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Putting women first: applying a gender lens to COVID-19 response in Pakistan

By: Dr. Tabinda Sarosh, Country Director, Pathfinder Pakistan, & Jodi DiProfio, MA

This blog is our second in a series related to how we are adapting Naya Qadam, our program in Pakistan, to slow COVID-19 infections while supporting the health system to offer essential sexual and reproductive health care during this global pandemic. You can read the first blog in the series here.

For more than 30 years, Pathfinder’s staff in Pakistan have been on the frontlines, partnering with Lady Health Workers, community midwives, policy makers, academics, and youth champions. Through these partnerships, we have advocated for gender equality and tackled harmful gender norms and practices, such as gender-based violence and early marriage.

Over the last three years, Pathfinder has supported communities and local governments across Pakistan to shift gender norms, increase family planning, and improve reproductive health through our Bill & Melinda Gates Foundation-funded Naya Qadam project. But the COVID-19 pandemic has hampered our efforts, threatening hard-won advances in gender equality and sexual and reproductive health and rights (SRHR). We are adapting—quickly and judiciously—to protect advances in gender equality and to continue to serve the women and girls who face increased vulnerability during crises.

Protecting and supporting female health workers

First and foremost, Naya Qadam has addressed the gendered challenges of COVID-19 by mitigating risks to female health workers.

Two essential cadres of health workers advancing SRHR—Lady Health Workers and community midwives—entered this crisis facing unique challenges. These cadres work on the frontlines in their communities, providing essential SRHR services including family planning, maternity care, and treatment for sexually transmitted infections. Yet, these women often struggle to receive supplies, continuing education, and supportive supervision that other health cadres based in public health facilities may receive. Furthermore, they face gender-driven challenges due to social norms—norms that discourage women from working outside the home, becoming educated and empowered, and that encourage the acceptance and normalization of gender-based violence within homes and communities.

Since the onset of the COVID-19 crisis, female health workers have faced additional risks and challenges: mobility restrictions, increased risk of COVID-19 infection and transmission without protective equipment, supplies and infection prevention training, and pressure from their families to stop work and close maternity clinics.

To protect and support Lady Health Workers and community midwives while they continue to advance SRHR during this crisis, Naya Qadam has made several adaptations:

  • Collaboration with local government to assess where needs are the greatest and to support delivery of essential resources to female health workers, including infection prevention supplies and personal protective equipment
  • Creation of virtual support platforms via WhatsApp, including mentorship networks.
  • Development of digital tools to ensure ongoing supportive supervision, including digital content on “COVID-19 and maternal health.”

Gender-sensitive messaging and services to communities

Second, Naya Qadam is ensuring gender-sensitive SRHR content is integrated into public health messaging on COVID-19. As COVID-19 sweeps through communities across Pakistan, Naya Qadam is working with the local government to embed gender-sensitive SRHR content in public health messages disseminated as part of pandemic response. These communications are delivered through television, radio, and local loudspeaker announcements in mosques, and digitally through mobile phones.

Naya Qadam is also providing guidance, virtual training, and job aids to all frontline health workers, enhancing their capacity to respond to survivors of gender-based violence and make appropriate referrals.

These interventions are crucial. Based on past epidemic experience, we know communities in Pakistan will be impacted by COVID-19 in the short-, mid-, and long-term. Early reports suggested that direct COVID-19 fatality rates may be higher among men with hypotheses linking to masculine norms related to tobacco use and reluctance to access health services. However, women and girls are bearing the brunt of COVID-19’s secondary impacts.

Globally, women and girls are experiencing increased exposure to COVID-19, with 70 percent of frontline health workers being women; skyrocketing rates of gender-based violence; and increased barriers to accessing contraception and maternal health care. Likely mid- and long-term impacts include increases in unintended pregnancies and unsafe abortions, drops in girls school enrollment, rising early and child marriage rates, and more women dying of avoidable obstetric complications as fear of viral exposure keeps women from seeking care.

As Pakistan’s health system is strained by the need to respond to COVID-19, essential SRHR services are being de-prioritized and, in some cases, suspended. For example, regardless of inclusion in global essential service package guidelines, family planning services under the Population Welfare Department have been suspended in some provinces.  Many public-sector services have reduced staff and clinics that ordinarily provide gynecologic or gender-based violence treatment and support are closing.

Gender-responsive policies that serve women and girls

Naya Qadam is working to counter this policies and influence gender-responsive policies that ensure the continuation of essential SRHR support throughout all phases of the COVID-19 pandemic. This has included contributions to Sindh Province’s Guidelines on Family Planning and Reproductive Health During COVID-19 and the Pakistan Alliance for Post-Abortion Care’s Statement on Coronavirus (COVID-19) Infection & SRH and Post-Abortion Care.

The needs of Pakistani women and girls will be impacted for decades to come if intentional efforts aren’t made to shore up a gender-equitable COVID-19 response and protect essential services such as those for family planning, maternal health care, and gender-based violence. Naya Qadam is committed to supporting a gender-equitable response to the pandemic in Pakistan and sharing our learning with the global SRHR community so that these types of gender-equitable approaches can be adapted and scaled up to protect and empower women and girls around the world.