A young boy leads a group of men who are guiding a donkey and cart through flood waters.


Pakistan floods crisis: the hidden cost on sexual and reproductive health & rights

Our Strategic Advisor in Pakistan, Neha Mankani, has been travelling to affected areas to offer her skills as a midwife. Neha explains how the floods are creating a crisis for sexual and reproductive health and rights and how local civil society groups are responding.

A young boy leads a cart pulled by an ox through flood waters. Three men stand on top of the cart with a motorcycle

Rainfall equivalent to nearly 3 to 5 times the national 30-year average has covered up to one-third of Pakistan with water. The death toll is over 1500 and continues to go up, with 33 million people affected through displacement and loss of homes and property. (UN OCHA). While the rains have now stopped, rising temperatures and melting glaciers have further exacerbated the situation, with miles of lakes where villages used to be.

As the emergency continues and families move to makeshift shelters, we see a major SRHR crisis unfold – menstrual health challenges; health and safety issues linked to water and sanitation concerns, as up to 300 people use one makeshift latrine; a dramatic increase in maternal and neonatal mortalities and morbidities; and an increase in sexual violence.

Women and girls, particularly adolescent girls, are at additional risk, including the risk of child marriage and forms of sexual abuse and exploitation such as rape, harassment and trafficking. Marginalised people including people with disabilities are experiencing increased vulnerability due to disrupted access to essential services. Children and marginalised groups are vulnerable to abuse, violence and exploitation at aid distribution points.

One of the worst hit areas of Sindh has been Dadu district, which has been inundated with water from a lake, a river, and hill torrents. As a result, hundreds of villages in Dadu are now underwater. What was a ten minute road connecting two cities in the district is now a one hour boat ride.

Previous AmplifyChange grantee partner Sujag Sansar Organization (SSO) works in Dadu district and have been at the forefront of working with communities, especially in SRHR services and community mobilisation, during this time. As soon as the floods hit, SSO started a free boat service to rescue families from water logged areas. The organization has 30 anti-child marriage committees in the district that have been mobilised to stay in the sites where internally displaced persons (IDPs) have set up camps. The committees report any cases of sexual violence or transactional marriage that are taking place to SSO.

CEO of SSO, Mashooque Bhirmani, shares:

What we are seeing in this disaster is what our previous experience has shown: that during natural disasters, when parents already find themselves financially vulnerable and struggling to meet basic needs of their families, we suddenly start seeing an increase in selling of minors into marriage.

Forum for Dignity Initiatives (FDI), a previous AmplifyChange grantee partner, are providing menstruation and personal hygiene kits for girls and women in flood affected areas of Naseerabad and Jafferabad districts of Balochistan. Over 5,000 kits have been prepared and distributed by their team and volunteers. FDI is trying to work with the provincial disaster management authority to set up safe spaces for girls, women, transgender persons and persons with disabilities to seek psychosocial support. In addition, they are urging the health department of Balochistan for the provision of contraceptives in flood affected areas.

Shirakat-Partnership for Development are an AmplifyChange grantee partner that have been contributing to immediate flood relief in Nowshera, Rajanpur and Jafferabad. Their work includes provision of food staples and non-food items to displaced communities, as well as sourcing solar lights to improve safety at camps for vulnerable populations.

Three people are on a wooden boat, floating through flood waters.

As part of my own work as a midwife and through Mama Baby Fund, we are making clean delivery kits for displaced women who are due to give birth in flood hit areas and holding large maternal and neonatal health camps in areas with major identified needs. Through these camps, we are providing pregnant women with check-ups, medicines and supplements, identifying complications, and teaching the use of delivery kits. I worked with SSO to provide maternal health services in Dadu.

On the day that I arrived at Dadu and connected with Mashooque, we heard of two maternal deaths in the community. The women who died had been rescued by boat, but could not reach health facilities on time due to infrastructural challenges. While I set up my maternal health camp, I watched Mashooque report a case of sexual violence at a camp we had just crossed. I asked him about the challenges he faces while doing this:

The family of the perpetrator asked for him to be forgiven, but women are afraid to sleep in these camps. If we do not report, there will never be any accountability.

We stayed with SSO for two days in the district, during which the community volunteers working with the organisation helped us locate and mobilise pregnant women and newborns requiring care. Over the course of two days, we provided reproductive and menstrual health products, maternal health services and clean delivery kits to over 250 women. We provided services to pregnant women due to give birth in the next few weeks, many of whom will deliver in tents, boats or makeshift clinics. We saw cases of reproductive tract and sexually transmitted infections. Women came to us with concerns about the interruption of family planning services and care. I have seen this trend in my work in reproductive health in crisis situations – the inability to get an implant or IUCD removed, or access a contraceptive pill or injection.

Asking about his next plans for the community, Mashooque shared that he plans to use theatre and music to provide health education and edutainment to flood-affected communities in IDP camps, particularly children and women, to dissipate fear and trauma and improve SRHR services.

The stigma surrounding sexual and reproductive health and rights means we may be slow to see how these basic human rights are impacted by environmental crisis. But what we are learning in Pakistan is that sexual and reproductive health and rights are vulnerable to a climate-change driven crisis like the floods in Pakistan. This can compromises basic human freedom, dignity and life anywhere.


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