PAKISTAN: Internally displaced persons of North Waziristan, reproductive health and Gender

Pakistan like other developing countries that face, dearth of democracy and abundance of abusive authority has never been a homogenous country. There is the Pakistan of masses and there is the Pakistan of classes. For the poor and powerless of this sixth most populous country, human development based on essential core values like self esteem, dignity and ability to choose is nothing but a dream – rather  a dream to dream.

Right now there is another Pakistan emerging from North Waziristan of Federally Administered Tribal Areas (FATA) in Bannu (mainly) of Khyber Pakhtoonkhwa (KPK) province, annihilating recklessly all estimates in demography.

This population of more than one million mainly consists of women and children. In this emergency humanitarian setting where nothing seems normal, it is alarming to note the survival and glorification of patriarchy and its ill-manifestations. While medical doctors (mostly men) who are medical doctors because they  obtained admission into medical colleges on the reserved seats for FATA are reluctant to serve  these “Internally Displaced Persons” (IDPs) – the idea of a male heath provider attending  women and girls who need health care is simply unthinkable and merits condemnation.

The strategic and significant gender challenges and questions have incessantly branched from the deep rooted patriarchy, endorsed by the politics of culture and religion; defined and dictated mostly by power elites of societies, cultures, subcultures and politics.

Gender is a social construction whereas sex is a biological incidence if not an accident. Had there been a mathematical formula of gender it should be sexes + classes construction, no matter how faulty and or unfair is always premeditated. Awkwardly,  but as expected, the class issues have been deliberately marginalized in gender discourse and programming in Pakistan as academia and industry both are  customarily subjugated by  apathetic elites.

Those who dish up as recruits of donor agencies or donor driven organizations are under the compulsion of convenient choices.  Thus, on the exterior there is a lot of hustle and bustle, clatter and clamor about gender mainstreaming, gender equality, incorporating gender perspectives in the complex and convoluted spectrum of Reproductive Health (RH) (that becomes trickier to tell if written, said and articulated as Sexual and Reproductive Health ‘SRH’ and Sexual and Reproductive Health Rights ‘SRHR’), fancy conferences at the national and international levels and carefully selected delegations from poor and developing countries and so on and so forth. However, the reality on the ground ceaselessly validates that gender has yet to be inferred unmistakably and applied manifestly in the showground of RH.

The predicament of Internally Displaced Persons (IDPs) from North Waziristan (NWA) in Pakistan provides one proof that RH as a gender issue has yet to translate from well documented International Conference on Population and development – ICPD’s Program of Action (Cairo 1994) and Fourth World Conference on Women’s Beijing Platform for action (1995) and follow up into culturally appropriate, socially acceptable and technically viable humane actions.

Reprehensibly, UN agencies and related organizations (recipient of funds) are focusing on filling out some prescribed proforma to address very weighty issues in a humanitarian setting and launching selfies campaign to attend to RH.

According to the renowned activist and writer on gender and RH, Ms.Hilda Saeed “Any plans for SRH for IDPs will have to be measured by the yardstick of equality and social justice. Earlier catastrophes, the earthquake of 2005, the floods of 2010 and 2011, all highlighted the shocking paucity of streamlined mechanisms for care of the numerous survivors, yet, they also highlighted the heart warming response of the entire nation to help all those in need. Today, the IDPs also need this caring approach.

Today is no different in terms of needs, though the root cause is not natural calamities but extremism and terrorism—and the IDPs are bearing the brunt of the violence. Thousands of them have travelled long distances in extreme privation, and are living under harsh conditions. SRH for IDPs will need to bear in mind these (above) impinging circumstances, for example, poverty, inadequate nutrition, hygiene and sanitation. Close proximity of so many humans may itself lead to proliferation of infectious diseases, so that too, is an aspect to be considered.”

Reportedly, many IDPs have large families and several children. There are polygamous men as well. These are some of the existent problems, but they also present opportunities. The displacement and the caseload have overburdened health facilities and services.

There is considerable number of expecting mothers but they are unable to access the services because of cultural reasons, limited mobility or even the location of the facilities is high and limited outreach services. The scope of services offered at these facilities is limited.

The data or surveillance of RH issues does not take place, so identification of related issues may be not representing a holistic picture or evidence about RH issues is not available.

Information about the services and facilities available never reach the women so some promotional and educational activities need to be a built in component of the related services.

Men who emerged as a “new segment of population”  in International Conference on Population and Development (ICPD – who should be involved in RH to attain gender equality and empowerment of women – are not  animatedly engaged in addressing the SRH issues as may be suggested by the absence of any  verifiable data or information.

Dr.  Tufail Muhammad, a leading child specialist and RH practitioner based in KP, summarized key RH issues as lack of: Ante natal care, care during delivery, and facility for contraception, water, sanitation & hygiene facilities, just distribution of food and other necessities and sanitary pads for women to maintain menstrual hygiene.

“High vulnerability to gender based violence and sexual abuse could be the consequences in the current scenario” opined Dr. Nasser Mohyuddin, a senior Public health expert and Director National Institute of Population Studies.

Relevant agencies from UN as always are disseminating calls for proposals with complicated technical frameworks, blue eyed  consultants are ‘productive”, powerful and influential international “NON PROFITS” are also active- all competing for limited dollars in the kitty.

Ineffective prescriptions should no longer be considered. Our programs should be connected to indigenous perspectives and informed. Gender Based Violence has to be accepted and included as RH issue and men in different roles have to be effectively informed about long term damages (physical, psychological and emotional) caused to women and children by treating violence as a private and non pathological matter.

While traditional approaches of donors and technical agencies including traditional indicators of women’s health   – which is practically limited to maternal health as womanhood and motherhood are loosely used and abused interchangeably especially in Islamic and conservative countries – are failing to measure status of women in general and their health including RH statuses in particular the need of the hour is to look for transformative approaches with empathy.

Reproductive health – gender nexus is a human rights Issue as an urgent question demands a clear understanding for gaining genuine results and impacts of money invested in the name of these issues.

About the author: Dr.Rakhshinda Perveen is a recognized public health and gender expert besides being a perpetual activist dreamer based in Pakistan. She can be reached at