YET again, the low status of women in this country stands exposed in all its ugliness. A United Nations report released on Wednesday examines the 17 Sustainable Development Goals and their impact on the lives of women and girls. According to the findings, 4.9 million women between the ages of 19 and 49 years in Pakistan are simultaneously deprived in four SDG-related dimensions, with health being one of them. The disaggregated results are an indictment of not only cultural mindsets that keep women in subjugation but also of governmental apathy. On average, 48.1pc of women and girls between 15 and 49 years of age have no say in decisions about their own health. Those in rural areas are 1.3 times more likely to experience such lack of agency than their counterparts in urban locations. Sindhi and Pakhtun women and girls are the most disadvantaged in this category with between 62pc and 65pc reporting no say in health matters. Notably however, Pakhtun women and girls, regardless of income level or location, are the most suppressed on this score with higher than the national average unable to participate in decisions about their health.

Pakistan’s deeply entrenched patriarchy relegates women to the bottom of the pile in an already inequitable system. They are expected to defer to men in decisions that can affect the rest of their lives; where health is concerned, these could include questions about how many children to bear, when to seek medical attention for themselves and their children, and so on. Consider the skewed gender ratio in Pakistan — 105 men for every 100 women in a world where the longer life expectancy of women means they outnumber men in most countries. But what else can be the outcome given the traditional preference for males in our culture? Girls get the shorter end of the stick from infancy onwards, leading to higher levels of malnourishment and anaemia among women, increased risk of death in childbirth and chronic health conditions.

However, cultural patterns are not immutable. As successful polio-vaccination campaigns have demonstrated, community-based interventions are the most effective in changing attitudes subtly and non-threateningly. Lady Health Workers, using the same approach, have also made considerable strides in spreading public awareness about other health-related issues, especially pertaining to pregnancy and childbirth; their numbers can be further enhanced to reach more women. But decisions about one’s health are no different from decisions about other aspects of one’s life. For women to acquire that level of autonomy requires whittling away at age-old notions. An enlightened education curriculum, more schools and colleges, increased employment opportunities for women, and implementation of pro-women laws all have a role to play. It is to our detriment as a nation that half our population does not have the tools or the agency to lead a more fulfilling existence.

Published in Dawn, February 16th, 2018