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The unsung heroines

January 02, 2013

THEY are the easiest of targets, little groups of women, clutching medical boxes and knocking on doors. From modest entryways to hovels to elaborate doors of mansions, from huts in lush villages to crumbling dwellings on craggy hills, all have borne the knocks of Pakistan’s Lady Health Workers (LHW).

As this past December revealed, killing them takes almost nothing — a few bullets on defenceless unarmed bodies, is all it takes to kill the women that take healthcare to the most distant doorways of Pakistan.

It is no surprise that since the attacks, the LHWs tasked for years with the job of eradicating polio across Pakistan, have balked at continuing their work. At a protest held in Rawalpindi after the attacks, more than 250 LHWs in the city refused to continue with the task of immunisations.

They disassociated themselves from the three-day campaign for Short Interval Additional Dose which was to begin on Dec 27, explaining that the lack of security made it impossible for them to do their jobs. Their position was reiterated by the Lady Health Worker Welfare Association chairperson Bushra Arain who said that LHWs in Rawalpindi, Faisalabad and Lahore would not take part in the programme as even with police protection there was little guarantee that they would be safe. Since then, similar announcements have been made by LHWs in other parts of the country, all of them fearing another spate of killings.

In the wake of the killings, there has been much discussion regarding the poli-ticisation of polio in the country. The Tehrik-i-Taliban Pakistan has waged a spiteful and sophisticated campaign to connect the issue of vaccinations to that of drone attacks and foreign intervention.

Under that warped logic, inoculating children against a debilitating disease equals supporting foreign intervention in the country or being insufficiently sympathetic or outraged by the child victims of drone attacks in North and South Waziristan.

In the simplistic equations that extremist groups have become so adept at propagating, if you don’t want the CIA in Pakistan, you also don’t want Pakistani children vaccinated against polio.

That is just one discordant angle of the polio debate and its distortions of what is authentically Pakistani (hence permissible) and the vast, often arbitrary and rapidly increasing swathes of what is foreign and hence impermissible.

As women’s issues generally fare, the understanding and estimation of what the LHW programme has actually accomplished in its years of existence are the details easily ignored or left out.

Since its initiation in 1994, the LHW programme has trained nearly 100,000 women to provide community health services in the rural areas of Pakistan. In doing so, it has become the mainstay of providing primary healthcare to millions of Pakistani children who live hundreds of miles away from healthcare facilities.

Furthermore, because the workers hired under the LHW programme are women, they have been able to transcend the gender divisions that have in previous decades prevented women and children confined to their homes from accessing medical care.

In this sense, these health workers provide not only inoculations against polio but are also the initial point of contact for millions of women and children on issues such as contraception, complications related to child birth and common childhood illnesses.

It is the LHW that provides basic health education to millions of pregnant women in Pakistan, who will likely never see a doctor and who nevertheless need to be screened for complications that may result in still births or death of the mother during childbirth.

For millions of Pakistani women and children, therefore, the LHW programme is the only form of primary healthcare they will ever receive. This has remained so even as government expenditures on health in Pakistan have not increased from the paltry allotment that they have received over the past several years.

The worth of the programme must be measured also by the number of women it has lifted out of poverty. As reported in the media as well as in recent research reports, the LHW programme forms one of the few non-agricultural options for employment for women in rural Pakistan.

While the programme initially faced difficulties in recruiting women, in the years since its operation it has become increasingly popular, attracting droves of applicants who wish to contribute to the family income and help their communities.

In urban and semi-urban areas, educated girls emerging from colleges have found the LHW programme a welcome arena to obtain stable employment that increases their earning power and gives them greater autonomy in decision-making even within their families.

The attack on LHWs as part of the extremist onslaught on polio vaccinations in Pakistan is in sum an attack on the primary healthcare system of the country and the women who make it possible.

Unlike so many laws and initiatives to empower women that have been championed over the years, the programme is one that has actually worked despite the meagre budgetary investment it has received.

An attack on the LHW, therefore, is not simply a point of opposition against polio vaccinations or a campaign against the presence of foreign aid agencies in Pakistan.

It is, instead, the annihilation of a foot-soldier of progress in a country where improvements are elusive. The failure to provide security, to protest and to recognise the contributions of these brave women, is to accept that millions of Pakistani women and children are undeserving of either health or empowerment and destined for destitution and death as prescribed by the politics of the day.

The writer is an attorney teaching constitutional law and political philosophy.