Framework for Health and Gender Equality

Framework of Health and Survival
GROUP MEMBERS: Marhaba rana 01, Mahnoor Tahir 03, Najaf Liaqat 04, Tayyaba
Naseem 11, Aruma Ashraf 12
Dr. Farhan (SOCIOLOGY OF GENDER STUDIES)

Health
 Health is a state of complete physical, mental and
social well-being and not merely the absence of
disease or infirmity.
 The enjoyment of the highest attainable standard of
health is one of the fundamental rights of every human
being without distinction of race, religion, political belief,
economic or social condition.

 Unequal development in different countries in the
promotion of health and control of diseases, especially
communicable disease, is a common danger.
 Governments have a responsibility for the health of
their peoples which can be fulfilled only by the
provision of adequate health and social measures.

Source: world Bank
Current health Expenditure (% of GDP)

Source: world Bank
Current health Expenditure of Pakistan (% of GDP)

 PAKISTAN is a known low-spender on health. To
put things into perspective, according to estimates
done in 2017-18, Pakistan spent $45 per person on
health, while Iran spent $484 and Qatar spent
$1,716 per capita
 A more recent estimate from 2017, including
investments in the health system, sets the bar at $271
per person.

 $86 is recommended as minimum public-sector
spending whereas the above-mentioned $45 per capita
in Pakistan is the total health expenditure. The
breakdown is disturbing: only $14 is spent by the public
sector on each citizen annually whereas the citizens
themselves spend $28 (private-sector spending) and a
mere $3 comes from external sources.

 The federal budget 2021-22 has seen an increase of 11pc
relative to the previous year.
 In nominal terms, the health budget has gone up from
around Rs25.5 billion to Rs28.3bn though it is still a mere
0.4pc of the total budget.
 The federal development budget (PSDP) has a “particular
focus on strengthening the health sector” and it has seen an
increase of 49.6pc ie from Rs14.5bn in 2020-21 to
Rs21.7bn.
 One of the government priorities for the current fiscal year is
impact mitigation of Covid-19

 Rs100bn is dedicated only for Covid-19 related
expenditures ie almost four times the budget for routine
healthcare
2020-21 2022-23
Punjab 156.7bn 370bn
Khyber Pakhtunkhwa 124bn 142bn
Sindh 132.8bn 172bn
Balochistan 31.4bn 44.6bn
Source: Dawn News

As is obvious, there is an overall upward trend in health
budget allocations at the federal and provincial levels
which is good news. Covid-19 has played a significant
role in this

Global Gender Gap Report 2021
 The global gender gap framework includes Economic Participation and Opportunity,
Educational Attainment, Political Empowerment, Health and Survival.
 We will be discussing in detail the indicators and challenges faced by global world and
Pakistan in the framework of health and survival
 Pakistan according to GGGR 2021 ranks 153 out of 156 countries.
 Scores 0.556 , 0.00=imparity and 1.00=parity
 Health and survival : 2006 score rank was 112 and 0.951
 The score rank of 2021 is 153 and 0.944

Continued..
 Pakistan is at 7th out of 8 countries, and the gender gap is 94.4%
 There are three indicators which are causing gender disparities:
1. Sex ratio at birth
2. Gender selective practices
3. Violence
 Causes, prevalence and statistics of each indicator in Global and Pakistan’s context would be
discussed
 Health and Survival is the second-best subindex in terms of progress towards gender parity
globally.

Sex ratio at birth
 The sex ratio at birth refers to the number of boys born alive per 100 girls
born alive.
 The sex ratio at birth (SRB) for a given population over a given time period
is the ratio of the number of male live births in the population to the number
of female live births to the population, scaled to a denominator of 100, i.e., it
is the number of male live births for every 100 female live births.

Sex ratio in Pakistan
 Pakistan male to female ratio at birth was at level of 109
males per 100 females in 2020, unchanged from 2015.
 Across the world there are differences in the sex ratio at
different life stages. In the absence of selective abortion
practices, births in a given population are typically male-
biased – the chances of having a boy are very slightly
higher than having a girl.

 Sex selection is the attempt to control the sex of the
offspring to achieve a desired sex. It can be
accomplished in several ways, both pre- and post-
implantation of an embryo, as well as at childbirth.
 Modern science provides people with new ,modern and
more effective methods for sex selection.
 Its is allowed for medical reasons but prohibited for non-
medical reasons in many countries but in some countries
it is not allowed for both reasons.

 Gender selection or sex selection practice is observed
all over the world but its is much common in south Asia .
 On contrary ,sex selection for non-medical reasons
subject of recurrent ethical and public policy debate in
many countries.
 In 36 countries restrictive stance adopted with laws and
policies on sex selection including China,India,Turkey
Australia, Canada and 25 European countries.

Reasons for sex selection practice
 According to the United Nations Population funds, the reasons behind sex
selection are due to three factors and provide an understanding for sex ratio
imbalances.
 A preference for sons which stems from household structures in which girls
and women have a marginal social, economic and symbolic position, and
consequently enjoy fewer rights .These household structures also focus on
security in which sons are expected to provide support to their parents
throughout their life.
 Technological growth of prenatal diagnosis which allows parents to know the
sex of their unborn child; and
 Low fertility which increases the need for sex selection by reducing the
probability of having a daughter in smaller families.

Methods for Sex selection
 There are three methods through which desired sex is obtained mostly.
Pre-implantation
 Two major types of pre-implantation methods can be used for social sex
selection. Both of them are based on actively rendering the second sex
chromosome to be either a Y-chromosome (resulting in a male), or an X
chromosome (resulting in a female).
Post-implantation
 Sex selection after implantation can be performed by parental sex
discernment, followed by sex selective abortion of any offspring of the
unwanted sex. For prenatal sex discernment, a blood test can be taken
from the mother for testing of small amounts of fetal DNA within it, and has
been estimated to be reliable more than 98% of the time, as long as the
samples are taken after the seventh week of pregnancy.

Post-birth
 sex selective infanticide - Killing children of the
unwanted sex. Though illegal in most parts of the
world, it is still practiced.
 Sex-selective child abandonment- Abandoning
children of the unwanted sex. Though illegal in most
parts of the world, it is still practiced.
 Sex-selective adoption - Placing children of the
unwanted sex up for adoption. Less commonly
viewed as a method of social sex selection,
adoption affords families that have a gender
preference a legal means of choosing offspring of a
particular sex.

Gender selection practices:
Pakistan has one of the highest desired sex ratios in the world. Prenatal
sex selection against females (PSS) is generally evidenced by a
masculinization of the sex ratio at birth. Son preference and prenatal sex
selection against females have resulted in significant sex ratio at birth (SRB)
imbalances well documented in several Asian countries, including India,
China and Pakistan. The SRB bias is generally used as indicator for the
extent and trends of prenatal sex selection against females. which shows
that boys are prioritize to girls. Different methods of sex selection are used
in Pakistan. These include medical and non medical methods and
procedures.
There are also some illegal methods and practices used to get desired
gender of baby.

Causes for sex selection practices:
 In countries like Pakistan, where the fertility transition is well under way, the
dual desire for small families and male offspring exerts strong pressure on
sonless parents to select for a son. This is because the probability of
remaining sonless, when left to chance, increases exponentially with fewer
children.
 Decreasing fertility increases the likelihood of remaining sonless; therefore,
more couples feel pressured to secure a male offspring through prenatal
sex selection.
 male preference is due to tradition of males carrying forward the family
name, notion of males providing old age security and support, male
patriarchy, and rigorous gender stereotyping.
 In the societies like India, Pakistan and Bangladesh, people ask for high
dowry, – and this may be one reason why families would prefer boys.

Medical methods:
 PSS is thought to have largely resulted from fetal sex determination (mainly
ultrasound), followed by the abortion of female fetuses. More recently, PSS has also
become technically possible through advances in medically assisted reproduction
techniques.
 There are clinical methods -- IUI and PGD --to conceive the desired gender of an
unborn baby.
 In the IUI method, male and female sperms are separated and the preferred sperm is
reinserted into the woman’s body.
 The other method is the PGD method which is done in Pakistan too and it requires lots
of work.
 “The embryo is fertilized in a lab and then the early genetic traits of the embryo are
determined,” says Dr Chohan, fertility expert at the Lady Wellington Hospital.
 The IUI has an 85 per cent success rate and the PGD a 95 percent success rate.

Non medical methods and illegal
practices:
 In Pakistan there are instances of female infanticide, illegal abortions, and
many families regard their daughters as burden.
 Female Infanticide:
 Female infanticide is the deliberate killing of newborn female children.
 Infanticide is illegal in Pakistan. However, people do not report these
cases, making it impossible for police to investigate. According to National
Right to Live News, in 2017, only one case was actually reported, but 345
babies were found dead in Pakistan's capital between January 2017 and
Spring of 2018.

 In 2019, the Edhi foundation found 375 newborn bodies buried in
various parts of Karachi, 99 percent of them were girls.
 Spokesperson suggested two reasons for this: pregnancies out of
wedlock, and the fact that many people do not want girl children.
These reasons seem to be enough and appropriate for deliberate
murder of little humans who have just come into the world.

Sex selective abortions:
 Abortion is illegal in Pakistan, except if needed to preserve the pregnant woman' life or
health. Like many subjects related sex selection, abortion is rarely discussed, either
publicly or privately. That is a common practice, not only by qualified doctors and nurses
in hospitals and clinics, but also by quacks and midwives, as well as at homes using
ways and means handed down by old women of families, which leads to many health
problems and death of many women.
 The proportion of women thought to have complications from abortion procedures
performed by traditional birth attendants ranges from 55% among nonpoor urban women
to 68% among poor rural women.

• An estimated 41–49% of abortions performed by Lady Health Visitors, nurses and
midwives are thought to result in complications, compared with just one in 10 abortions
performed by gynecologists.

Disadvantages of sex selection:
 gender disadvantage originate from a parental preference for boys over girls that lead to
important implications for future life opportunities, autonomy and adult mental health.
 Pakistani couples could continue pursuing sons by having additional children, but at the
cost of larger family sizes and underinvestment in daughters.
 Many people, especially in rural areas, have inheritance issues and want sons in their
family. If they keep producing daughters, either the girls are mistreated or killed, or the
man marries again. There is a high chance of over population and domestic violence too
because of this.

 At Pakistan's current slow pace of fertility decline, it will reach
replacement level in approximately 35 years. By this time its population
will have increased by more than a hundred million to around 300
million, maintaining its rank as one of the half-dozen most populous
countries in the world.
 This population growth would provide additional challenges for a country
that ranks in the bottom quartile of the Human Development Index
(indicating low levels of health, wealth, and education) and in the top
quartile of the gender inequality index (indicating major disadvantages
for girls and women).

Possible responses to and consequences of,
conflicting pressures related to smaller family size
and the desire for son

There are many possible ways to define violence. The World Health
Organization defines violence as:The intentional use of physical force or
power, threatened or actual, against oneself, another person, or against a
group or community, that either results in or has a high likelihood of resulting
in injury, death, psychological harm, maldevelopment or deprivation.The
definition used by the World Health Organization associates intentionality with
the committing of the act itself, irrespective of the outcome it produces.
Excluded from the definition are unintentional incidents – such as most road
traffic injuries and burns.

• Intentionally:
 One of the more complex aspects of the definition is the matter of intentionality. Two
important points about this should be noted. First, even though violence is
distinguished from unintended events that result in injuries, the presence of an
intent to use force does not necessarily mean that there was an intent to cause
damage. Indeed, there may be a considerable disparity between intended behavior
and intended consequence.
 As examples, a youth may be involved in a physical fight with another youth. The
use of a fist against the head or the use of a weapon in the dispute certainly
increases the risk of serious injury or death, though neither outcome may be
intended. A parent may vigorously shake a crying infant with the intent to quieten it.
Such an action, however, may instead cause brain damage. Force was clearly used,
but without the intention of causing an injury.

GBV w.r.t gender gap report:
 Women are often subject to violence: 45.2% of women
ages 15–19 have been married as children and 53.3% of
women have experienced violence in their lifetime.
Although gender gaps in Health and Survival (96.2%) as
measured by sex ratio at birth and life expectancy are
relatively small, a more specific look at health indicates that
a broader shift is required to achieve better security and
health conditions for women.
 Women still suffer other forms of discrimination, in
accessing financial services or inheritance, as well as
security concerns: 28% of women have been subject to
violence at least once in their lifetime.

Gender-based violence (GBV) or violence against women and girls
(VAWG), is a global pandemic that affects 1 in 3 women in their lifetime.
The numbers are staggering:
• 35% of women worldwide have experienced either physical and/or
sexual intimate partner violence or non-partner sexual violence.
Globally, 7% of women have been sexually assaulted by someone other
than a partner.
Globally, as many as 38% of murders of women are committed by an
intimate partner.
200 million women have experienced female genital mutilation/cutting.

Continued:
 Earlier this year, the UN found alarmingly high levels of violence against women and
girls, with one in three women across the globe experiencing violence in their lifetimes.
Worldwide, most violence against women is committed by a current or former intimate
partner, leading some to warn that there is in fact no place less safe for a woman than
in her own home.
 These rates vary by region and country but they all add up to a disturbing picture. A UN
study on why some men use violence against women (VAW) collected data from
Bangladesh, China, Cambodia, Indonesia, Sri Lanka, and Papua New Guinea, and
found that between 25-68 percent of women reported experiencing physical and/or
sexual violence by an intimate partner in their lifetime.
 Recent National Demographic and Health Surveys show that in the Philippines, one in
four women and girls (ages 15-49) have experienced some form of violence by a
current or former spouse
 in Cambodia it is one in three, and in Pakistan it is nearly two in five. Gender-based
violence does not only affect adult women. In 2012, violence was the second leading
cause of death among adolescent girls (ages 10-19), with the highest levels of violent
death found in South Asia, where almost 30,000 girls died as a result of violence.

World bank’s strategy
 The World Bank is committed to addressing gender-based violence
through investment, research and learning, and collaboration with
stakeholders around the world.
 Since 2003, the World Bank has engaged with countries and partners to
support projects and knowledge products aimed at preventing and
addressing GBV.
 The World Bank regularly convenes a wide range of development
stakeholders to share knowledge and build evidence on what works to
address violence against women and girls.

Strengthening institutional efforts to
address GBV
 In October 2016, the World Bank launched the Global Gender-Based
Violence Task Force to strengthen the institution’s efforts to prevent
and respond to risks of GBV, and particularly sexual exploitation and
abuse (SEA) that may arise in World Bank-supported projects
In line with its commitments under IDA 18, the World Bank developed
an Action Plan for Implementation of the Task
Force’s recommendations, consolidating key actions across
institutional priorities linked to enhancing social risk management,
strengthening operational systems to enhance accountability, and
building staff and client capacity to address risks of GBV through
training and guidance materials.

Violence as an indicator; Pakistani
Context
 CAUSES:
 One out of three women in the world experience physical or sexual violence in their lifetime,
according to WHO ‘making it the most widespread but among the least reported human rights
abuses’. When women experience violence, entire families and communities suffer. In fact,
violence against women impacts entire economies and countries. Increased abuse is a pattern
repeated in emergencies, natural disasters, wars, economic crisis or during disease outbreaks.

To be continued…
 According to the Human Rights Watch, gender-based violence occurs as a cause
and consequence of gender inequities. It includes a range of violent acts mainly
committed by men against women, within the context of the subordinate status
females in society, which is seeks to preserve. Violence against women includes:
 Domestic violence by family members or intimate partners, including physical,
sexual or psychological harm, sexual violence including rape, sexual abuse, forced
pregnancies and prostitution, traditional harmful practices including female genital
mutilation, honor killing and dowry related violence and human trafficking.

Causes and Prevalence; why its
common?
 Another cause highlighted this year was the pandemic, A
pandemic deepens economic and social stress coupled with
restricted movement and social isolation measures, increasing
gender-based violence exponentially (UNODC).
 The financial, domestic and health pressures during the lockdown
compound domestic abuse.
 GBV (Gender based violence) in Pakistan pervades class,
religion, and ethnicity, and prevails in both urban and rural areas.
GBV includes a range of violent acts committed by men against
women within the context of women’s subordinate status within
homes, communities, and society.

 Implementation of GBV-related laws is weak for several reasons. Women
and/or their families do not report cases of GBV due to feelings of shame or
fear of stigma and/or subsequent harm. Police have very limited resources
for responding to cases of GBV, and police may not report or incorrectly
report cases of GBV as they are often viewed as family matters. Further,
medical and legal providers and police do not have training to recognize
signs of GBV or how to provide medical and psychological support to
victims, while both police and judges tend to be male and may also be
bribed. Prosecutions of GBV cases are lengthy, and victims or their families
often seek redress through more traditional forms of dispute resolution.

To be Continued..
 The trajectory of domestic violence can present complex challenges to core institutions of the
state particularly the ‘Criminal Justice System’. ‘In some cases, adolescents engage in violent
behaviors in the home. Despite the prevalence of this form of violence it is not always
recognized by the CJS.

Continued..
 Overall Situation in Pakistan:
In Pakistan, mental health professionals providing online therapy sessions also report
that they have seen a rise in the cases of domestic abuse in the wake of the COVID 19
lockdown in Pakistan. ‘Domestic abuse has already been a haunting problem in
Pakistan; more cases are surfacing in this time of anxiety and depression for all.
A pandemic deepens economic and social stress coupled with restricted movement
and social isolation measures, increasing gender-based violence exponentially.
Evidence suggests that financial, domestic and health pressures during the lockdown
increase domestic abuse and other forms of gender-based violence. Pakistan is no
exception where incidents of domestic violence have been occurring at an alarming
rate.

Statistics:
 In a developing country like Pakistan with already very low indicators of
socio- economic development, an epidemic is likely to further compound
pre-existing gender inequalities.’ 28% of women aged between 15-49 have
experienced physical violence since the age of 15, and 6% have
experienced sexual violence. 7% of the women who have ever been
pregnant have experienced violence during their pregnancy and 34% of
ever-married women have experienced spousal physical, sexual, or
emotional violence. The most common type of spousal violence is
emotional violence (26%) which is followed by physical violence (23%). 5%
of the married women have experienced spousal sexual violence
(Advocacy brief 4 gender report, Gender and Pandemic URGENT CALL
FOR ACTION ,UNODC)

 Ministry of Human Rights depicts trends across age underlining the
severity of the problem in three categories of VAW (violence against
women) namely emotional (25%), physical (23%)and sexual
violence(5%).
 Pakistan has closed 94.4% of its Health and Survival gender gap,
negatively impacted by wide sex ratio at birth (92%) due to gender-
based sex-selective practices, and 85% of women have suffered
intimate partner violence (GGGR 2021)

Continued:
 The cases of violence against women and rape in Pakistan were doubled in the last six
months of 2020 as compared to the first six months of the year. Similarly, the number of child
abuse cases reported three times more in second half compared to first half of 2020. The
province of Punjab has reported maximum cases of child abuse followed by Sindh and
Khyber-Pakhtunkhwa.
 The alarming statistics were revealed in a report titled “Tracking Numbers: State of Violence
Against Women and Children in Pakistan” launched on the occasion of International Women
Day by Sustainable Social Development Organization (SSDO).
 The report presents an alarming situation in the country about failure of the government in
preventing child abuses and violation against women as the number of such cases witnessed
manifold increase during the year 2020. The research report contains data collected from
government record and media reports during a period from January 1 to December 31, 2020.

Continued..
 There is need of serious efforts by governments at all levels to ensure the implementation of
laws related to the protection of women and children in country,” Executive Director SSDO
Syed Kausar Abbas said, adding the local government institutions and the police must play a
proactive role in curbing the menace of violations of rights.
 According to official data analysis, 8 out of 9 indicators namely child abuse (1,920 cases),
child labor (117 cases), child marriages (32 cases), domestic violence (1,422 cases), violence
against women (9,401 cases), rape (4, 321), kidnapping (15,714 cases) and honor killing
(2,556 cases) had high occurrence throughout country. There was no cases recorded of
harassment at workplace in criminal record because the subject is dealt in office of
ombudsperson. In official record, the province of Punjab followed by the province of Sindh
reported a considerable surge in almost all of these indicators. The maximum number of
cases recorded in kidnapping and violence against women.

 The women and child rights violation reported in media are less as
compared to the official records that suggests that either media has not
given priority to these reported cases or the media has failed to properly
report such incidents.

Key Issues and Challenges:
 Absence of clearly defined policy and strategic response framework on how to tackle issue of
domestic violence
 Lack of coordination among institutions and stakeholders ● Limited availability of
disaggregated data
 Inadequate oversight mechanism
 Deficient capacity of societal watchdogs
 Lack of awareness of general public and societal barriers ● Resource constraints and
outreach capacities
 Lack of targeted training and orientation plans for first responders
 Need to update legal framework including development and enforcement of new SOPs,
Rules, Procedures, and Guidelines.

Conclusion and Recommendations:
 Pakistan’s high rates of newborn mortality could be associated with a lack of clear, inclusive,
and objective policy-making processes, and a failure to formulate a comprehensive and clear
policy.
 An evaluation of previous and existent policies relevant to newborn survival in Pakistan
uncovers several weaknesses reflected in poor implementation of these policies.
 Any future health policy-making with a focus on improving newborn survival in Pakistan or
other similar situations may benefit from a translation of evidence, clear target-setting, and
decentralization of child healthcare services.
 Control on the pandemic; COVID can also help the global world to improve the health and
survival framework.
 The desired goals should be transformed into implementation plans and strategies, including
specific programs, interventions, and clinical standards, and separate clinical guidelines for
health workers.
 To reduce over population, a two child or three child policy must be introduced.

Framework for Health and Gender Equality

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