Journalist and commentator Aina Khan recently traveled with Global One as part of the UK diaspora to help raise awareness of polio eradication efforts. This World Immunization Week, she reflects upon her recent trip and highlights the lives of the unsung heroes who are integral to the eradication of this deadly disease!
In January earlier this year, I accompanied Global One, an NGO led by Muslim women, on a delegation to Pakistan to see the work being done to eradicate polio and assess how Pakistani diaspora in the UK like myself could engage with efforts there. During this World Immunization Week (24-30 April 2017), memories of this experience raised vividly into my mind.
One of three countries where polio is still an epidemic
Despite the fact millions of British babies receive polio vaccinations every year at birth, Pakistan, along with Afghanistan and Nigeria, is one of three countries in the world where it is still an epidemic. Overshadowed by the ghost of Osama Bin Laden, there is a deep sense of distrust towards western NGOs delivering vaccination programs in Pakistani communities, after a polio immunization campaign led by a Pakistani doctor was used to track Bin Laden down by the CIA in 2011.
Beyond the headlines about how polio eradication is contentious in Pakistan, I knew very little about it. It’s a common tale of woe – when the diaspora are amputated from the goings on of the motherland. The opportunity to go on this delegation was as good an opportunity as any to learn something about the country that was home to my grandparents.
Our first stop was a primary school for young Afghan refugee girls in Nowshera, the northern province of Khyber Pukhtunkhwa (KPK).
I was immediately struck by the rubble surrounding the white painted walls of the school, remnants of houses which belonged to Afghan refugee families. The wood which used to form the roofs of these homes had been taken by Afghan families repatriated back to Afghanistan by the Pakistani government. With no other form of transportation, the wood was used as their only form of shelter from the sun, as they lumbered the heavy load from one country to the other.
The uphill struggles to eradicate polio
At first glance, the rubble looked entirely abandoned. But every time I turned to look away, children with blonde-flecked hair, sun-burned skin and wide eyes scuttled out of the sand like mice. The sight of these children appearing and disappearing like ghosts was eerily reflective of the problems with the porous border between Afghanistan and Pakistan. With no official border demarcated, there is no knowing who is crossing the border. This fluid movement of people has been one of the many uphill struggles to eradicate polio.
At the gates to the school, a group of young school girls with white hijabs wrapped around their small faces, smiled at me in welcome.
As they led me in, I was greeted by the sight of over forty women sat on foldable chairs with their backs to me. One of the facilitators at the school informed me that they had been waiting for five hours in the winter sun just to meet with us. Their anticipation of the arrival of strangers from another country was both endearing and overwhelming.
The gatekeepers to ending polio
A health worker, her voice slightly muffled by the black scarf she had wrapped around her face, stood in front of this group delivering a community health session. The tone in which she spoke to them in Pashto was warm, affectionate, like that of a close friend:
“My sisters, if you do not look after yourself, who will look after you children? You have an obligation to look after both yourself and your children. Eat well. If you have blood pressure problems, drink milk, it will help to lower it. If your iron is low, then spinach is a great natural source.”
Her name was Seema, and she was one of the quietly witty, dedicated lady health workers I met during my trip.
Within a few years of her marriage, Seema’s husband died suddenly, leaving her with two young children to fend for. She was later approached by someone in the community to become a health worker, and after completing her training, she’s been working with women in Nowshera ever since.
It cannot be understated how instrumental female health-workers are in the eradication of polio. They are the gatekeepers to the homes of women in Pakistan. Like Seema, they are well-known, trusted community members who go into homes administering vaccinations, giving advice on nutrition, sanitation, and family planning. In communities that are destitute and have very little access to medication, nutritional advice might seem like bare necessities.
But malnourishment in addition to poor literacy rates is heavily linked with rates of polio. It’s ironic that Seema’s hardship was a blessing for the Afghan refugee women at the school, but her services there are gold-dust.
Ustadh, a man of many hats
I later met with the headmaster of the school for Afghan refugee girls, known by everyone as Ustadh (teacher). He was a tall, gentle and erect figure who migrated from Kabul twenty years ago. Ustadh was a man of many hats: not only was he the headmaster of the school for Afghan refugee girls; he was also a member of the local shura, a council of elders whose word was effectively law in the communities they oversaw.
Ustadh spoke about the grim futures of many of the children attending the school. “Beyond these walls, there is nothing for them out there.” On vaccination, he spoke about how it was a point of distrust for many, particularly because some local religious scholars had issued fatwas, legal religious rulings, claiming that it wasn’t permissible for Muslims to vaccinate their children. The shura was a very necessary influence in appealing to religious scholars and members of the wider community and educating them that this was not in fact true, and that to protect children from debilitating viruses such as polio through vaccination was a religious obligation.
Speaking to Ustadh, it became clear that the eradication of polio – and more in general immunization – isn’t simply a matter of swooping in and administering drops and injections. It’s also a matter of winning the hearts and minds of people. It requires cultural and religious sensitivity, something that men like Ustadh are very acutely aware of. It’s an uphill struggle on many fronts, which requires many different solutions.
Female health workers taking the lead
Our second stop was a health clinic nestled in a slum on close to the coast of Karachi. In Nowshera, the women I met were mostly Pashtun-speaking from Afghanistan, however; here there were women from the Sindh region, from northern Pakistan and Afghanistan, who had their own distinctive dress, language and culture.
The notorious Karachi heat, even at that time of year when it was considered to be cool, was beating down hard, a far cry from the cool northern breeze of Nowshera. Apart from a few shopkeepers and some children walking barefoot, there didn’t appear to be many people out on streets lined with colourful plastic bags tossed to the side onto mounds of rubbish, burning under the sun. The health clinic, however, was a buzzing hive of activity.
Mothers streamed into the clinic, their young babies clutched tight in their arms. As with Nowshera and any other region in Pakistan, it was the female health workers manning the helms. I watched as they spoke soothingly with mothers who would then hesitantly hand over their children, knowing what was to come as the health worker reached into the cooling box beside her, administering the polio drops followed by not one, not two, but three injections which disappeared into the soft pink flesh of babies, a piercing cry bellowing out from their small mouths. In a few seconds, it was over. It was as quick as that. Then the next mother would come in.
A small price to pay for a life free of disease
Saffiyah was only a few months old at the time I met her. Before she went into the clinic, her face was jubilant as her mother proudly held onto her, playing with the beaded necklace she made herself around her daughter’s neck. However, after receiving her injections, Saffiyah’s eyes welled with tears, smudging the kohl in her eyes. Still, it was the small price she had to pay for a life free of disease.
At the Karachi clinic, health workers didn’t just administer polio vaccinations, but other vaccinations such as tetanus and TB. This was part of a growing call to push through not just polio vaccination, but routine immunization for other diseases as well. As much as eradicating polio is a priority, it is just the tip of the iceberg. Polio is a gateway disease to many others. If routine immunization is pushed through, it will offer a long term solution which could see education and sanitation efforts implemented as well, as well as a polio-free Pakistan.
“It has to be done.”
Along with a few other women, Maanvi (pictured below) was one of the community health workers who oversaw post-natal and anti-natal care in the area.
At the time we met her, Maanvi was herself six months pregnant. “When I have my baby, I’m going to return to my job after my maternity leave.” Despite facing the colossal task of visiting thousands of women living in district, going door-to-door raising awareness on the importance of immunization, Maanvi and her colleagues were resolute in their determination to reach every door, every mother, and every child. She smiled as she saw the look of surprise on my face when she told me how many homes she was responsible for, and simply said: “It has to be done.”
‘Women are just as good at farming as men’
With the global population projected to hit 9 billion by 2050 and food demand to rise by 60%, there is an urgent need to increase and better utilise the ‘man’ power in food production. We currently look to sustainable agricultural methods to increase food supply and reduce undernourishment and hunger felt by the world’s poor. Studies reveal that GDP growth generated by agriculture is up to four times more effective in poverty reduction than in any other sector. However, by evaluating this issue through a gender perspective, the impact could be even greater if women’s efforts were taken more into account.
Currently one third of the world’s population claim their livelihood from agriculture and in developing countries 43% of them are women. As they make up almost half of the agricultural population, investing in their farming abilities could have a significant influence on overall agricultural effort. But it is in these regions where gender disparity is rife – men produce on average 30% more yield than women. Yet 60-80% of the food produced in developing countries (the majority of which are non-commercial staple foods such as maize, rice and wheat) are farmed by women, despite them only owning less than 2% of agricultural land. These inequalities highlight the inefficiency for the full potential for food production to be met. Studies show that if women had the same access to agricultural inputs as men in developing countries, yields could increase by up to 4%, thereby reducing the number of undernourished people by 15% – that’s the equivalent of feeding the populations of Chad, Burundi, Zambia, Ethiopia, Eritrea and Haiti!
With statistics like this, there is evidently a growing awareness of the benefits from investing in women. So why then has progress lacked? Over the years, the journey to women’s empowerment has been arduous but gender disparities have slowly become more acknowledged in the development discourse. The root causes of a woman’s inability to benefit from farming lies within traditional, cultural and political injustices that restrict a woman from climbing the economic ladder. According to UN Women, there are various barriers preventing equal access to resources and services such as:
- Land Rights – In developing countries only 10-20% of landholders are women as rights to land are hard to obtain.
- Ownership of Capital – Women often lack of access to credit and loans which reduces their ability to buy fertilisers, seeds or to seek new economic opportunities. Women are more likely to own small livestock and poultry compared to large farm animals which often only allows for small-scale farming projects.
- Level of Education – Women who have less number of years studying then men are disadvantaged. The opportunity to study new agricultural techniques or business management, alongside basic literacy and numerical skills is vital to agricultural management. The educational gap is largest in Asia and Sub-Saharan Africa, with almost a 4-5 year gap in the number of years in education between men and women in Tajikistan, Indonesia and Malawi.
- Income – In developing countries, women spend almost all their earnings from marketing agricultural products to preparing and collecting food for the household, whereas men spend at least 25% of their earnings on other things. There are also perceptions that women are less commercially viable in terms of their labour and produce – only 15% of agricultural extension officers are women – so many of them tend to be in lower paid jobs.
Women can often be trapped in this cycle in the agricultural industry and with the growing pressure of feeding larger families and dealing with unpredictable crop conditions, the gender gap could widen. Hence it is crucial for policy makers to recognise the potential of women as key to solving the future food crisis problem.
There is evidence to show that gender sensitive agricultural environments tend to produce higher yields and these countries tend to be more food secure. The Economist Intelligence Unit’s Global Food Security Index has a strong positive correlation with the Women’s Economic Opportunity Index, which highlighted that women who have more equal resources and opportunities can produce higher and better quality agricultural yields. More research needs to be focussed in understanding the relationship between gender equality and agriculture, as with a stronger evidence base, policy makers will be more inclined to tailor farming and land rights to be more gender sensitive as well as sustainable.
In a wider context, the recognition of gender in farming is not only beneficial for food security, but other aspects of poverty as well. Empowering women in agriculture can not only tackle insecurity, but also produce ‘positive secondary effects’ in the lives of women, their families and their community. Closing the gender gap alone could lift 100-150 million people out of poverty.
“Empowered women have healthier and better educated children” Anna Faith, UN Women
With the Sustainable Development Goals (SDG’s) being finalised in September, this is a timely moment for us to re-evaluate our current approach to tackling poverty issues. NGO’s, governments and communities must work together to promote women’s contributions to tackling global issues and create opportunities for this to continue. Funding female farmers is the next logical step for sustainable farming – it seems that investing in women clearly is the seed that can lead to the growth of a better world.
UN Food and Agricultural Organisation: World Food Summit Fact Sheet,
National Geographic Food Edition