The province of Sindh in Pakistan passed The 2019 Sindh Reproductive Healthcare Rights Bill on November 14th, 2019, with the objective of strengthening the availability and quality of reproductive health care services. The legislation broadened the provisions and scope of family planning and other reproductive health services, and committed the government to strengthening health facilities, with a focus on underserved areas.
This is monumental in a country that still does not recognize health as a basic human right. It was estimated that 80 women in Pakistan die every day due to preventable causes related to childbirth, there are millions that suffer from long term complications due to poor care during pregnancy or delivery. Much of these complications and deaths could be avoided through improving access to quality and affordable reproductive health care services.
While these laws would address issues related to access of services related to women of reproductive age, it still begs to question whether we are doing enough to change the structural conditions that lead to early age marriage (which, in turn, result in early age pregnancy) and to improve access of healthcare services to marginalized and oppressed groups such as refugees, particularly women.
With a burgeoning youth population (approximately 64% of the total population), unequal distribution of resources, climate change, inflation and growing conservatism, young girls in Pakistan are even more vulnerable to harmful practices such as child and early age marriage (CEAM). The current reproductive bill of Sindh, the province with the highest instances of CEAM and the only province where the legal age of marriage is currently 18, does not show any reflection on this matter. At a national level, the political will to counter CEAM is missing. It is imperative to tackle the structural conditions that lead young girls into early marriages including the incorporation of comprehensive sexual education into the education curricula.
Further, the bill does not reflect on the distinct issues of refugee women’s inaccessibility to healthcare services. According to this article in Newsweek, refugees have been settled in Pakistan for over three decades and continue to give birth in deplorable conditions.
“Without any maternity services, refugee women have no option but to give birth with the help of traditional birth attendants or elder family members.”Nagina Sayed, 34, for Newsweek.
Despite some wins, the most vulnerable populations will continue to suffer from lack of access. Progress cannot be symptomatic, it must be inclusive and reflect the varied needs based on socio-economic, age and refugee status. Pakistan cannot achieve its goals for universal coverage, if it continues to ignore the needs of traditionally marginalized and vulnerable groups.