Pakistan set its sights on having at least 30 percent of its 230 million people fully vaccinated by the end of 2021. As the year drew to a close, it seemed like it would achieve this target. Chances are, however, the majority of the Pakistanis who have had their complete COVID-19 shots so far are men.
As late as Sept. 30, 2021, only 37 percent of the Pakistanis who had been fully vaccinated were women. Only 38 percent of those who just had their first shot were women. Most of the women who are going unvaccinated are in the rural areas, where females are marginalized even more than their urban counterparts. The trend has not gone unnoticed among authorities. Recently, Provincial Minister of Khyber Pakhtunkhwa (KPK) for Finance Taimur Khan Jhagra tweeted: “It’s not just the young that (sic) need to register and vaccinate. We need to encourage and facilitate women (as well).”
“Eight percent eligible women registered vs 18 percent men,” he also noted, citing official data as of June 23, 2021. He then went on to tweet that in his province, only four out of its 35 districts had more than 35 percent of the women eligible for the vaccine registering for jabs.
Patriarchal Pakistan has long been inhospitable to women. Discriminated against since birth, rural women, in particular, are usually denied access to education and are confined to the home, where they are saddled with all kinds of tasks and responsibilities. Men control every aspect of women’s lives and decide almost everything for female family members.
In Pakistan, the healthcare needs of men come first. No wonder more men than women are vaccinated against COVID-19.
Such a situation has only kept Pakistani women away from COVID-19 vaccines. The International Medical Corps (IMC) has found women among those most hesitant to get the jabs in Pakistan. IMC explains that “due to cultural restrictions, women are less exposed to people outside their families and have few sources of information. Patriarchal values also place men’s healthcare needs first and women’s second.”
IMC recently completed a vaccine hesitancy survey of some 190,000 people in KPK’s Peshawar District. In an article posted on IMC’s website, it reports: “Our survey team found that 74 percent of women had not heard about COVID-19 vaccines. Their reasons for not getting vaccinated included not having access to the technology required to register for the vaccine, not knowing where the vaccination centers are, and not being allowed to go to the centers unaccompanied.”
“Another barrier for women, refugees, and displaced people is a lack of confidence in health systems and their ability to safely administer vaccines,” IMC adds. “This feeling is common among marginalized communities worldwide — they do not trust the health system because they don’t feel they are a part of it.”
Women health workers on call
Such distrust is partly why Pakistan set up a Lady Health Worker (LHW) program in 1995. Authorities thought that women who kept mostly to themselves and their families would be more open to dealing with female health workers from the area.
Working even during harsh weather conditions, the LHWs have since made progress in educating rural women on general health, nutrition, and hygiene. But even before COVID-19 came along, they have been having trouble with vaccines. The LHWs have faced security threats and harassment while vaccinating children against polio. One news report even says that LHWs were among the 70 polio vaccination workers who have been killed since 2012, most of them in KPK.
Fortunately, the LHWs have not encountered similar violence over their attempts to convince rural women to get COVID-19 jabs. But they have been up against similar resistance, which stems largely from misinformation — or even lack of information — about the vaccines.
“I still don’t know how to make people understand the validity of the vaccines,” says Sakina Bibi, who works as an LHW in a community in rural Punjab. “Mainly when I speak to women about vaccines, they assert corona doesn’t exist, so why should they get jabs. Most women tell me that vaccines will negatively affect their health.”
“There’s a lot of misinformation and also lack of awareness and information regarding vaccination across the country,” comments Tooba Syed, a grassroots political organizer and gender researcher. “There’s a general mistrust of public health systems across the world, and that has historical roots, of course, given how the colonialists have often used public health for sterilization of the native populations in the past.”
Thirty-five-year-old Shazia, for instance, is convinced that the “vaccine can cause infertility among young women.” That is the reason why she still refuses to sign up for a jab even after she learned how to register for a COVID-19 shot from the LHW assigned to her village in Punjab. Many others who are hesitant to have shots cite religious beliefs or conspiracy theories that include the vaccines supposedly having microchips.
The government has tried to counter rumors and disinformation about the vaccines. But observers point out that authorities have relied too heavily on digital tools such as the mobile phone and the internet to spread correct information and awareness about the disease and the vaccines, as well as for registration for the jabs. This has shut out many women, especially those in rural areas. According to the 2020 Mobile Gender Gap Report, Pakistani women are 49 percent less likely than men to use mobile phones and the internet; only 19 percent of the country’s women have access to mobile phones as opposed to 37 percent of men. The gender digital divide has also been cited by UN Women in explaining why Pakistani women are unable to access information on COVID-19.
Shots in the dark
In theory, the LHWs are well-positioned to provide women with the right information about COVID-19 and the vaccines. Apparently, though, the LHWs themselves have not been getting adequate information, especially about the shots.
Sakina, who is one of four LHWs in her assigned area, says that she knows little about the COVID-19 vaccine that she has been made to administer. “We are giving people shots because it is our job, but in actuality, nobody has given us satisfactory information about the vaccines,” she says. “So whenever we go from house to house, we have to face different questions and most of the time we are unable to give proper answers.”
The community where Sakina and her colleagues are assigned has a population of about 13,000. To get as many women among the residents vaccinated, Sakina and the other LHWs were each told to aim for administering 10 shots a day. There were days that Sakina was able to meet her daily goal, but sometimes she was able to administer only seven jabs. On really bad days, she was not able to give anyone any shot at all.
An overreliance on digital tools to spread information about COVID-19 and the vaccines has shut out many women in rural areas.
These days, she and the other LHWs have stopped trying to give shots because of a shortage of vaccines. But she says that on average, she had been able to convince one woman out of a family of six.
“I walked door to door to request people to get a vaccination, but women started arguing and denying the facts of existence of COVID,” Sakina says.
She continues, “Village women ask me, ‘When the Pakistan government and the prime minister cannot provide us good health, affordable food, and hospital facilities, then what is the purpose of us getting a vaccination? We are going to die anyway from hunger and fewer resources.’”
Tooba Syed, however, thinks the government would do well to develop the LHWs some more. “I believe the government can really work on developing a community healthcare system in which LHWs play the most important role,” she says. “They form the backbone of community health in the country. The government should announce special incentives for the LHWs to encourage them as well …. The awareness can be brought through public health sessions at the community level, with the assistance of LHWs in these areas and with the involvement of community leaders.”
“Our government has not involved communities and people in this drive, which is one of its limitations in my opinion,” says Syed. “Local leaders can influence rural populations to get vaccinated.” ●
Saba Chaudhary is an independent journalist and activist based in Pakistan. Her work focuses on human rights, gender, and socio-political issues.
