Country of ‘first boys’: health inequalities Part – II

In my previous article, ‘Country of ‘first boys’: education disparities’ (June 8), I explained how the existing inequalities in education are leaving millions of girls and boys behind, and how successive governments and market forces have enabled only ‘first boys’ to realize their dreams, failing to tap on the potential of millions of ‘last girls and boys’.

Statistics shared in the article revealed that it is still a distant dream to fill the gap in the girls net enrolment rate at the primary level so that ‘last girls’ could catch up. Income, gender, and geography are key determinants of literacy in Pakistan. The question that must be asked is: for how long will this unequal and unjust educational system continue to deny millions of ‘last girls and ‘boys’ who could be the best engineers, computer scientists, economists, politicians and what not of quality education? We have left them to live a life that only involves tending to animals, fetching water, and doing household chores.

The story does not end here. Nutrition and primary healthcare are two other areas where massive inequalities exist and vividly explain the difference between ‘first boys’ and ‘last girls’. These three elements education, nutrition and primary health care including both preventive and curative are determining factors for a person’s wellbeing, productivity, social peace and development.

Immunization is the best proxy indicator for child health. According to the Pakistan Social and Living Standards Measurement 2018-19 – the latest available data – 68 per cent of children aged 12-23 months are fully immunized. There is disparity among urban and rural areas and men and women. Seventy-six per cent urban men are immunized in comparison to 63 per cent rural women. This means that during the period, one-third of girls in rural areas were not immunized to protect them from lifelong impairments.

Similarly, there is a wide gap among provinces. In Punjab, urban boys and rural girls’ immunization is 85 per cent and 78 per cent, showing a seven percentage point difference. This gap is massive in Sindh, where urban boys and rural girls’ immunization is 67 per cent and 35 per cent, showing 32 percentage points difference.

The number of girls in rural Sindh getting immunized is way below than those in rural Punjab. This difference between urban boys and rural girls’ immunization is less in KP, where 79 per cent urban boys and 61 per cent rural girls are immunized. Balochistan even lags behind Sindh where 50 per cent urban boys and only 26 per cent rural girls are immunized. This information reveals that three-fourths of girls in Balochistan and two-thirds of girls in Sindh are not immunized and face the risk of long-term health complications.

The situation is worse if seen through different income groups based on per-capita household consumption. Eighty-six per cent urban boys from the top income group is immunized while only 52 per cent of girls from low-income groups in rural areas are immunized. There are wide inter- and intra-provincial gaps in immunization among different income groups; and if geography and gender layers are added, it becomes even worse.

For example, the immunization rate in urban boys from the top income group and low-income groups in Punjab is 88 per cent and 87 per cent, and in rural areas, it is 88 per cent and 76 per cent, revealing the urban-rural divide. The immunization rate for urban girls from the top income group and low-income groups is 90 per cent and 61 per cent, while it is 89 per cent and 67 per cent for girls in rural areas, showing a major gap among girls in urban and rural areas in Punjab.

This means that 39 per cent of urban girls and 33 per cent rural girls in Punjab from low-income groups are not immunized as compared to 13 per cent and 24 per cent unvaccinated boys from low-income groups in both urban and rural areas.

In Sindh, which lags behind Punjab and ranks low in the overall immunization rate of Pakistan, the immunization rate in urban boys from top and low-income groups is 81 per cent and 58 per cent, while it is 27 per cent and 38 per cent among rural boys, revealing a difference in both urban and rural areas and between top and low-income groups.

The immunization rate for urban girls from top and low-income groups in Sindh is 73 per cent and 20 per cent, while it is 68 per cent and 36 per cent for rural girls.

This means that 80 per cent urban girls and 64 per cent rural girls from low-income groups in Sindh are not immunized, as compared to 42 per cent and 62 per cent unvaccinated boys from low-income groups in the province’s urban and rural areas. Interestingly, in Sindh, there is a little difference in immunization between rural boys and girls from low-income groups.

In Balochistan, the immunization rate for urban boys and girls and rural girls from top income groups is 81 per cent, 85 per cent and 73 per cent respectively, which is near the national average, while only rural boys from top income groups have a low immunization rate of 39 per cent. However, in low-income groups, only 28 per cent urban boys and 16 per cent rural boys are immunized. Only 30 per cent girls from urban areas and 25 per cent from rural areas are immunized. This reveals a massive divide among different income groups as well as urban-rural differences.

In KP, the immunization rates for urban boys and girls and rural boys and girls from top income groups is 96 per cent, 100 per cent, 71 per cent and 64 per cent respectively, which is near the national average. However, in low-income groups, 65 per cent urban boys and 54 per cent rural boys are immunized and 53 per cent urban girls and 52 per cent rural girls are immunized.

Sindh and Balochistan are worst-performing with regard to child immunization. Overall, 79 per cent and 73 per cent of boys and girls from top-income groups are immunized, while 42 per cent and 33 per cent of boys and girls from low-income group are immunized in Sindh.

Sindh’s immunization of its children from lower income groups is almost half of Punjab’s rate for the similar income group. The immunization rate for both boys and girls in top income groups in Balochistan is near to that of all other provinces excluding Sindh, while the immunization rate for low-income groups is 18 per cent and 25 per cent for boys and girls respectively.

These unfortunate last children, especially ‘last girls’ who might face lifelong health challenges due to not having access to basic immunization, will further widen the gender gap in all aspects of economic and social life.

Geography, gender and income are key determinants of chances of healthy lives people may have in the future. Provincial disparities also reveal that where effective governance and progressive policies are making differences, they will have all the reasons to dominate public life in the future and those remaining will always be laggards.

To be continued

The writer is an Islamabad-based environmental and human rights activist.