The federal government of Pakistan has recently started a Lady Health Workers (LHWs) program in Karachi, which currently employs 100,000 women both in rural and urban areas. This 15 month program consists of training in family planning, basic hygiene, and child health only to name a few. It is designed for women who are interested in providing health services to their communities, while generating some family income. LHWs do not directly receive a salary but they do get a stipend, which helps with the family expenses. Consider this stipend as an incentive for these women. The following are the successes and challenges of this particular program

Successes:
1) Pakistan is a patriarchal society with men dominating the public sphere while women are confined to the private sphere. The state in turn supports patriarchal norms and institutions by restricting women’s mobility outside the private sphere. The initiation of this program has resulted in an unprecedented move, allowing women rights to access the public sphere since they have to make home visits and collaborate with other health care providers.
2) Contribution to household income and hence, poverty management
3) Source of empowerment as women find meaning in their lives through service for others.
4) LHWs from a dominate caste achieves access to greater number of households
5) LHWs gain confidence to teach, learn and to make decisions, which was initially seen as a “mans job”
6) LHWs have access to information and intellectual sources
7) Use of contraceptives for the first time, upon completion of Family Planning course module
8) Establishment of meaningful relationships outside the private sphere and away from family life (i.e. with other women and men as well)
9) Men utilizing family planning techniques and obtaining information from LHWs
10) Establishment of relationships with other community organizations and politics
11) LHWs have gained increased household status and respect, even within their own families
12) New found interest in enterprise and ability to change one’s own situation as well a that of others

Challenges:
1) Only women from a dominate caste gain access to greater number of households-inequality
2) Men are no longer seen as the sole “breadwinner” of their households, creating increased tension between husbands and wives in some households. Also, women are being empowered at the expense of men’s self esteem and their ability to provide for their families. Some men do not feel as useful as they once used to. Think about the cultural norms in a traditional Pakistani society. A change or anything out of the norm would definitely alter a society’s perception and attitude. Change is not always taken positively, especially when is accompanied by strong emotions. This change is devastating for these men because they have always been used to one way of doing things. They have now been exposed to “another way” and not all men are happy with this change.
3) Since the LHWs have approximately 100 households to visit, they have less time to attend to their household responsibilities. Therefore, increased numbers of young women have to pick up on household chores left behind by their mothers, sisters or mother-in-laws. These are very young women who are being asked to give up their schooling and even their childhood. Interviews have shown that since the world load and expectations of these young women are increasing, there is greater amount of tension between mothers and daughters, even hostility.

Even a move in the right direction comes with a cost....