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Women should leave the hospital with a contraceptive

Pakistan must ensure that women are included in the family planning process

 Published: September 26, 2019

An Internally Displaced Pakistan woman from the North Waziristan tribal region carries her sick child. PHOTO: AFP

By Farahnaz Zahidi

Her backache is better, and she is feeling relieved for more than one reason. An hour ago, Azra got an Intrauterine Contraceptive Device (IUCD) which she calls a Challa (ring) inserted, with her own free will; the IUCD will potentially give her a break of five years from conceiving a child. This 30-plus years old mother of three, who does not know even her own exact age, knows well now that to remain healthy to look after her three children, and to possibly give birth to healthy children in the future, her body needs a break. Azra had come to the Naudero Rural Health Centre (RHC), District Larkana, Sindh, complaining of bleeding since eight days. This was her second miscarriage. The medical staff, after an ultrasound, told her she had been pregnant since nine weeks and her pregnancy could no longer be sustained. As her dilation and curettage (D&C) was performed, she also got the IUCD inserted. “My husband did not want me to use a permanent method of contraception as we may want to have children after a gap of some years,” she said. Muhammad Panjal, her husband, and Azra herself, mutually decided to go for a long-term contraceptive, an IUCD in their case. “One of our focuses presently is to encourage women to go for long-term contraceptives, like we did for Azra,” says Naghma, working for Pathfinder as a Technical Supervisor for the district of Larkana for Family Planning (FP) related initiatives. Azra is all praise for the staff at RHC who made her understand what was best for her and her family. “We counsel the patients mostly during the antenatal visits; this gives us enough time inform them about the various choices of contraceptives, their benefits, as well as side-effects if any. The decision, then, remains with the patient; she chooses, after discussing with her family, the FP method best suited for her,” says Dr Erum Siyal, working at RHC Naudero.

Dr Siyal explains why Post-partum family planning (PPFP) is a key focus for FP in areas like Naudero. “Once they leave the hospital after delivery, they rarely come back. Reasons are many. Lack of mobility, lack of resources to pay for transport to reach the hospital, lack of awareness – these are all deterrents,” she says.

Dr Azra Ahsan, a gynecologist and obstetrician with a special focus on family planning and maternal health, terms the focus on PPFP as being “extremely important’, adding that it is all the more important because the Contraceptive Prevalence Rate (CPR) is insufficient for effective family planning, which means people are not using enough FP methods. “The silver lining, however, is that women are coming to health facilities to have their babies in increasing numbers. This is a moment to seize and an opportunity not to be missed,” says Ahsan.

Grass root level initiatives like Naya Qadam, implemented by Pathfinder International, have an increased focus on access to post pregnancy family planning. Naya Qadam is a consortium of six organizations – Pathfinder, Aahung, Greenstar Social Marketing (GSM), National Committee on Maternal and Neonatal Health (NCMNH), IPAS and Shirkat Gah – working in six districts of Punjab and Sindh provinces. The objective is to increase access to high quality PPFP with a focus on young women (age 15-24) in Sindh and Punjab. Naya Qadam is introducing a multi-sectoral, counseling-centered, integrated life cycle approach to post-pregnancy service delivery. It aims to lessen the widening gap between service availability and unmet need by upgrading lady health workers, community midwives, and lady health visitors’ (LHVs) capacity to offer services through redesigning antenatal care as a lever for taking full advantage of the postpartum moment to offer FP.

Women like Azra go back to their villages after getting contraception, and become informal activists of FP, convincing their female friends and relatives to do the same. According to Dr Siyal “the awareness has increased and continues increasing at a fast pace”.

57-years-old Salma John from Jamshed Town, Garden East Karachi, has been working as a Lady Health Worker (LHW) since 2003. “Contraception should be carried out within 24 to 48 hours after delivery or DNC, and within ten minutes after the placenta is expelled. That is the best time to do it, otherwise most women do not come back for follow up.” John shares that condoms and pills still remain the most popular methods of contraception. Examples of modern methods include the pill, intrauterine devices, implants, injectables, and condoms. “With the help of Naya Qadam’s training sessions, we learn something new every time,” says, John, explaining how LHWs stay abreast with the latest developments in the field of FP. Each LHW, in John’s area, covers a population of 1000, which means she has to visit 100 to 150 houses. “Attitudes vary greatly across ethnicities and demographics matter a lot,” says John.

Experts predict that by 2030, Pakistan’s population will swell up 245 million, making it the 4th most populous nation in the world. According to the latest Pakistan Demographic and Health Survey (PDHS) 2017-18, 17 per cent of currently married women have an unmet need for family planning. If all married women who want to space or limit their children were to use a family planning method, the contraceptive prevalence rate (CPR) would increase from 34 percent to 52 percent. Only 34 percent of currently married women are using a contraceptive method either to space or to limit births.

Zahida Parveen, an LHW for District Okara, Punjab, sounds very hopeful. “Over 20 years as an LHW, I have visited thousands of houses, often visiting 15 houses a day. And I have seen how the awareness about family planning has grown exponentially. Initially people were so skeptical of LHWs visiting and counseling them, especially about FP, that they would not even touch the Paracetamol we sometimes gave them for pain or fever. The mother-in-laws in particular felt we are part of some sinister scheme to stop their daughters-in-law from having children, and want to stop their future generations from coming into this world,” she says. Now, she happily reports, even long-term contraceptives like IUCD are accepted as a choice by many women. The training she and other LHWs are receiving by Naya Qadam has taught them about newer forms of contraception too, like Levonorgestrel Implants – implantable subcutaneous contraceptive capsules – sold under brand names like Norplant and Jadelle. “It has taken years to win over the trust of these families; now they are open to the counseling services we provide for them,” says Parveen.

Social attitudes and changing mindsets remains one of the biggest challenges. Based on her experience of more than 15 years, John feels that attitudes towards FP have improved. “Now women are becoming aware enough to themselves giving permission to get contraceptives. However male involvement is still deep-rooted, as are the pressures of in-laws. One of the biggest tasks of LHWs is counseling the families,” she says.

“Women are raised in the community to accept patriarchy and gender inequality, letting go off their rights to choose for themselves. This further empowers men and other household figures, like mothers-in-law, to decide about potential size of families,” says Tabinda Sarosh, a women’s rights and reproductive health advocate, and currently the Country Director of Pathfinder International. In many families, desire to have sons results in increase in family size, and men make most decisions on health, economics and rights of family members, yet do not take responsibility for contraception, she explains. As someone who is running projects with the Government of Pakistan for quality services of FP, Sarosh feels that the most important solution to the problem is re-construction of the existing social and gender norms, by working from policy to communities, through multi-level and multi-sectoral interventions. “Combining health, education, gender, and micro-finance interventions to create an enabling environment for women to get equal opportunities in education, employment and health related decisions” is the baseline solution in her opinion.

Provincial governments are showing an upward swing, and the thrust on FP seems to have started to show improvement.

Minister for Health, Punjab, Dr Yasmin Rashid, is focusing especially on two areas as priority – Maternal Health and Child Health – says Dr Akhtar Rasheed, who works as Technical Lead for Family Planning and Nutrition, government of Punjab, assistant the province’s Minister for Health as Adviser. “We want family planning to become a means for improving maternal health by ensuring that women have a gap of at least three years between having children,” he says. 1195 basic health units are working 24/7 in Punjab, in addition RHCs, DHQ hospitals, and tehsil-level hospitals. “Our focus is on facilitating antenatal care and visits, and use this opportunity to counsel the women to go for long-term family planning,” says Rasheed.

Focal person of the Sindh FP2020 and Technical Adviser of the Costed Implementation Plan’s (CIP), Dr Talib Lashari, says that the CIP’s implementation in the province of Sindh is underway at a fast pace. The province of Sindh became the first province to come up with a roadmap, the CIP, for achieving FP2020 goals. “Our focus is on increasing and enhancing existing services. We have 72 Reproductive Health Service A Centres (RHS-A) located in DHQs that supply a full range of all kinds of contraceptive methods. A new choice among contraceptives that has been approved is an easy-to-use subcutaneous contraceptive injection that women can give to themselves to prevent pregnancies for short term like 3-months; it is called Sayana Press. This has been introduced in 17 districts already and will be introduced in another 12 districts by December. Our aim is to increase the CPR to 45% by 2020. Post the release of the latest PDHS, research conducted by departments under the CIP Secretariat shows that the CPR has already reached 34%. But to reach our target, we will have to work two fold,” says Lashari.

Both the Sindh government and Punjab government provide contraceptives free of cost. In Punjab, the government even gives women the facility of free pick up to reach the hospital for deliver free of cost to encourage them to deliver at proper health facilities.

What is a fresh spin on the strategy for FP is that to increase the contraceptive prevalence rate (CPR), the government of Sindh is now focusing on urban migratory population and slums. “For this the Karachi Urban Plan is being made. Part of the efforts is to counsel migratory communities in their own language. We are focusing on PPFP, and 1758 doctors are being trained across Sindh for it. Tertiary hospitals are also being looped in for FP efforts. Trainings are also being conducted for helping insert devices that release levonorgestrel for birth control,” says Lashari.  He adds that in Sindh the political commitment is a hundred percent. However, he accepts that while there are opportunities, there are challenges too, and much needs to be done. “We have a window of optimism due to the above steps being taken.”

“When a woman goes through the often traumatic experience of a miscarriage, an abortion, or childbirth, and especially if her pregnancy was not a desired one, she is more receptive to the idea of getting PPFP. By PPFP, I mean both post-partum family planning and post-pregnancy family planning. That is the best time to make sure she goes home with a contraceptive,” says Rasheed.

While modern methods are being introduced and both public and private sectors are working on increasing awareness about FP as well as working on supply of contraceptives, there is little that can be done to bring women back to the hospital once they leave. Thus, post pregnancy family planning remains the key. “The women should not only leave the hospital with a baby, but with a contraceptive too,” says Ahsan.

An abridged version of this article was published in The Express Tribune here.

Let us talk numbers – Contraception in Pakistan

For Pakistan to climb the ladder of development indicators, the issue of family planning needs urgent attention

Let us talk numbers
Only 34 percent of married women are using a contraceptive method.

While we are at it, let us talk more numbers. According to the latest Pakistan Demographic and Health Survey (PDHS) 2017-18, 52 percent of currently married women age 15-49 in Pakistan have a demand for family planning (FP), 19 percent for spacing births, and 33 percent for limiting births. Only 34 percent of currently married women are using a contraceptive method either to space or to limit births, and therefore have fulfilled their need. However, 17 percent of currently married women have an unmet need for family planning — 10 percent want to space and 8 percent desire to limit births but are currently not using any contraception. If all married women who want to space or limit their children were to use a family planning method, the contraceptive prevalence rate (CPR) would increase from 34 percent to 52 percent.

Humans require developed ecosystems to survive and thrive, something that we are unable to provide to more than 220 million people. Of the 17 Sustainable Development Goals (SDGs), Pakistan is lagging behind at most. According to UNICEF, 23 million children between the ages of 5 and 16 are out of school in Pakistan, a whopping 44 percent of the total population in this age group. There are some five million children between the ages of 5 to 9 who are not in school, making it the world’s second-highest number of out-of-school children (OOSC) at the primary level. Not just this but also that gender-wise, boys outnumber girls at every stage of education. In Balochistan alone, 78 percent of girls are out of school. For every 10.7 million boys that are enrolled at the primary level, 8.6 million girls are enrolled, and dropouts of female students remain high. Health experts say that over 44 percent of Pakistani children under five years are stunted due to chronic malnutrition.

It is not that Pakistan is not working on these issues. Yes, clearly, the work is not enough, but there is something more to the failing state of our social indicators. That is, perhaps, the missing link we do not see enough work being done on — family planning. The strapping Pakistani youth in such high numbers could be Pakistan’s asset; they are, instead, Pakistan’s Achilles heel. The nation has to not just feed the 220 million plus people. It also has to provide opportunities for growth and development so that Pakistani people can tap into their potential for economic prosperity of themselves and of the country.

The dots have been joined. Why, then, are we failing at it?

Lack of political will, and perhaps realisation among the upper echelons of power regarding the importance of mitigating this increase in population has been a consistent issue. Earlier this year, the Ministry of Health formulated an action plan for population control. The draft shows that the government is aiming at obtaining universal productive health services by 2025. The buck stops at the National Task Force on Population Control, headed by Prime Minister Imran Khan. But the real test is not just the approval of such action plans, but actually the implementation. The plans have been multiple but the implementation has clearly not been enough. When a country’s biggest issue has been its national security, followed if not preceded by layered and debilitating economic crises, family planning seems to be a lesser important challenge. In reality, it is one of the biggest ones.

What the proposed law is doing is updating an old piece of legislation with some new principles of human and women’s rights and ensuring that processes are made easier and more streamlined and that the suffering of a significant number of people in their country is reduced.

Healthcare persons and experts working at the grass root level cite many potential issues. While antenatal care and visits from a skilled healthcare provider may have improved, there is still much to be done. Midwives and lady health visitors can play an imperative role in this, and it is these programmes that need to be strengthened through their training and capacity-building. Perhaps this is why modern contraceptive use by married women has stagnated over the last 5 years, with 26 percent of women using a modern method in 2012-13 and 25 percent in 2017-18, according to the PDHS. Lady health workers play a major role in dispensing injectables, oral pills, and condoms to women, 18 percent, 26 percent, and 15 percent respectively.

Modern methods include injectables, intrauterine devices (IUDs), contraceptive pills, implants, male condoms, the standard days method, lactational amenorrhoea method, and emergency contraception.

69 percent of unplanned pregnancies end in induced abortion in Pakistan, states a recent study by Guttmacher Institute titled “Adding It Up: Costs and Benefits of Meeting the Contraceptive and Maternal and Newborn Health Needs of Women in Pakistan”. The study further informs that fully meeting married women’s need for contraception would lead to an estimated reduction of nearly 1,000 maternal deaths annually.

Contraceptive discontinuation, myths surrounding use of modern contraceptives, fear of side effects, lack of awareness, an absence of decisions made mutually by the couple without interference of mothers-in-law and societal dictates — the reasons are multiple.

World Contraception Day falls on the 26th of September. It is a reminder that for Pakistan’s well-being, much needed impetus for the issue of family planning is the solution. It is only then that Pakistan can hope to climb the rungs on the ladder of development indicators.

http://tns.thenews.com.pk/let-us-talk-numbers/#.XZGtB0YzbIU

 

Wearing second hat as family’s sole breadwinner

November 12, 2018

ASIYA’S day starts at 5.30am. She says her prayers, cooks breakfast for her family, and a curry for dinner, wakes up her three children, feeds them, sends them to school, and then cleans her one-room rented accommodation in a shanty town of Karachi. She leaves home at 9am to work as a domestic helper, and gets back by 6pm. Then onwards, household chores keep her occupied.

Her husband doesn’t have a job since they moved from south Punjab to Karachi. Yet, she is the one doing double duty, managing her home and wearing a second hat as the family’s sole breadwinner.

“Time for myself? Never thought about it,” she says. Her monthly salary is Rs20,000 ($150).

Across a few roads where more affluent Karachiites reside lives Saima (name changed) who earns six times as much as Asiya, her monthly salary as an assistant manager at a multinational firm touching Rs120,000 ($900), more than what her husband earns. Yet Saima’s routine is pretty similar to Asiya’s. In addition she is a caretaker to her elderly mother-in-law once she is back from work.

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UNDP’s human development report highlights that care work, mostly undertaken by women, is what enables a majority of the paid work which drives economies. Yet, as it is unpaid, it is under-documented and taken for granted. According to a recent report by the International Labour Organisa­tion (ILO), globally women perform 76.2 per cent of total hours of unpaid care work, more than three times as much as men.

In Asia and the Pacific, this rises to 80pc, where women spend 4.1 times more time in unpaid care work than men. Around the world, women spend two to 10 times more time on unpaid care work than men. Countries have valued unpaid care work between 15 and 39pc of national GDP.

At the recent United Nations World Data Forum 2018 hosted by the UAE government, Gender Data remained at the forefront of discussion as more than 2000 academics, statisticians, and activists from both the public and private sectors globally sat down to discuss the impact of data, especially Gender Data. Data2X, led by the United Nations Foundation, is a key organisation among Gender Data initiatives, and defines Gender Data as “data that is disaggregated by sex (e.g. school enrollment by sex), as well as data that pertains specifically to women and girls (e.g. maternal mortality rates). This data is critical to determining the size and nature of social and economic problems, the causes and consequences of those problems, how to design policies to combat them, and the effectiveness and cost-effectiveness of those policies”.

While the Pakistan government strives to get over its economic crises and the subsequent cost on human development, half of the country’s population — women — and data related to their needs and their economic contribution remains mostly missing.

Women’s rights proponents like Ume Laila Azhar, Executive Director of Home Net Pakistan, highlight these issues at the policy level.

“If women are counted in statistics, their work must be counted too,” she says. Ms Azhar adds that in the Human Development Index, if women are not recorded in the labour participation figures, it shows low female participation. “If the numbers of women in the work force appear to be too small, women are not considered at the policy level — policies that translate into job opportunities or initiatives for skill development for women,” she says.

Time Use Surveys (TUS), an important tool in this regard, measure how, on an average, people spend their 24 hours in what activities. “TUS are the best instrument to measure unpaid care work, since they measure the time people spent on this work,” says Mayra Buvinic, senior fellow at Data2X and an internationally recognised expert on gender and development. Linking the dots of TUS to the evaluation of unpaid work, Ms Buvinic says that by assigning a value to unpaid care work, “you make this work visible to policymakers who design policies to increase labour force participation rates and provide social services, including paid care services”. “Unpaid care needs to be factored in the design of these policies since it conflicts with labour force participation and it provides an estimate of the need for child and elder care,” she adds.

The 17 Sustainable Development Goals (SDGs) target to improve women’s lives by encouraging their economic participation and financial inclusion. Gender Data is an important tool in the achievement of the SDGs.

A recent tweet by philanthropist Shaniera Akram resonated with the twitterati where she mentioned how women’s multi-tasking and contribution is undervalued. Speaking with Dawn, Ms Akram says that women are often overworked and under-appreciated, not just in Pakistan but all over the world.

“Women can’t be taken for granted anymore. Men can’t just take all the credit, especially when the women — mother, daughter or wife — are taking care of everything behind the scenes,” she says, suggesting that society will benefit from incentivising staying home and taking care of children, the elderly and sick or disabled relatives, with a domestic allowance for women.

“We must focus on getting to a point where women don’t just have the right but also the choice between wanting to stay at home and going into the formal work force,” she adds.

“When families in rural Sindh or Punjab work on lands of landlords with tenancy arrangements, the whole household is working — including the women and children — whose contribution isn’t counted,” points out Ms Azhar. Rural women do a lot of unpaid work like growing vegetables for food sustenance, looking after cattle and milking cows, doing not double but triple duties.

“A woman overworking is a form of exploitation, and she doesn’t get the respect and acknowledgement she deserves for her contribution,” she says.

The author is a freelance writer and her work can be seen at chaaidaani.­wordpress.com

 

Women on the go – How information technology has helped Pakistani women’s mobility

Access to smart phones and internet has played a major role in adding to the mobility of women

Women on the go

It takes 34-years-old Afshan Babar some 90 minutes to reach from her home in Surjani Town to the training centre run by TAF Foundation (TAFF) where she is enrolled in the Cooking and Housekeeping course at TAFF-VTI.  There was a time when she could not have imagined stepping out of the house alone.

Now, the ability to reach from point A to point B has changed her life. “Watching others use public transport is what encouraged and motivated me,” says Babar. She has now joined the millions of Pakistani women, particularly in urban Pakistan, who are daring to be mobile on their own.

The credit for this acceleration in the number of women daring to go where no woman from their family had gone before goes, according to experts, to access to information technology and cellular mobile phones.

For Amber Zulfiqar, a Food and Travel Influencer & Digital PR Consultant, services like smart phone taxi services have eased up travelling for women. “Women are taking inspiration from other women — it grows like a chain. When a woman lets go of her fears of travelling alone, it is because she has heard stories of her friends using it or read encouraging material online.”

Most gender experts like Mahnaz Rahman, Director, Sindh chapter of the Aurat Foundation, agree that cellular phone access is a blessing for Pakistani women. “Technology has shown women a path that is a means to an end. Sitting at home, many women have become entrepreneurs with the help of social media,” says Rahman, adding that as ours is a patriarchal society, men have better access to information technology as more men than women have cellular phones, especially smart phones.

“Nonetheless, access to information technology has helped women get exposure to the world and step outside their cocoons, not just physically but also intellectually,” she says.

“The first step for women is to step out of their homes. Exposure helps them evolve and grow. This mobility is not just travelling from point A to point B — it is also about joining the workforce,” says Sibtain Naqvi, Head of Public Affairs at Careem.

Naqvi echoes the opinion that mobility is a serious challenge in Pakistan. “A mega city like Karachi is without a serving metro system. And the challenge is bigger for women. Even privileged women are dependent on males of the family to go out; women from the middle class who are educated are expected to sit at home simply because getting to work poses a challenge. The vans that women use to get to office and go back home do not provide personal mobility,” he adds.

A woman’s needs are beyond just getting to work or dropping and picking her children, and the urban woman has a lot on her plate owing to fast-paced lifestyles of both spouses. Taxis are prohibitively expensive, often not maintained, with rash drivers and security issues; rickshaws pose their own sets of problems.

Even privileged women are dependent on males of the family to go out; women from the middle class who are educated are expected to sit at home simply because getting to work poses a challenge.

Once urban women of Pakistan got access to cellular technology, smart phone taxi services began to fill the gap. “We are happy to share that 70 per cent of Careem’s customers who ride are females — females from all areas and all economic strata. What apps have done is that they have empowered women to make their own choices — something they do not get to exercise beyond the kitchen,” he says.

The impact of women’s access to technology is not just limited to riding with the help of such apps, but goes beyond. For Quratulain Tejani, for example, being a digital strategist and entrepreneur would not have been possible without access to a smart phone. “A few apps and tools have changed my life completely. Google Maps have made mobility so much easier and convenient. I can go from one corner of the city to another, knowing that I can find my routes easily. Even when I’m driving around and get lost, all I need is 3G and Google Maps to help me find my way,” she says, adding that Google Drive and WhatsApp have facilitated her in her professional life.

For the 200 plus female captains in Careem and for the female entrepreneurs behind the thousands of home-based small entrepreneurships that rely on social media for their marketing, cellular technology is providing opportunities of work.

These impacts are not limited to just upper tiers of society. In TAFF, one of the projects includes training and placement of women from underserved backgrounds in the Domestic Help industry.

“I’ve witnessed a dramatic transformation in students who graduate from our programme. Women who had never stepped out of their houses are now riding buses around the town to reach their workplaces on time. These are women who overcame their fears, including that of travelling on public transport to earn living incomes for their families.

“Most of them are also now part of WhatsApp groups created by TAFF-VTI to stay in touch with both students and alumni which is a testimony that technology is not only being introduced to but utilised as well by our students and graduates,” says Hammad Mateen, Programme Head at TAFF-VTI.

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The mobility, then, is more than just physical. Naqvi observes that generally, technology is associated with the male gender, especially in South Asia; while girls are encouraged to join Fine Arts and Humanities, boys are encouraged to work in the field of IT. But smartphones may have broken this technological barrier for women.

“We are seeing an interplay between women and technology. Even my mother has now moved to a smart phone so that she no longer has to wait for me to take her somewhere — she can just call a smart phone taxi service. This is true both for generations of technology immigrants as well as technology natives like the youth. This change is not just of physical mobility. It is sociologic as well as demographic,” he says.

However, experts like Uzma Quresh, Social Development Specialist with the World Bank Group warn against the vulnerabilities that women are exposed to due to being active on social media and using information technology. She cites examples of cyber harassment and also mentions cases of honour killings where a girl was killed because of having access to a phone or the internet.

“Virtual mobility gives women job opportunities. E-commerce portals and IT-related skills are profitable avenues for women and also give them exposure,” she says, but adds that society has to work not just on facilitating physical mobility of women but also ensure that virtual mobility does not lead to irreversible repercussions and safety threats for women.

“It is not enough to give women access to information technology and social media; we have to work on changing mindsets,” she says. The need, then, is that the collective social thought-process moves from being restrictive to being enabling for women. That, perhaps, will be real mobility for the women of Pakistan.

Why must women get an ID card?

The reasons for women lagging behind men in the race to get registered as citizens are many, and in rural areas the factors multiply

Why get an ID card?

“Traditionally, in our village, people didn’t feel it was necessary for a woman to have a national identity card (NIC),” she says. Men are the ones who traditionally own property, get preference in education, and have ambitions to be financially independent, not women. But some ten years ago, Kaneez found an incentive to rush to get her NIC made — the Benazir Income Support Programme (BISP) that gave her the hope of a monthly stipend.

Today, at the age of 41, Kaneez is thankful she got the NIC, as none of the employers in Karachi want to hire her as house help till she shows them her NIC. “Once we moved to Karachi, I realised that to get my daughters admitted in school I needed to get their B Forms made.”

The reasons for women lagging behind men in the race to get registered as citizens are many, and in rural areas the factors multiply.

If women do not have an identity card, they lose out on everything, says Maliha Zia Lari, lawyer and gender activist. “Without it they are not recognised by law; they officially do not exist. It has a massive impact on the personal, the social and the institutional levels.”

Without the NIC, women cannot reach out for any legal protection, their ability do anything on their own is curtailed; they cannot hope for independence. They cannot own or inherit property, and also cannot hope for insurance or be the beneficiary of any welfare initiative, as Lari explains. “Nadra requires a family certificate now for everything, so even the husband not having an ID card poses a problem if and when the wife and children want to get registered. Child marriage cannot be mitigated if a girl without an ID card is married off as she may be a minor for all we know.”

The reasons for women lagging behind men in the race to get registered as citizens are many, and in rural areas the factors multiply. “One of the issues is fulfilling the legal requirements and documentation required for getting the CNIC. Women in rural areas often don’t have means to readily get to the towns, are illiterate, have restrictions on mobility due to traditional customs and cannot travel alone [due to security reasons or family restrictions], and male members of their families don’t always support them to get to offices of the National Database & Registration Authority (Nadra),” says Ali Akbar from the Association for Water, Applied Education & Renewable Energy (AWARE) in district Tharparkar.

Read also: The cultural blockade

Akbar shares instances where women who did not have NICs were exploited and robbed of their rights. “Brothers and fathers who were not willing to give the rightful share of wealth to a sister or a daughter would, to close the revenue department’s record, get the tehsildar to record the statement of a couple of villagers mentioning that Mr so and so has no sister/daughters or that she has died or she is not claiming her right, and thus this male member of the family has the right to hold this property. But now the Nadra record is computerised and the woman has to be present and her statement recorded before the magistrate or registrar for any change in the legal ownership of property. The NIC, then, is a basic pillar for the empowerment of any woman.”

However, the awareness about the importance of being a registered citizen is growing among Pakistani women. Mahnaz Rahman, Director, Sindh chapter of the Aurat Foundation, says the projects by AF aim to incentivise it in many ways for women. “For example, we tell Muslim women that you need it to go for Hajj otherwise you cannot get a passport to travel for the pilgrimage. There is increased realisation about this among the lower income and middle income strata as well where the women are working to support their families,” she says.

Currently, AF is working on a project aimed at women from non-Muslim communities, encouraging them to get CNICs and in turn to exercise their right to cast the vote.

The BISP has had a positive impact in encouraging women like Kaneez to apply for NICs. “Our surveys show that numbers of women who have registered for the NIC has increased exponentially,” says Hasrat Prakash, Field Supervisor, BISP, in Mithi and Chachro, district Tharparkar, who adds that women are not just going for the ID card but are actually opting for the Smart National Identity Card (SNIC), Pakistan’s first national electronic identity card. The SNIC contains a data chip and many security features.

“BISP now requires biometric verification, which incentivised making of these SNICs. The incentive, of course, is the money stipend. The best part is that more women are now included in the voters’ list, and that more people are registering daughters at birth for the B Form, especially the eldest daughter of each family,” says Prakash.

As mobility still remains a real issue for women, facilitation efforts are being made by various organisations to help them get registered. “If in any locality we find one hundred or more women who need to get registered, Nadra’s mobile van comes there to help us and register women on the spot. There are holistic efforts by the civil society, aid agencies, Nadra and BISP among others, and the situation is comparatively better,” says Rahman, but also adds that more campaigns and efforts are needed for social mobilisation.

“Registering can be a tiresome process and if the people are not highly motivated why would they give up on a week’s daily wages to get an identity card?” says Lari, adding that “the most important thing that needs to be done is make the registration free as well as easier.”

http://tns.thenews.com.pk/get-id-card/#.Wi-XQt-WbIU

No woman no water: empowering women to be water and sanitation decision-makers

They carry water home, store it, keep it as clean as possible. Yet women are kept out of major decisions around water supply.

During this year’s World Water Week in Stockholm, experts focused on an age-old problem: how to recognise and value the central role women play in solving water-related issues.

Tracing the recent history of this attempt, Ankur Gupta of the Global Water Programmetold thethirdpole.net: “You can look back at the Dublin 1992 principles that state clearly [the need for] the involvement of women in water management. There is a lot of evidence coming up pointing in the direction that exclusion of women is harmful, especially in Wash (water, sanitation and hygiene).”

Particularly in South Asia, Gupta commented, it is necessary to involve women in decision-making about water supply, starting at the household level. “To fall back on clichés, this helps women in terms of self-esteem and confidence; better water management gives them more free time to engage in other activities. Most importantly, Wash and water management activities need to be monetised and recognised. But for that, the required political will is missing.”

Gupta suggested specific remedies: providing scholarships for women to study water related professions, quotas for women to take up roles on boards and committees, and the provision of menstrual hygiene management facilities.

Read more: Open defecation ends in Bangladesh – almost

Wherever women have been empowered to decide on issues of water, sanitation and hygiene, the results have been excellent. This is how Bangladesh has recently succeeded in controlling open defecation, said Akramul Islam, director of the Bangladesh Rural Advancement Committee‘s (Brac) Wash programme.

“Women in rural areas are vulnerable when it comes to the use of latrines,” said Islam. “Brac’s participatory rural appraisal started including both men and women. This helped us know for sure where new latrines are needed and what their design should be [according to gender-specific needs], because it is often unsafe for women to walk far to use the toilet.”

In this programme, Brac gives leadership training to one male and one female from each community. “Slowly, women have started voicing their opinions and that is very encouraging,” said Islam.

Who carries water home

Brac has another big first: working on making water carrying a shared responsibility of men and women. Women carrying water is a practice so ingrained in South Asia that it is almost a taboo to think otherwise. But Brac is doing just that.

“We are motivating men to collect water so that it is no longer seen just as a woman’s responsibility,” Islam told thethirdpole.net. “To counsel the communities [especially the men], we have brought the village Imams on board. We counsel them and give them small booklets with information they can disseminate through Khutbas (sermons).” And attitudes are slowly changing, Islam said.

“Urban women are some of the greatest water wasters,” said Muhammad Ashraf, chairman, Pakistan Council of Research in Water Resources. “They should be involved in the Wash sector and water conservation at the domestic level.” If women are included in decisions pertaining to Wash, they and their children would be the first to benefit from it, Ashraf pointed out.

The level of education and awareness among women has a direct impact on Wash, said Pervaiz Amir, director of the Pakistan Water Partnership. “Women in Kashmir’s rural areas are [relatively] educated; they give high priority to investment in toilets. On the other hand, the situation in Tharparkar and Cholistan is bad due to a lack of education. Engaging women in public services and increasing their job opportunities can have a direct impact on sanitation and hygiene services.”

Pointing to the link between sanitation and nutrition, Amir also emphasised the need to have women “closely tied to all household-related water decisions. They collect water and regulate the level of usage. When women are excluded, the results are poor, leading to social disharmony and even conflict”.

Positively, there is an overall increase in attention to gender gaps in many spheres, said Maitreyi B. Das, global lead for social inclusion at the World Bank. “This year, World Water Week in Stockholm has made a concerted effort to have more sessions on gender issues. I think there is a greater realisation that SDG6 will not be met unless we focus on men and women separately and together,” said Das referring to the UN’s sustainable development goal to ensure availability and sustainable management of water and sanitation for all by 2030.

After talking about the particular need for inclusion of women in water management in South Asia, Das added: “As our recent report notes, overall gender inequalities are mirrored in water related domains. We will neither achieve our water-related goals nor our goals for gender equality unless we address gender in everything we do, in every sector.”

https://www.thethirdpole.net/2017/09/07/no-woman-no-water-so-women-must-decide/

Also published here: https://www.dawn.com/news/1357427/no-woman-no-water-empowering-women-to-be-water-and-sanitation-decision-makers

What makes a Pakistani male “manly”?

Being a man isn’t just about masculinity

Published: September 17, 2016

It is generally seen as okay for a man to speak loudly or even yell or curse. Even in the most seemingly progressive families, girls are often told not to talk or laugh loudly. PHOTO: RANGIZZZ/SHUTTERSTOCK

“But that’s how we guys are.”

Is a common response when a woman asks a man about a few traits and attitudes that are seen as manly and macho.

While walking on a street near you, in a mall, or even when couples enter weddings – a familiar scenario ensues. The husband can be seen walking a few steps ahead of the wife for sure, and the wife trudging behind him, adjusting her ensemble, trying to catch up.

For Pakistani males, Def Leppard’s classic Two Steps Behind You is too mushy I’m sure. It is seen as some mark of masculinity to walk at least two steps ahead, if not four.

In our society, or maybe that is how it is all over the world, a few things are seen as ‘guy things.’

For example, the obscene joke sharing. It seems that there is an unsaid rule that in order to classify as a man, you absolutely must share lame and cheap jokes, and video clips and photographs of women in awkward or objectionable poses. Whatever one shares amongst friends is the personal business of each individual. But what is worrisome is how this is seen as a sign of masculinity. Such stereotypes are so etched in our social fabric that we are conditioned to think this is what makes a guy a ‘man.’

Ever seen prime time dramas on Pakistani television channels? They all seem to imply that it is some signature symptom of manliness for men to have affairs, cheat on the wife, and have physical needs, while a good, demure woman is stereotyped as a prudish character who is always shy and playing hard to get.

It is generally seen as okay for a man to speak loudly or even yell or curse. Even in the most seemingly progressive families, girls are often told not to talk or laugh loudly.

It is the men who are supposed to drive the car even if the wife or sister is the better driver or even if the poor husband or brother is exhausted after a long day at work. It is encouraging, actually, when one meets a man who is man enough to say “I don’t enjoy driving” if he doesn’t. But mostly they are unable to voice it, just like it is not easy for a woman to say she does not enjoy cooking.

Women themselves are participants in the act of perpetuating these stereotypes.

They feel sympathy for their sons or brothers if they help the wife with carrying the baby,change the baby’s diapers, or God forbids take paternal leave. Helping in the kitchen is something real men, of course, don’t do.

This conventionalising is not always in favour of men, and is not always healthy. Consider the economic arena.

In this age of inflation and consumerism, one salary is often not enough to support a family. With more and more women joining the work force in Pakistan, both can spend on the collective household. But gender stereotyping ends up pushing both males and females in pigeonholes of rigidly defined roles. The man ends up not helping the woman in the kitchen and housework even if she is also an earning member of the family. Similarly, even if he does end up lending a hand at home, many working women confess to feeling a pinch inside when they have to spend on their families. The feeling is best described as being made to do something they are not supposed to be doing.

Man-kind has not really progressed that much, has it, when the marks of manliness are not values like strength, courage and honesty, but instead driving a sports car, riding a massive motorbike in boots, or smoking a cigarette in public.

There are some inherent traits and tilts that are natural to both the genders. Some of these are natural. But others are not. They are just by-products of being exposed to certain socio-cultural habits of a nation.

For those who are the strongest of men, it wouldn’t be a bad idea to push their boundaries and challenge these norms by walking behind the wife or speaking softly and let the woman in your life have the last word. Being a man takes more than that.

Farahnaz Zahidi

Farahnaz Zahidi

Farahnaz is a writer and editor, and has worked as the Features Editor with The Express Tribune. Her focus is human-centric feature stories. She now writes as a freelancer, and works in the field of marketing and corporate communications. She loves literature and traveling. Her work can be seen at chaaidaani.wordpress.com/