Reproductive Health

AN OVERVIEW OF REPRODUCTIVE HEALTH STATUS IN BALOCHI

Deprivation, vulnerability and insecurity define poverty in Pakistan and it is estimated that at present 16 million Pakistanis are living in absolute poverty. The cycle of poverty is exacerbated by ill health. This is perpetuated by a lack of awareness of the importance of rights associated with health, in particular to Women and adolescents.

The low levels of knowledge about health issues and availability of health services are illustrated in the high maternal mortality rates (MMR), 350-400 deaths per 100,000 live births nationally while in Balochistan it is 530-800 and Infant Mortality Rated (IMR) 90 deaths per 1000 live births nationally while the figure is abysmally 105 in Balochistan. Studies conducted confirm serious disparities in demand and supply of the RH services specifically in the areas of Emergency Obstetric Care (EmOC), Family Planning (FP), HIV/AIDS, Sexually Transmitted Infections (STls), and Sexual and Gender-based Violence (GBV).

In Balochistan, generally the health services have been provided through static health facilities like BHUs, RHCs and DHQs offering basic primary health care (PHC) services and to some extent basic and comprehensive EmOC services. Reproductive Health (RH) is recognized as a basic human right that applies to all, men, women, youth and adolescents. However, there is still an enormous gap in the provision of broadened Reproductive Health Care (RHC) in the areas of Emergency Obstetric Care (EmOC), family planning (FP), HIV/AIDS and Sexually Transmitted Infections (STls), and Gender-based Violence (GBV). The shift of focus from primary health care to RH, the lack of financial, technical and community resources undoubtedly are impacting the communities living in Balochistan with low literacy levels, rigid tribal setups, and poor road infrastructure. Furthermore, key RH indicators for Balochistan are poorer in comparison to national estimates, reflecting low levels of awareness, gender disparities, poor capacity of service delivery system and also an unmet need for RH services amongst local populations.

Existing problems

BRSP aims to address the identified gaps in both the supply and demand for Reproductive Health services, such as: inadequately equipped and functioning facilities; weak referral systems; poor access to Emergency Obstetric Care (EmOC) services; poor Health Service Providers knowledge of modern contraceptive methods, safe sex promotion, Sexually Transmitted Infections (STIs) and HIV/AIDS transmission; limited access to safe blood transfusions; absence of addressing Gender-based Violence; lack of male involvement in RH issues; limited decision-making power of women; lack of adolescent RH services; lack of infection prevention protocols; and low community awareness of RH services.

Objectives of Reproductive Health program

1. Mobilize communities for improved awareness of RH issues and rights, and enhanced demand for access to RH services;
2. Improve access to standardized reproductive and sexual health services for women, men and adolescents;
3. Strengthen governance and management of health sector for effective RH care through Skill Development;
4. Ensure political commitment for advancing RH status of the communities in the province;

Program implementation strategy

Community Mobilization

• Holding sensitization meetings with already existing COs (Community Organizations) and VOs (village organizations) of BRSP;
• Establishing/strengthening male and female Village Health Committees (VHCs) at the community level through COs and VOs;
• Establishing a referral system from the community level to the relevant health facility;
• Sensitizing and educating communities including men, women, youth, adolescents and community gate keepers (decision makers) for improved awareness through community meetings, group counseling, peer education, life skills based education, IEC, Theatre, Popular music and other appropriate means of communication about a broad range of RH issues and rights, health care seeking behaviors, service provision etc.

Service Provision

• Upgrading and equipping facilities with essential supplies including RH commodities, condoms, contraceptives, delivery kits, resuscitation equipment)
• Establishing and strengthening a functional referral system and village based ambulance services for basic and comprehensive EmOC;
• Recruiting Women Medical officers/LHVs to strengthen the facilities as per requirements
• Strengthening the screening and supply of safe blood through DHQs
• Establishing and strengthening community-based RH care services provided by LHWs, CHEs, TBAs and other Birth Attendants (BA); including provision of safe delivery kits, STI management kits, Contraceptives

Trainings and capacity building activities

• Establishing and building the capacity of Community Health Educators (CHEs) on counselling and communication about RH (including puberty, conception, STIs, FP, GBV etc)
• Skill building of traditional birth attendants.
• Skill Building of public and private medical doctors and LHVs on Safe Motherhood (including EmOC, tetanus toxoid (TT) vaccination, STI management, Modern Methods of FP, Counselling and Communication on RH issues, Youth Friendly Health Services etc.

Advocacy

• Establish district advisory groups comprising politicians, tribal elders, government officials and religious leaders.
• Organizing advocacy workshops and seminars at union council, district and provincial level
• Commemorating international days i.e. Health Day, Youth Day, Women’s Day,
• Establishing active linkages with provincial and district governments to advocate RH issues
• Producing Radio and TV documentaries

BRSP’s current interventions in Reproductive Health

1. European Commission funded project “Improved Reproductive Health Status of Women, Men, Youth and Adolescents in Pakistan”

The project “Improved Reproductive Health Status of Women, Men, Youth and Adolescents in Pakistan” has been designed by BRSP for district Mastung and Pishin. It is a 42 month venture starting from January 2009 that focuses to improve the Reproductive Health and overall well being of women, men, youth, and adolescents in Balochistan province.

BRSP envisages increasing access to, enhancing demand for and improving management of Reproductive Health particularly maternal and child health services in public and private sectors RH service facilities. The project aims to enhance community awareness of RH issues, including the right to RH services, and empower vulnerable people to exercise their right and responsibility to access quality RH services. It also strengthens the service delivery by enhancing the capacities of service providers and service delivery points. Furthermore, BRSP also advocates key policy makers and opinion leaders to ensure political commitment for developing an enabling environment for RH interventions.

2. Family Advancement for Life & Health (FALAH)

The project Family Advancement for Life & Health (FALAH) is implemented in 20 districts of Pakistan by a consortium led by Population Council and the other partners include Greenstar Social Marketing, HANDS-Health & Nutrition Development Society, JHPIEGO, Mercy Corps, RSPN-Rural Support Programme Network, Save the Children-USA and Balochistan Rural Support Programme (BRSP). BRSP is implementing the social mobilization component in two districts of Khuzdar and Jafarabad. The project primarily focuses on Repositioning of Family Planning/Birth Spacing as a health intervention, addressing unmet needs by increasing contraceptive choices and access to quality family planning services in public and private sectors and enhancing contraceptive security in 20 districts of Pakistan.