Cost of ignoring health risks

The youth of Pakistan are not provided age-appropriate sexual health information through responsible channels

By Qadeer Baig and Ahmad Shah Durrani

Ignorance on the part of our society and government towards sexual health problems of the population has led to a population explosion, adding further strain on our already out-stretched state structure. Sexual health crisis -- after years of being ignored on a social and institutional level -- has attained critical mass and has severely impacted lives of a majority of the population, especially women and children. The issue cannot be ignored any longer, especially after the international recognition of a link between sexual health promotion and poverty reduction in developing countries.

In terms of exposure to sexual health risks, the state of affairs of women in Pakistan is by far the worst, owing to pervasion of discriminatory gender norms that perpetuate gender inequality. Gender inequity, which is defined by the Sloan Work and Family Research Network of Boston College, as, "A social order in which women and men share the same opportunities and the same constraints on full participation in both the economic and the domestic realm", is a common phenomenon in Pakistan. According to one estimate, only 33 per cent of women (above 10 years) have completed primary education and the total number of employed women is nearly four times less than that of men in Pakistan. Discriminatory gender norms -- which restrict mobility, societal representation, and access to health and education services for women -- have the combined effect of objectifying women as means of reproduction, housework, and sexual gratification.

Among the 1,321 instances of gender-based violence reported in the first quarter of 2008 alone, there were an overwhelming number of cases of women being buried alive, tortured, gang-raped and burnt with acid. Similarly, poor access to opportunities in education and employment for women and their socially-defined role as objects of reproduction is the main cause behind the 83 maternal deaths that take place in Pakistan on average every day. It is estimated that over 80 percent of these deaths occur due to wholly communicable causes such as the fact that only 34 percent of all deliveries are attended to by trained health professionals that derive from poverty, illiteracy and gender imbalances. Regretfully, the grim picture painted by these facts is hardly given due attention by both the media and civil society.

Women are not the only human beings exposed to increased sexual health risks in Pakistan: the sorry state of adolescents is also undeniable and has been highlighted consistently by the Ministry of Youth Affairs as an area of action, although little has been done in this regard. Just as sexual ill-health of women is intrinsically linked with gender norms and cultural practices, an analysis of the root causes of poor sexual health state of young people in Pakistan also reveals the existence of cultural norms as a key factor in young people's prevalent sexual health status. As a result of these cultural norms -- which disapprove of open discussion on sex and sexuality related issues to protect the moral fabric of society -- the youth of Pakistan are not provided age-appropriate sexual health information through responsible channels.

According to a research study conducted by the World Population Foundation on the Status of Sexual Health and Rights of Young People in Pakistan 2010, young people are at an increased risk of, "…abuse, exploitation and disease", which is why it is not uncommon for young people to indulge in a number of risky sexual activities such as having unprotected sex with sex-workers that has debilitating impacts on their sexual, mental and emotional well-being. Another concerning effect of the aforementioned cultural norms is that it legitimises the denial of sexual and reproductive health services to young people, with disregard to their sexual well-being and needs. The same research study concludes that the right to healthcare and health protection is amongst the four most infringed rights of young people in Pakistan.

Despite the strong case that can be made for the provision of education to the youth, there has been strong social opposition towards such ideas in the past: some schools were targeted in August 2009 for providing sexual health education to its secondary-level students, after pressure exerted by right-wing groups. It is highly likely that sexual health counseling will also evoke a similar response.

Hence, it is clear that sexual health of the Pakistani population -- particularly women and adolescents -- is something that needs to be addressed on an immediate basis. The fact that the prevalent situation derives from ignorance and out-dated cultural norms and practices, makes it imperative upon us to extract our heads from sand and initiate open, respectful and informative discussions about sexual health rights issues. This will not only streamline the cultural order, making it more responsive to the needs of women and children, but will also provide an added advantage of making civil society an important stakeholder in the countrywide integration of sexual and reproductive health rights that will have a significant bearing on the success and sustainability of all efforts in the supply and demand mechanisms of the sexual health, including family planning services.

The recent spate of floods has only exacerbated the situation as they have devastated the lives of people. More importantly, 85 percent of the displaced people are women and children, a segment of the population whose sexual health rights are violated even in regular circumstances, who are suffering not only from the usual pangs of hunger but also increased risk of sexual exploitation and disease. Yet, these increased health risks have not been highlighted adequately.

In this backdrop, the WPF, Pakistan and CSO working on RH issues commemorated the World Sexual Health Day (WSHD) in Pakistan on September 4. The aim of this initiative was to initiate open, informative and constructive discussion of sexual health and rights. The World Association for Sexual Health has declared September 4 as WSHD every year. By promoting WSHD in Pakistan, the WPF will begin addressing the root cause of Pakistan's sexual ill-health which is a lack of concerned awareness of general public and policy-makers regarding sexual health and rights issues.