Insights

Context: Gender, Health, and Education in Pakistan

Pakistan’s population is 49% female and ranks 142 out of 146 countries in terms of gender disparity, measured at 57.5%[1] in the World Economic Forum’s Gender Gap Report from 2023. The disparity is particularly apparent when it comes to access and availability of opportunities and facilities in education and health. The national male literacy rate for ages 10 and above is 73.4% while female literacy is 53%. In Khyber Pakhtunkhwa (KP) province, where the New Partnerships Initiative EXPAND: New Partners for Better Health (NPI EXPAND)’s partners are implementing projects, the male literacy rate is 72.8% and female literacy is 37%.[2] Out of the 4.7 million out of school children aged five to 16 years in KP, three million are girls.[3]

Traditional gender roles, lack of equal financial opportunities, socio-economic factors, and traditional cultural barriers contribute to women’s limited access to resources, education, health services, especially for family planning and reproductive health, and financial independence. Reproductive health and menstruation are considered taboo topics too shameful to discuss, leading to a lack of utilization of healthcare facilities by women. The national contraceptive prevalence rate (all methods) is 34%; the rate for KP is 30.9%.[4] The National Report on the Status of Women in Pakistan 2023 identified that nationally, distance, and access to health facilities is a challenge for 66% of women in rural areas.[5] These realities result in women and girls’ lack of access to healthcare including for family planning (FP) and reproductive health as well as education, and require a comprehensive strategy to address them.

Gender Integration in NPI EXPAND HDA Programming

In Pakistan, NPI EXPAND is implementing USAID’s Human Development Activity (HDA) to advance locally led development in elementary and primary education, maternal, newborn and child health, and family planning in Buner and Upper Dir districts in KP. Addressing social and gender barriers to increase access to basic education and health services is a key objective of the program. To achieve this, NPI EXPAND HDA’s local partners were encouraged to focus on providing gender-integrated health and education services, information, and supplies to communities.

NPI EXPAND HDA’s partners’ field-based activities explored opportunities to address social and gender barriers to increase access to basic health and education services. Their interventions challenged gender stereotypes, addressed societal and cultural taboos, increased educational opportunities, raised awareness on men’s engagement in family planning and women’s need for quality reproductive health services, and encouraged entrepreneurial approaches for girls and women in the program target areas of Buner and Upper Dir.

Education

The Accelerated Learning Program is one approach to reaching out of school youth, especially girls. The    Accelerated Learning Program centers are supported by the KP government to address the absence of formal schools. Out of school children can enroll in these centers and transition to formal schools once they attain the level of education appropriate to their age and grade level. These centers have helped increase girls’ access to education, many of whom had either never been to school or had dropped out due to a lack of girls’ schools in their areas.  NPI EXPAND HDA awarded grants to local partners to enable out of school children gain access to basic education, focusing on adolescent girls in the Upper Dir and Buner districts.

These non-formal education centers implemented by NPI EXPAND HDA partners HUJRA Village Support Organization, National Integrated Development Association-Pakistan, Participatory Rural Development Society, Peace and Development Organization, Takal Welfare Organization, and Women Empowerment Organization enrolled 10,340 students, from 2022-2023, 87% female, providing a safe space for out of school girls to pursue their education dreams. 553 teachers, 83.4% of whom are women, have also been trained to run and manage Accelerated Learning Program centers in their communities.

NPI EXPAND HDA partner Peace and Development Organization established 54 Accelerated Learning Program centers and recruited 54 teachers for the 1,930 out-of-school girls in district Upper Dir. Finding appropriate local resources became a challenge when 37 out of the 54 selected teachers refused to join the program, citing travel difficulties. The Peace and Development Organization identified graduates from local communities to teach in the centers and trained them on content and teaching strategies. Among them was Saba Gul, who motivated her community members to support and promote girls’ education. Owing to her dedication and hard work, girls from Saba’s class who were once out of school with no opportunity or hope for an education, achieved high grades in their classes. Her community members and fellow teachers acknowledged Saba’s contribution and said, “The average grades for the three levels that Ms. Saba teaches are 64.9%, 70.5% and 68%. These are a testament to her hard work and dedication–she goes above and beyond to ensure that these children receive a quality education.”

The success of these centers was due to a number of factors and strategies. Partners conducted sessions to engage parents and raise awareness about the importance of girls’ education, promoting the concept that an educated female population will contribute to the overall development of the community. Educated girls are more likely to contribute to the economy, improving their families’ financial situations and reducing poverty in the long term. They shared success stories of women from similar backgrounds who benefited from non-formal education and worked with community leaders to run a door-to-door campaign to help ensure that girls enrolled in the Accelerated Learning Program centers complete their appropriate grade levels.

Other factors that encouraged parents to send their daughters to these centers included easy access, since they are usually located within communities, reducing travel time and making the journey safer especially in areas where formal schools may be difficult to access. They provided a more supportive environment, which was an advantage in areas where formal schools may be overcrowded. Students were taught by female teachers from their own communities, increasing the likelihood of parents feeling more comfortable about sending their daughters. The Accelerated Learning Program centers offered flexible schedules, accommodating other responsibilities girls might have, such as domestic chores, and were usually more affordable than formal schools since they provided books and other resources free of cost.

In these remote and conservative areas, many of which lack access to formal schools for girls, these centers will provide an opportunity for young girls to pursue an education. Parents are likely to be more comfortable sending their daughters to an educational center run by someone from their own community, with female teachers.

Health

Health and community representation are other areas where NPI EXPAND HDA partners made community representation structures more gender inclusive. In Tehsil Mandar, district Buner, the seven Primary Health Care Management Committees had no female participants, since women in this remote district do not typically participate in such activities due to local norms and traditions. The Foundation for Rural Development convinced committee members of the importance of female membership and female members were included in six out of seven Primary Health Care Management Committees. Similarly, the Sustainable Development Policy Institute identified the absence of women members in six Primary Health Care Management Committees in Tehsils Daggar and Gagra, district Buner. To address this, the organization invited female community members and Lady Health Visitors to attend the meeting as observers and the meeting minutes were officially shared with the district authorities emphasizing the women’s valuable input and perspectives. The Sustainable Development Policy Institute advocated for change by disseminating these minutes and formally petitioning the District Health Officer to include women’s representation in the committees. In response, the District Health Officer issued an official notification to include Lady Health Visitors in the committees throughout the district. Female participation in these health management committees can help ensure that women’s health needs are addressed and they have increased access to quality FP and maternal, newborn, and child health (MNCH) services.

The absence of men and religious influencers from the FP and MNCH dialogue makes access to health information and services difficult for women who depend mostly on men as the primary source for information and decision making. NPI EXPAND HDA partners the Foundation for Rural Development, the Women Empowerment Organization, the Sustainable Development Policy Institute, and Saibaan Development Organization pursued an innovative approach to reduce gender disparity in the health sector. They engaged religious leaders, male community members, community influencers and youth on FP and MNCH from the target areas as champions of change since they are widely respected in the region and their messages are perceived positively. The partners engaged these groups through community-based dialogue and awareness raising initiatives, trained them on FP and MNCH and then supported them to run their own sessions in their communities. 188 religious leaders trained by NPI EXPAND HDA’s partners delivered 420 Friday sermons, the largest weekly forum where men congregate for prayers, with integrated messages on FP and MNCH. The Imam (prayer leader) Ibrahim at Naranj village, district Buner, discussed topics such as potential complications for expectant mothers if they engage in hard labor during pregnancy, emphasizing the need to ensure adequate care for expectant mothers to ensure safe delivery. His messages were taken positively by the community and the community members were encouraged to protect the well-being of pregnant mothers by ceasing their engagement in physically taxing work. One religious leader said that integrating FP and MNCH messages into Friday sermons helped NPI EXPAND HDA partners increase the reach and effectiveness of their messaging.

Greenstar Social Marketing created entrepreneurship opportunities for women through its project with Sitara Bajis, a network of community mobilizers providing FP and family health services in areas not covered by the government’s Lady Health Worker program. Deen Jahan, a mother of four in district Buner, discussed the opportunity with her husband and convinced him that the additional income generated through her work as a Sitara Baji could help improve their family’s standard of living. She applied for the position and was selected. After extensive training on healthy birth spacing, Deen was able to convince her own husband and his conservative family about the importance of FP and begin practicing FP herself. She is now using her own story of change as motivation to promote healthy birth spacing in her community, while making a secondary income for her household. Deen’s awareness raising sessions with her community members are changing community attitudes towards FP while making her self-reliant and confident in her own life.

Sustainable Outcomes

Interventions in the education domain, such as the government ensuring continued training of female teachers on health and menstruation hygiene management and integrating this across schools in the district will help ensure sustainability of these initiatives. Engaging men as decision-makers in promoting FP and maternal health promotes gender equality and empowers women to access essential healthcare services. Enrolling women as members in Parent-Teacher Councils and Primary Health Care Management Committees and orienting all members on their roles and responsibilities has strengthened these local community structures and enabled them to work with the responsible government departments to help ensure quality health and education services.

NPI EXPAND HDA’s partners are also helping to ensure a move towards gender transformative approaches through mainstreaming and integrating gender in proposals for future projects. Investing in gender-focused interventions will benefit partner organizations to strengthen their organizational processes and help transform community perspectives on gender, ultimately encouraging positive outcomes at the community level.

[1] https://www3.weforum.org/docs/WEF_GGGR_2023.pdf

[2] https://www.finance.gov.pk/survey/chapters_23/10_Education.pdf

[3] https://www.app.com.pk/features/bringing-4-7mn-out-of-school-children-in-kp-under-education-net-a-gigantic-task/

[4] https://www.pbs.gov.pk/sites/default/files/social_statistics/contraceptive_performance_reports/ACP_Report_2020-21.pdf

[5] https://pakistan.unwomen.org/sites/default/files/2023-07/summary_-nrsw-inl_final.pdf