PDH survey and status of women

By Zubeida Mustafa

WE as a nation shy away from the specifics. That is why numerical data is not our forte. We generalise the information available and reach sweeping conclusions.This also explains why holding a census or organising surveys is never the first priority of governments even though policymaking tends to be lopsided without accurate statistics.With the national census — it should have been held last year — in the doldrums, the findings of the Pakistan Demographic and Health Survey 2006-07 should normally come as a boon to the planners. The PDHS report has now been made public and contains a wealth of information not only on the country’s demographic and health profile but also other related issues. True, it cannot replace the national census but conducted by the National Institute of Population Studies with assistance from USAID, Unicef and UNFPA, this survey should somewhat help fill the gap in knowledge in vital areas.But as is the case with many surveys of this nature in Pakistan, can one vouch for the accuracy of all the data so assiduously collected? Not that the survey was not conscientiously conducted. The problem would lie at the respondents’ end. Given the low level of literacy, absence of a tradition of documenting and maintaining records and a disinclination to share personal information with strangers, the interviewers’ task would not have been an easy one, especially when gathering information through verbal autopsies — a new device to authenticate data on maternal mortality.Hence it becomes difficult to determine which information contained in the report should be accepted as valid and which should be received with healthy scepticism. What is perplexing is the basic contradiction between the dismal picture of the status of women that emerges from the survey and the rosy findings about the falling birth rate and increasing contraceptive use. Normally an improvement in the standing of women leads to a slowdown in the population growth.According to PDHS, the population growth rate has declined to 1.9 per cent (from 2.4 per cent in 1990), total fertility rate — that is the average number of children a woman has in her reproductive years — stands at 4.1 (from 5.4 children in 1990), and the contraceptive prevalence rate is 30 per cent (up from nine per cent in 1990). Infant mortality rate has declined to 78 deaths per 1,000 live births (86 in 1990) and under-five mortality stands at 94 per 1,000 births (103 in 1990).But the flip side is that the data does not indicate any convincing evidence that the status of women in Pakistan has improved substantially. With a sex ratio of 102 men to 100 women Pakistan cannot really claim to have given a fair deal to its female population. Biologically, women are known to outlive men if they enjoy in equal measure the quality of life available to men. That is why in all developed states where gender discrimination is minimal women outnumber men and have a longer life expectancy.In terms of education, it is true that more girls are now being enrolled in school today than before. But progress is slow and two-thirds of them still remain out of school. The authors of the survey categorically state, “Education can redirect the attitudes and behaviours of population towards improvement in the quality of life … Therefore its relationship to population growth cannot be underestimated.”It is now well established that education is inversely linked to the number of children a woman has. The longer the period a girl spends in school, the smaller her family size. The PDHS states the TFR is 2.5 children lower among women with a higher education level than their uneducated sisters.Employment is another major determinant of family size. Women who work outside their homes receive wider exposure and have a steady income that gives them a sense of control over their own lives. The survey found only a quarter of women in employment which again is a low labour participation ratio. It has improved over the years — several decades ago it was barely three per cent — but is still not really something to write home about.The key chapter in the context of the status of women is the one on adult and maternal mortality. Written by Farid Midhet and Sadiqua Jafarey (the latter an experienced and senior gynaecologist) this section observes, “MMR is believed to be the most sensitive indicator of women’s status in a society and the quality and accessibility of maternal health services available to women. A maternal death is not merely the result of treatment failure; rather it is the outcome of a complex interplay between a myriad social, cultural and economic factors…. [it] reflects the failure of society to look after the life and health of its mothers.”It is significant that these two writers question in couched terms the MMR of 276 per 100,000 live births cited by the survey. “It is possible that the above factors have resulted in an underestimate of maternal mortality,” they write. Many cultural factors could account for underestimating the MMR. Given the fact that an overwhelming majority of births are not attended by a skilled birth attendant, most expectant mothers do not receive antenatal care, and death resulting from abortion by unskilled practitioners is not reported correctly, it is difficult to believe that the maternal mortality ratio has registered such a steep fall from the 500 being cited a few years ago.The gender-specific preference of women for children — very few women without sons wished to limit their family size — is a major indicator of where we stand. Boys are still the first choice of an overwhelming majority of parents. This accounts for the many large families.Can society claim to care for its female members when women giving their reason for not using contraceptives say, “up to God” (28.4 per cent), “husband opposed” (9.9 per cent) and “religious prohibition” (three per cent)? The most telling statement on the status of women in Pakistan is the pattern of contraceptive use. Against 8.2 per cent female sterilisation only 0.1 per cent men opt for this method.zubeidam@gmail.com