Council Commentary

PAKISTAN: Perspectives on Inequalities Magnified by COVID-19

This past year, the coronavirus pandemic has impacted every country, every community, and every person in this world – but not equally nor in the same ways. For communities who experience vulnerability and marginalization, because of structural barriers such as economic inequality, racism, harmful gender norms, and numerous other intertwining factors, these challenges have been exacerbated and inequalities even further exposed by the pandemic. 

As our epidemiologists, laboratory scientists, public health specialists and researchers have worked to produce relevant and timely evidence to support national health ministries and other government agencies around the world in their COVID-19 response strategies, they have seen first-hand the effects and impacts of COVID-19 on populations and communities experiencing the most marginalization and poverty. Many of our colleagues, especially those conducting research in the communities in which they live and work, see their work as key to addressing many of the historical inequities that are familiar to them. As part of a series we are sharing throughout this week, we asked a few of them to reflect on their work and how they hope, through research and evidence generation, that they will help address the various inequities that are being magnified by the pandemic.

Learn more about work from our colleagues in Pakistan: 

Samia Shah, Project Director; and Iram Kamran, Deputy Programs Director 

Pakistan is currently in the midst of its third wave of the COVID-19 pandemic. In Pakistan, and around the world, the pandemic has disproportionally affected women and children, especially poor rural women. Recognizing our responsibility to provide evidence to policy makers and other relevant stakeholders, the Pakistan office focused on conducting research around the impact of the pandemic on the lives of poor women; capturing disruptions in health system, particularly in sexual and reproductive health services; and the effects of school closures on adolescents. 

One of the research studies we conducted was with women beneficiaries of the Benazir Income Support Programme (BISP), Pakistan’s largest social protection program, and with healthcare providers during the peak of the COVID-19 pandemic. We found that COVID-19 and related lockdowns drastically changed the lives of poor women. Women felt distressed by the decline in food availability and resultant hunger within their families due to loss of work and income. A majority reported experiencing psychological violence and mental health issues such as depression. Women also faced challenges in obtaining antenatal care and delivery services due to the COVID-19 lockdowns. Service providers were under considerable stress due to their fear of catching the virus and transferring it to their families; limited availability of COVID-19 protection kits; and frequent disruption of contraceptives and medicines supply. The study’s findings provide urgently needed evidence for formulating policies and programs for safeguarding the reproductive rights of poor women and ensuring service delivery by supporting service providers during the COVID-19 pandemic. It also casts light on other actions that can support some of Pakistan’s poorest families through the government’s social protection program and other social safety nets.  

Other studies aimed to assist policymakers and other stakeholders in identifying gaps in public healthcare delivery and strengthening health systems to better meet the sexual and reproductive health and preventive healthcare needs of the public, especially those who are more vulnerable in times of crisis.  Investigating the status of sexual and reproductive health service provision at public healthcare facilities in the Islamabad Capital Territory (ICT) and the effect of COVID -19 on service provision, we found that some pandemic-related disruptions in health services seemed to be diminishing, but critical family planning services remained disrupted. Overall, the health system was ill-prepared to deal with the pandemic, and very few service providers were provided training on sexual and reproductive health-related topics across the public healthcare facilities.  

Like many of our colleagues, including those from Kenya and Bangladesh, we worked to understand the impact of COVID-19 related school closures on millions of students in Pakistan and investigated the gendered effects of school closures on the education, health, nutrition, and wellbeing of school-aged children and adolescents. Our evidence highlights that the key challenges facing adolescents and children include access to remote learning and difficulty in adjusting to online platforms as a means of continuing education, which disproportionately affected girls, particularly those from lower income and rural areas without digital access. The evidence also reported instances of students dropping out due to financial pressures and found that these disruptions were a significant source of mental stress for adolescents, with girls suffering more.  

We hope the results from this study, as well as related findings from our Council peers in countries around the world, can be used by UN agencies and global leaders, as well as national and local governments, advocates, and local implementing partners, to inform response plans, policies, and programs as we continue to address the adverse effects of the COVID-19 pandemic. 

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Read additional perspectives on this topic from Council colleagues in Bangladesh and Mexico, published in the last two days, and stay tuned for contributions from colleagues in Kenya (tomorrow) and India (Friday.) 

Learn more about the research collected worldwide by the Population Council to address the populations at the greatest disadvantage and inform responses to the COVID-19 pandemic on the new Humanitarian Task Force site.