| |
|
Many young mothers and children in areas hit by 2006 earthquake in Pakistan have better access to health care than before the disaster, as a result of joint efforts to restore services.
 Play video
|
|
|
| OVERVIEW |
|
|
The Programme
RHIYA Pakistan was implemented between 2004 and 2006 and involved 3 partner NGOs. The programme targeted vulnerable youth aged 15-24 in 5 districts of the country. The goal of the programme was to contribute to improved adolescent reproductive health and well-being of adolescents and youth in Pakistan. A key strategy in achieving this was to develop an integrated programme, working with parents, school teachers, religious leaders and health service providers. The programme provided 60,000 gatekeepers with information on SRH health and the approach to working with these gatekeepers is documented in Teenagers, Tensil Nazims, Mothers and Mullahs: New alliances for Young Peoples Reproductive Health in the Case Studies from RHIYA: Good Practices for Creating and Enabling Environment
Key activities include peer education, life skills training, theatre and edu-tainment. Youth Friendly Centres (YFC) were established and provided important spaces for young people to access information and services. Typically these YFCs offered cultural events, sports activities, awareness sessions, literacy classes and vocational training. The YFCs provided some services; counseling and contraceptives, but the majority of clinical services were through referrals to local private ASRH providers. During the period of the RHIYA, 30,000 consultations were provided to young people.
Source: Empowered young girls
Achievements
The key achievement in Pakistan has been the move towards an enabling environment for ARH. Significant advocacy efforts among policy makers and gatekeepers have resulted in the establishment of 40 Youth Friendly Centres, 20 for girls and 20 for boys. In addition, some of these YFC have taken an important step towards sustainability by becoming Citizen Community Boards which are therefore eligible for 80% government funding. This process is documented in Opening the Doors to the Corridors of Power Good Practices in Advocating for Policy Development.
All of the projects were sensitive to the religious and cultural context of SRH in Pakistan. One NGO conducted research in an attempt to show that Reproductive Health is compatible with the teaching of Islam. This broke the myth that Islam is against the provision of sexual and reproductive health information and allowed religious leaders to give project activities official sanction and support. This approach features in a thematic paper on Reproductive Health and Islamic Context in the Final RHIYA Publication A Catalyst for Change
The Way Forward
The RHIYA model in Pakistan has demonstrated that there is potential for national level advocacy on ASRH. Successful approaches such as working with communities and religious leaders need to be scaled up. Organizations including those within the government need to seize the momentum generated by the RHIYA to work together for a National Advocacy Strategy and to continue to advocate for ARH by improving data collection and use on young people and ARH and ensuring the voice of young people is heard throughout the country and at the highest levels. These and other recommendations come out of a National Parliamentary Study commissioned by the RHIYA.
|
|
|
| PROFILE |
|
History / Culture: In 1947, under the acceptance of the British Empire, Pakistan formed a separated state from India along religious lines; the population is thus 97% Muslim and Pakistan is an Islamic Republic since 1956.
Geography: Pakistan has a border with China on the North, with Afghanistan and Iran on the West, and with India on the East. There is an access to the Arabian Sea on the South.
Population / Demography: Pakistan is the sixth most populated country in the world, with 158 million people. The Population Growth Rate is 2 % per year. 67.5 % of the population is living in rural areas. An estimated 50% of the population will resettle in urban areas during the next 20 years. The proportion of the population living below the poverty line actually increased from 22% in 1990 to 31% in 2000. The population density is 179 people per square kilometer.
Economy / Productivity: Pakistan is essentially an agricultural country. There is a wide income disparity between the poorest and the wealthiest households in Pakistan. Pakistan’s economy has gradually improved over the last ten years. However, in this largely rural, agricultural-baled economy, landlessness has increased over the past decade. Currently half the rural poor have no land of their own; in some provinces it is as high as 70%. As a result, many head to towns and cities. Poverty tends to be concentrated in large families that have few wage earners, high dependency ratios, are sometimes headed by females and those that have no assets.
|
|
[+] view more
|
|
|
| BACKGROUND |
|
|
Characteristics of Youth and Adolescent Population: In Pakistan government policies classify people below the age of 18 as children. Being one of the most populous countries in the world, Pakistan in 2002, had an adolescent population of 25 million (aged 15-25), and this number was projected to increase (1). Young people are raised within households and communities that play a deep instrumental role in shaping individuals’ personalities. A community is at the same time defined by its geographic localization, its ethnicity, its language, its culture and related factors (2). Religion is very important. In many areas religious leaders are opposed to discussions around SRH. At the beginning of the RHIYA programme one cleric issued a Religious Fatwa against the programme in his area; however this was subsequently removed following advocacy from other religious scholars.
Education / Socio-Economic Development: Despite significant achievement in increasing literacy during the last three decade from 27 % to 55 % for males and from 8 % to 32 % for females, 50 million people, around 21 million male and 29 million women (10 years and above) are counted as illiterate. Opportunities for young people largely depend on whether they live in rural or urban areas, but also whether they are male or female: indeed, the number school facilities are less important in rural areas, and when available, there are not always accessible to females. Concerning work, the gender gap remains: the majority of young males begin working in the paid labour force, whereas less than 40% of females enter the work force before 24. Moreover, employment domains are segregated by gender, with males working outside in skilled labour, in factories, and females working at home embroidering for example (3).
Health and Knowledge on Sexuality and Reproductive Health: A major problem is chronic malnutrition; 40% of children under 5 suffer from protein energy malnutrition. As a consequence of these factors there are high rates of infant, child and maternal mortality. Despite a drop in fertility rates, from 5.3 in 1993 to 4.6 in 2003, most women still lack access to quality reproductive health care, including family planning. The contraceptive prevalence rate for modern methods is only 36%, and three quarters of all births are not attended by skilled health personnel. Cultural norms do not allow free discussion of the needs of unmarried people related to their sexuality and these needs are not included in public policy. Universal knowledge of contraceptives is recorded as high as 97 %, however contraceptive prevalence rate remains low at 27%. The HIV/AIDS epidemic is considered to be at a low level.
Traditional Values and Attitudes / Marriage: As a traditional society, Pakistan harbors strong values on issues regarding the family, reproductive health and gender relationships. Society at large tends to regulate young people’s behaviour, ambitions and practices through restrictive norms. The situation is worse for girls whose mobility is restricted further at the onset of puberty and it is considered that she is now fully prepared to enter into marital life. However, in some communities married women are not allowed to leave their homes, even for a medical check-up without permission from and escort by a male family member. However, cultural norms and practices do vary between different communities.
As a result of these socio-cultural factors early marriages, teenage pregnancy and high fertility rates increase the incidence of maternal deaths of between 300-700 per 100,000 live births and infant mortality rates of 82 per 1000 live births. Abortion is illegal and premarital sex is taboo in this culture although the gap between mean age at first intercourse and age at marriage suggests that it does occur.
Actions: Priority SRH needs in Pakistan include the need for information, including changes at puberty, masturbation, homosexuality, nocturnal emissions and infertility. SRH issues include early marriage, domestic violence, unwanted pregnancies, unsafe abortions and RTI/STIs.
------------------------------------------------------------------------------------
(1) In Adolescents and Youth in Pakistan 2001-2002, A Nationally Representative Survey,
UNICEF, Population Council, Islamabad, 2002, p. xvii)
(2) Ibid. p. 108.
(3) Ibid. p. xviii
|
|
[+] view more
|
|
|
| |
|
|
| 
