Access to health facilitation was one of the development indications set forth in the Millennium Development Goals that we had to achieve by 2015. Three of the eight goals were focused upon the provision of health facilities to the world’s poor and the eradication of fatal diseases. Women, being one of the marginalised segments, were targeted in goal five for reducing maternal mortality ratio and improving the reproductive health of women. Like most of the developing countries Pakistan, lagged miles behind the set targets. Some issues existing from day one, were neither targeted in MDGs nor in post 2015 agenda. Those are so hidden that cannot be noticed without personal experience or detailed discussion with those who have passed through the process. Those issues are related to affordable health facilities for women, sympathy and humanity. No doubt maternal mortality is a big issue and can be reduced if child birth is attended to by trained birth attendants. The ground reality tells some different story that only training on the mechanism of child birth is not enough. Such trainings need to be associated with the concepts of sympathy and humanity. Otherwise, in a society like Pakistan where material is precious than man, conventionally trained birth attendants can devise new and unanticipated problems.

Continuous reports of multilateral donors on gaps in health services could not attract the reasonable attention of governments. On the other hand, those reports could motivate the private sector to come forward and fill the gap. Private clinics, gynaecology hospitals and maternity home centres started spreading in most districts of the Punjab province. Trained birth attendants or gynaecologists provide services at these units at unaffordable prices. The primary objective of these clinics is to exploit money out of the sufferings of women patients during pregnancy and during child birth. Once a pregnant woman approaches these clinics, she is advised to visit regularly and use specific drugs and food supplements for proper development of foetus. After being in continuous contact with these birth attendants, patients are completely dependent on their advice for delivery of child because they better understand history of the patient. Of course child birth is a painful process for mothers. When birth-pain starts it is inevitable to ensure child birth within a certain period of time, otherwise the foetus can be killed due to suffocation, inhaling particles of placenta, release of excreta of its own or dozens of other unknown reasons. Limbs of the newborn, especially head can also be affected to the abnormal. Many such complications can be cured later but that cause huge cost and a heap of worries for parents. The main cause becomes extraordinary delay in birth. No need to say that delay in delivery process causes excessive amount of pains and extra sufferings for mothers. This is commonplace at private service providing units. Only a fraction of mothers can escape this menace only due to their good luck. One secret revealed by a maternity worker on the condition of anonymity was alarming for me. When questioned why so many Caesarean Sections are done by private service providers, she told that main cause are the gynaecologists or birth attendants at private hospitals or clinics. Their ultimate desire is to not manage normal delivery of child. By different means they bring the patient up to the situation where surgery becomes inevitable. Many of the private service providers, right before delivery, reportedly manage to rupture the Amniotic Membrane with their own nail while posing a manual check-up. Amniotic Membrane is a sac around the foetus that contains amniotic fluid which is essential for keeping foetus healthy and developing. When amniotic membrane gets ruptured, amniotic fluid discharges leaving the foetus in extremely unprotected situation. That point creates urgency for Caesarean. If surgery is not carried out within minutes, the lives of mother and foetus can be in danger.

Before tremendous development in health sector women of poor communities had to face much pains without any cost, inside bounds of their homes. Now they have to buy pains and suffering at high price from these health units. Another major spending is added in subsistence lives of those families. Many of them borrow money for paying maternity hospitals fee. In health surveys it is displayed that percentage of users of health services is increased from this to that period. Access to health facility is improved. But the fact that is ignored is that money spent on maternal health facilities by the poor mothers is borrowed or diverted from other spending that will ultimately affect other important needs i.e the education of child, nutritional requirements of the mother and the newborn.

Abysmal levels of spending of government on health has brought the health sector at a miserable level. Health Facility Assessment Surveys conducted under supervision of provincial government mention numerous facilities for mothers and the newborns provided at Basic Health Units (BHU), Rural Health Centers (RHC) as well as Tehsil Headquarter Hospitals (THQH) and District Headquarter Hospitals (DHQH). The reality is contrary to the survey reports. All BHUs are devoid of various test services required during pregnancy and essential drugs required for normal delivery. At THQH and DHQH, C-section and incubator facilities are commonly absent. Wherever these are available, they are hardly used for patients. Why is this the case? Since every gynaecologist has his/her own private clinic or hospital where she/he works with maximum passion, they don’t care for the clinics at public hospitals. Criminally, they ignore patients in government hospitals so that they can book them for their private service units. The absence of gynaecologist at the time of need is omnipresent situation in THQHs and DHQHs. At the time of delivery, anytime some complication can happen that can require extra facilities i.e oxygen supplies, incubator and intensive care which government hospitals are unable to ensure. The dominant majority of THQH and DHQH are unable to maintain hygienic conditions up to the standards. This amalgamation of poor management of government hospitals and quest of doctors for business hunting for their private clinics create a horrible image of tehsil and district hospitals. In this situation, it is risky to go to THQH or DHQH for delivery purpose. Even subsistence families never want to put their patients at risk of death. Resultantly, business of private service providers is flourishing day and night. Seeing through the bright prospects, many Lady Health Visitors have started their own private hospitals. Although their hospitals do not have qualified doctors yet they display names of some doctors on banners to satisfy patients. Still, their business is flourishing; those are still better than government hospitals. This is a clear indication of the quality of health facility and access to same for women. Punjab hosts more than half population of the country and is relatively the most developed province in Pakistan. Women’s health rights in other provinces can be judged in comparison to the situation in Punjab. National and provincial governments have failed in ensuring this basic right for women. On the other hand they are not at all monitoring private health service providers in order to check their exploitation of women’s health rights.

Sustainable Development Goal 3 in post 2015 agenda sets target to reduce maternal mortality ratio to less than 70 per 100000 live births but, what about sufferings before death or sufferings that do not end in death? The Punjab Government started Women Empowerment Initiative in 2014 and Punjab Women Empowerment Package in 2012. Unfortunately women’s health rights are never addressed in both of the regulations made by the provincial government. Main focus of the 2012 and 2014 initiatives was on ensuring rights of women that are snatched on the basis of gender. So appreciable, but general human rights of women must not be ignored. A large number of civil society organisations in the country are working to protect women’s rights. Most of them put a major part of their efforts on ensuring rights of women that are held with men. At private gynaecological service units, women’s health rights are violated by women as well as men. Can we say poor women’s health rights are violated by rich women? Do not mean to raise rich-poor conflict but in reality gynaecologists earn too much contributing zero to national exchequer. In this situation integrated work of civil society is needed more than ever. Service delivery organisations and right based organisations should be in close contact for integrated efforts. Basic human needs ought to be mentioned in the list of basic human rights and should be addressed with priority as survival (right to live) is associated with basic needs.

Institutional exploitation of basic rights needs to be on priority agenda of development organisations.