An older sibling is visiting Pakistan these days. She came to participate in the Lahore Literary Festival. After the festival was done, she stayed on for a few weeks during which time she had a chance to meet old friends and look up some private educational setups. As an educationist, she is interested in the state of education in Pakistan and especially that for girls. After a recent interaction, she had an interesting discussion with me about ‘job opportunities’ available for girls after they receive an education.

An interesting part of any discussion about education of girls in our part of the world is that most middle and upper class families decided pretty early in the last century that girls should receive some sort of an education, even up to a professional level. But even a century later, most conservative Muslim families, at least in Pakistan, have difficulty in imagining let alone encouraging their daughters to go out and join the workforce. And even many well educated and supposedly ‘modern’ young men find it difficult to accept that their wives should go out and work full time.

Clearly, overall unemployment rate is pretty high in Pakistan but greater opportunities are becoming available in the traditional areas of female employment, including the service sector. Generally speaking, no country can really advance without the participation of half of its population in the workforce. However, I will leave the economic discussion to people more informed than I am but in my area of interest, educated women, jobless or not, play an extremely important part. Frankly, the overall state of health in Pakistan cannot be improved without providing education to all girls.

By education I do not mean the present definition of ‘literacy’ but rather an appropriate education and qualification at least up to and possibly beyond high school/matriculation. The conundrum of medical education exists where roughly two thirds of medical graduates are women and yet half of these women will never go onto practice medicine even though their services are badly needed. Objectively speaking, that is a tremendous waste of resources but even so such education is not wasted entirely.

So let me count the ways an educated woman impacts the health of her family. My discussion of course presumes that women will remain the primary care givers at home for the foreseeable future. The first and the most important fact is that married women that are educated tend to have fewer children. For a country like Pakistan the need to control a rapidly increasing population is absolutely vital. This cannot be achieved without educating women.

The second advantage of education to the level I have mentioned above is that the girls/women will generally be older and more physically mature when they get married. This is much more important than it seems. Young girls tend to have greater difficulty during pregnancy and in delivery of a child compared to physically mature women. This means a higher incidence of both maternal and child mortality as well as complications of child birth in these young woman. Pakistan has one of the highest incidences of child and maternal mortality among developing countries.

The third advantage is that educated women are more involved in their own health when pregnant. They seek medical advice, follow dietary guidelines and are checked up as needed for problems that can complicate pregnancy. Appropriate prenatal care as well as medically supervised delivery of a child is much safer and free from complications. This does not necessarily mean delivery in a hospital but having lady health visitors and trained midwifes available for prenatal monitoring and during delivery are often quite adequate.

The fourth advantage is in an area that has become a matter of serious concern more recently. That is the problem of ‘stunted’ children that are smaller and less developed for their age. Yes, poverty and general inadequacy of caloric intake is often at fault but in general the child of a healthy mother should not be stunted. If a healthy mother adequately breastfeeds a child for long enough the chances are that the child will grow normally for the first few years. This again requires some level of education. In some medical studies, it was found that mothers that did not know how to breastfeed properly and for how long were often responsible in part for the stunting of their children.

Another area of great concern is that Pakistan has a very high incidence of children that die before the age of five. Most of these deaths are due to water borne infections and communicable diseases. The first are often preventable through proper hygiene. Cleanliness, including hand washing after visiting the bathroom, straining and boiling drinking water and properly washing all raw edibles like fruits and vegetables, is also very important.

Many communicable diseases can be prevented by appropriate inoculation. Here again education is important to make sure that mothers actually go through these steps. And yes, the woman of the household can also make sure that the older people in the family also avoid these problems.

Then there is the general advantage of having educated women in the household. Better diets, clean living environment and proper medical attention can benefit all members of the family.

Coming to all those female doctors that do not practice medicine, they can be the source of education not only for members of their extended families but also for women in their neighbourhood. And as I often told my MBBS class during my lectures in cardiac medicine that if nothing else a physician can at least figure out if her parent, sibling, spouse or an adult child is having a major problem like a heart attack and more importantly what needs to be done about it emergently.

It is quite possible that I am overlooking a few other medical advantages of having an educated woman run a household. However, there is one other important factor that perhaps goes more for mental rather than physical health. Educated women take better care of their own physical appearances and at the same time encourage their spouses to look after themselves. Such better care includes proper diets, dental hygiene, good skin care and comfortable but attractive clothing. Clearly a nice looking wife and a well groomed husband will be capable of a better mutual relationship and as such provide a ‘healthier’ environment for their children to grow up in. And very importantly, educated women make sure that their children get a good education also.

It is, however, important that the educational system at least up to the high school level provide education about the health issues I have mentioned above. In my opinion, not only should girls be provided this sort of information but so should the boys. After all if a woman is not as well educated as her husband, at least her husband can tell her what needs to be done. And then there is always a possibility that in the not too distant future even in Pakistan some men might become primary caregivers for their children.