Unseen Scars

By LAIBA AMIN

When talk turns to public health in Pakistan, the focus too often stays on hospitals, doctors, and statistics. What rarely gets attention is the quiet suffering of women in rural villages where Pakistan cannot claim to be committed to development while half its population remains excluded from the basic conditions of health and dignity. Change demands sustained investment in infrastructure, education, and women’s empowerment. Most of all, it requires acknowledging that these issues are not side problems. They are central to the health and future of the nationPakistan cannot claim to be committed to development while half its population remains excluded from the basic conditions of health and dignity. Change demands sustained investment in infrastructure, education, and women’s empowerment. Most of all, it requires acknowledging that these issues are not side problems. They are central to the health and future of the nationeveryday life— menstruation, childbirth, defecating, washing— carries risk precisely because of how it is handled, or mishandled. These are not abstract academic problems. They are lived realities that shape bodies, shorten lives, dim opportunities, and whisper to girls from a young age that their health is unworthy of care. The evidence is stark, and the human cost of ignoring it is obvious.

Start with menstrual hygiene, one of the most basic yet neglected aspects of women’s health. In villages across Sindh, Punjab, Khyber Pakhtunkhwa, and Balochistan, most women do not have access to sanitary products. Many rely on old cloth, rags, or improvised materials like ash or sand. Some never use any absorbent at all. Studies suggest that up to 79 percent of menstruating girls and women in Pakistan do not hygienically manage menstruation because proper facilities, products, and disposal systems are absent.

Pakistan cannot claim to be committed to development while half its population remains excluded from the basic conditions of health and dignity. Change demands sustained investment in infrastructure, education, and women’s empowerment. Most of all, it requires acknowledging that these issues are not side problems. They are central to the health and future of the nation

This is not merely uncomfortable. Unhygienic menstrual practices increase the risk of reproductive tract infections, urinary tract infections, and pelvic inflammatory disease. One study found that over three-quarters of women presenting at clinics with symptoms had reproductive tract infections. In rural, flood-affected communities, women have been observed using tree leaves when sanitary products are unavailable, heightening exposure to bacteria.

Poor menstrual hygiene seeps into every aspect of life. Girls miss school not because they cannot learn, but because school toilets are nonexistent or shame-inducing. Women skip work because they fear being stared at or ridiculed. The mental weight of stigma and silence compounds the physical toll. This is period poverty in its rawest form. It is a health issue and a dignity issue, and it sits comfortably in public indifference.

Childbirth, too, remains mired in harmful traditions. In rural areas, most deliveries occur at home under the care of traditional birth attendants, known as dais. There is cultural value placed on these women, and family elders often resist clinical intervention as unnecessary or intrusive. The result is dangerous. Unsterilized instruments are used to cut umbilical cords. Contaminated surfaces and unwashed hands are routine. Harmful substances like cow dung or ghee are applied to umbilical stumps under the notion of healing, yet they introduce infection.

Field reports confirm that many pregnant women never receive even rudimentary antenatal care. In South Punjab, researchers found maternal death often stems from delays in seeking care, rooted in poverty, low education, and ingrained beliefs that pregnancy is a natural process requiring no medical oversight until it turns critical. Women are told that complications are normal or that doctors exist to profit from misfortune.

These practices compound Pakistan’s maternal mortality situation. The World Bank estimates maternal mortality at around 178 deaths per 100,000 live births, far higher than regional averages in South Asia. Rural women face even greater risk. Poverty, distance from healthcare facilities, and illiteracy make skilled care a luxury. When complications like hemorrhage, sepsis, or obstructed labor occur, transport delays and lack of emergency care turn preventable situations into tragedies.

Beyond childbirth and menstruation lie the everyday realities of sanitation. Many villages lack piped water. Women spend hours each day fetching water from distant hand pumps, wells, or contaminated surface sources. Sanitation infrastructure is poor; open defecation remains common, and the few latrines that exist are inadequate in privacy and hygiene. For women, this means holding urine until nightfall to avoid public exposure, which leads to urinary retention, infections, and chronic health issues.

Water, sanitation, and hygiene are not side issues. They are drivers of disease. Rural women suffer diarrheal diseases, hepatitis, typhoid, parasitic infections, and skin infections largely due to contaminated water and poor sanitation. Pregnant women and young children are most vulnerable, but the toll is felt across generations. Illness reduces productivity, distracts from education and income generation, and prolongs poverty.

It is tempting to attribute these conditions solely to poverty or infrastructure deficits. But culture and gender norms are equally culpable. Deeply entrenched taboos around menstruation and women’s bodies discourage open discussion or education. School curricula do not typically include menstrual health education. Many women learn about their own bodies from friends, peers, or older relatives who perpetuate misinformation. Illiteracy exacerbates the problem: educated women are far more likely to practice safe menstrual hygiene than those without schooling.

In matters of maternal health, male domination and decision-making mean women often seek care only when it is too late. Interviews with healthcare workers in rural districts paint a sobering picture: women do not visit clinics for prenatal checkups because families believe pregnancy complications are normal or because cultural beliefs restrict outside interaction. In some cases, relatives actively discourage medical care until a crisis necessitates it.

Solutions exist beyond mere infrastructure provision. They require a shift in mindset and in power dynamics. Community-led education that respects cultural contexts but does not shy away from health facts is one step. Projects that train local women as health educators and produce reusable sanitary pads have shown promise in Thatta and similar districts. Such efforts normalise conversation about menstrual hygiene and build local capacity rather than impose external solutions.

Government action must prioritize water and sanitation infrastructure alongside women’s health services. Clinics need skilled birth attendants and emergency obstetric care within reachable distance. Health education must be woven into schools and community programs. And critically, women need the autonomy to make decisions about their own health without requiring male permission or suffering social stigma. None of this will happen overnight, but evidence from local initiatives shows what is possible when communities are part of the solution rather than subjects of it.

The impact of unhygienic practices and rituals is not confined to statistics. It is felt in every avoidable infection, every preventable maternal death, and every girl who stops going to school because she bleeds every month without dignity or support. This is a failure of policy, of cultural inertia, and of collective will.

Pakistan cannot claim to be committed to development while half its population remains excluded from the basic conditions of health and dignity. Change demands sustained investment in infrastructure, education, and women’s empowerment. Most of all, it requires acknowledging that these issues are not side problems. They are central to the health and future of the nation.