By Anne Tinker

Women's disproportionate poverty, low social prestige, and reproductive function disclose them to excessive well-being dangers, leading to unnecessary agony and lots of preventable ailments. This document describes the illnesses of Pakistani ladies, whose healthiness and common welfare are one of the lowest on this planet, and identifies steps to deal with those difficulties.

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1 The two ministries that administer reproductive health services in Pakistanthe Ministry of Health and the Ministry of Population Welfarehave no reproductive health strategy or coordinated approach. Furthermore, bureaucratic problems generated by having two separate delivery mechanisms interfere with the effective planning and delivery of reproductive health services. An additional constraint is the extreme centralization of health management at the provincial level, and, for the Population Welfare Program, at the federal level.

The mortality of females is 66 percent higher for girls than for boys between the ages of 1 and 4, suggesting significantly less favorable treatment of girls than of boys (PDHS 1993). According to the Federal Table 1 Population Sex Ratio, 1951-92 (males per 100 females)Survey/censusAll areasUrban areasRural areasPDHS 1990/91108106110PDS 1984-90 (average)106108105PDS 1976109111108Census 1981110115109Census 1972114119113Census 1961116125113Census 1951117128114Source: Fikree and others 1996; PDHS 1992.

Cover: Logo image provided by Mother Care, a project of John Snow Inc. Library of Congress Cataloging-in-Publication Data Tinker, Anne G.  Tinker. p. cm. ).  Title. 04244'095491dc21 98-18444 CIP Page iii Contents Foreword v Acknowledgments vi Summary 1 1 Introduction 5 2 Extent and Dimensions of the Problem 6 Female Morbidity and Mortality 6 Fertility 11 Notes 13 3 Reproductive Health Services 14 Organization of Reproductive Health Services 14 Coverage and Utilization of Reproductive Health and Other Health Services 15 Notes 21 4 Building on Experience 22 Learning from Other Countries 22 Priorities 24 Notes 29 5 Conclusion 30 References 31 Figures 1 Total Fertility Rate, Selected Asian Countries 11 2 Unmet Need for Contraception, Selected Asian Countries 12 3 Proportion of Married Women Using Contraception, Selected Asian Countries 16 4 Distribution of Contraceptive Users by Method, 1996-97 17 5 Proportion of Births Attended by Health Provider Trained in Midwifery, Selected Asian Countries 17 6 Infant Mortality Rate, Selected Asian Countries 22 7 GNP per Capita, Selected Asian Countries 22 8 Literacy Rates, Selected Asian Countries 23 9 Population Doubling Time at Current Growth Rate, Selected Asian Countries 23 10 Proportion of Population under 15 Years of Age, Selected Asian Countries 23 11 Total Burden of Disease, Pakistan 24 Page iv Tables 1 Population Sex Ratio, 1951-92 6 2 Gender- and Age-Specific Mortality Rates 6 3 Frequency Distribution of Causes of Maternal Deaths, by Study Area, 1989-92 7 4 Prevalence of Anemia, by Province 9 5 Problems That Prompted Females to Seek Medical Care in the Past 14 Days, by Province and Adjusted Rates 10 6 Average Expenditure on Treatment of Illness, by Province 16 7 Contraceptive Prevalence Rate 16 8 Reasons for Delivery at Home, Sindh Province 19 9 Reproductive Health-Related Conditions in Pakistan, Males and Females 26 Page v Foreword Women's disproportionate poverty, low social status, and reproductive role expose them to high health risks, resulting in needless suffering and many preventable deaths.

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