, delivering consumerism in styrofoam food boxes. Then how could I have gotten it? My doctor friend says it doesn’t sound like coronavirus. I am relieved… for now, but still scared. Everyone is scared. Bleach. Door knobs. Vitamin C. Nigella seeds. Take off shoes at the entrance. My vocabulary is growing exponentially, so is the number of those affected by the virus.

Epiphanies: Meetings and classes are on Zoom now; adaptability is a human strength, I’m rediscovering. My feel-good factors are changing. I’m tempted to order some clothes for Eid from Pakistan Day sales online. But what is Eid going to be like this time? I already have so many clothes.

Self-reflection is routine now. Audio books are helpful. A book in hard-copy is back at my bedside. We are mopping and washing, grateful we are able to do it ourselves. The baking tray is out after ages. It isn’t easy living in semi-isolation. Life has lost its spontaneity. You can’t step out when you like. Life is more basic. We are moving from wants to needs. But acceptance is finding its way in. Humanity is becoming more of a fraternity; nothing bonds people more than shared pain. “Things” seem inconsequential when you hear of people dying; when you’re witnessing the plague of this era, and when healthcare saviours are risking their lives at the front-lines. What does it matter who won that argument on Facebook? What does it matter what someone said to me four years ago? What does it matter what anyone thinks of the car I drive? In the bigger scheme of things, what does actually matter? Being safe, healthy, content, with your loved ones, and accepting your vulnerability, yet reaching out only to The Creator. Perhaps that is the biggest takeaway of COVID-19.

https://www.thenews.com.pk/tns/detail/638842-coviddiaries-the-learning-curve?fbclid=IwAR3oyv5oDN1Jhm4_ddw2Oxt42YmgoI_UJuLMX-ALdyP2IbRFw1TH_9MMfW8