Women’s Wellbeing on the Move

In Pakistan, young women often lack decision-making autonomy and financial independence due to entrenched gender norms and cultural constraints. These challenges persist in urban areas, where lack of safety, transportation, and permissions limit women's ability to seek help or make choices. Conversations related to family planning and reproductive health typically exclude women's direct participation, with decisions shaped by mothers-in-law and husbands resulting in restricted agency for women to express their preferences. As a result, women may face health disparities, including limited access to information such as sexuality, puberty, and general body rights. Approximately 23% of Pakistan’s population comprises adolescents who have restricted access to SRHR information and services, which may be leading to unplanned pregnancies, early marriages, underutilization of contraceptives by men and women, and a legitimization of gender violence and inequality, often perpetrated upon women (Khan et al., 2022).

Furthermore, religion plays a dominant role in Pakistan, where Islam prioritizes modesty and prohibits premarital sexual activity. This cultural and religious conservatism has made SRHR a taboo topic for young women, despite that this includes broader women’s health issues pertaining to their biological, cognitive, and socioemotional well being. The assumption is that discussing SRHR conflicts with religious and cultural practices, limiting opportunities for open dialogues and informed choices regarding sexual and reproductive health. The limited participation of the education and health systems in addressing sexual and reproductive health topics with women also adds to the problem. Cultural taboos lead teachers to feel uncomfortable engaging in open conversations regarding SRHR, making it challenging for young women to access reliable information, both within and outside the formal educational system (Oxfam, 2016). In Pakistan, challenges regarding knowledge and accessibility of SRHR are faced by almost 63% of the population (Khan et al., 2023). The Sindh Reproductive Healthcare Rights Act 2019 has significant gaps, including the lack of extensive legislation certifying access to SRHR services, contraception, and age-appropriate sex education. Limited access to information and restricted mobility impede women's timely healthcare-seeking behavior, contributing to reduced investment in SRHR services, thus perpetuating a cycle of detrimental women's wellbeing.

“Women’s Wellbeing on the Move'', a mobile unit consisting of a fabricated van with two trained counselors on-board, is a solution designed to address critical gaps in access to safe and vetted SRHR information for young women with a strong emphasis on prevention and early screening. The intervention will be tested in public and private university settings in Karachi, Pakistan, serving female university students between the ages of 18-25. The innovation provides:

Education:  on various SRHR topics - ranging from menstruation (such as the difference between premenstrual dysphoric disorder [PMDD] and premenstrual syndrome [PMS] , to hormonal and bodily changes (such as vaginal discharge, pain, etc.), to gynecological conditions (such as self-screening for breast cancer and signs and symptoms of ovarian cancer), to family planning practices. With a focus on prevention education and access to information beyond the clinic, the initiative aims to demystify SRHR dialogue and encourage peer support, involving friends and family in the educational process. It would allow for a flexible space where these young women can obtain education about any SRHR topic they would be interested in through group awareness sessions and sharing circles.

Counseling: to address SRHR concerns faced by young women through a one-on-one engagement with the trained counsellors. The mobile unit provides consultations on various women's health-related issues, including family planning, menstruation, and nutritional education. The initiative recognizes the importance of personalized guidance and support in addressing individual SRHR needs and challenges, ensuring that young women receive the necessary information and advice in a private and comfortable setting.

Referrals: to ensure that young women receive comprehensive care. The mobile unit is equipped to handle routine management of chronic health issues, like polycystic ovarian syndrome (PCOS), but provides referrals to IRD’s integrated primary care service program, WellCheck, for more detailed reviews and consultations by physicians, gynecologists, and consultants, where needed. In the future, this initiative may be absorbed into WellCheck to expand upon its broad scope of integrated services. As part of the WellCheck model, this innovation serves as an outreach arm, particularly amongst young women who may not typically seek timely healthcare.

With support from the MIT Solve challenge, we aim to prototype his initiative in two public and two private universities, offering information in English and Urdu. During a one-year prototyping phase, we will build upon IRD’s existing women's wellness program and will focus on preventive measures, early screening, and timely diagnosis. The mobile unit will rotate between universities, staying for two to three days at each location, over a 4-month implementation period.

The innovation is for young women between the ages of 18-25, but in future may be expanded to include other age groups. At present, the innovation serves to: 

Increase Access to SRHR Services: 

Due to cultural taboos, religious prohibitions, fear of judgment and lack of privacy, young women may not seek SRHR guidance from families or friends, or treatment from health providers (Ghani et al, 2014), leaving them with lack of information about various SRHR issues such as normal bodily changes, signs of abnormal bodily changes related to various cancers or syndromes, or how to practice safe sex, leading to unplanned pregnancies, STDs, unsafe abortions, and delayed diagnosis of severe health conditions (Faisal et al. 2022). "Women's Wellbeing on the Move" will increase convenient access for young women to a mobile counseling van service present in their universities, when they have limited access to SRHR services due to cultural and financial barriers. 

Provide Information and Education for Informed Decisions: 

While access to SRHR-related information online is easy, quick, and cost-effective, the sheer volume of online information may make it difficult to ascertain quality and accuracy, causing further confusion and spreading of misinformation. Women may feel overwhelmed with the conflicting information available online, not specifically catered to their health, obstructing their ability to make informed decisions about their SRH, increasing their emotional distress and anxiety. In Pakistan's context, mothers are the primary source of information for young girls and women when it comes to SRHR topics such as menstruation and birth spacing practices. Such information may not be well-grounded due to family members' own lack of awareness and knowledge, resulting in establishing myths and incorrect perceptions around menstruation and women's reproductive health. Clinics or educational institutions may not be able to provide basic information around women's health due to limited resources, permissions, and their own information biases. Our solution serves as a reliable, credible information source, bridging the gap between online information and professional healthcare access, empowering young female students to make informed decisions, seek timely healthcare and monitor their bodies for early signs and symptoms of adverse conditions. 

Create a Safe Space for Empowerment: 

Though teachers are one of the key members within young female students' social ecology, young students may not approach them for SRH concerns due to fears of information leaking back to their parents, or the teachers' own cultural bias". Women's Wellbeing on the Move" aims to fill this knowledge gap by providing age-appropriate sex education information, involving parents and the school system if need be, thereby increasing access to reliable information and transparency. By curating a safe space within the university campus - an already established safe space for women as they seek education - this model allows access to privacy, authentic and evidence-based SRHR information, and peer support, empowering young women to make informed choices, and building a community for discourse.

IRD is a predominantly women-led organization, such that several of our founding members and most of the country affiliate directors are all women. IRD fosters gender-transformative approaches within our health programming, as well as for employees. It also offers a unique, fast-paced culture which attracts young talent who are able to take initiative and grow into their own. Many of the smaller projects which have grown to scale at IRD have resulted from trust in young people’s ideas and abilities to test and execute innovations through guidance.

As such, we possess strong first-hand experience of the specific access barriers and needs faced by young women in the developing world. IRD Pakistan hosts IRD’s largest team, and our team includes many young members who can relate closely to the target demographic and offer fresh insights into their experiences, offering appropriate ways of engagement.

IRD values community- and patient-centeredness, such that we take a user-led approach in the design, delivery, and dissemination of our innovations. This is not only clearly outlined in our evidence-based research approaches, whereby we utilize mixed methods to better understand the needs of those we seek to serve, but also in  lived experience panels. We have developed lived experience groups for Tuberculosis, HIV, COVID-19, and Psychosis, specifically to help design interventions, improve community understanding of research and public health systems, and amplify voices of those with embodied knowledge. Broadly, ensuring representation of lived experiences, whether they be patients, caregivers, providers, or the broader community, is imperative in our programming.

It is for this reason we are currently seeking to prototype service delivery for this innovation. By conducting focused demos of service delivery, we aim to utilize low-fidelity prototyping to understand users’ needs, incorporate human-centered design principles for participatory design and iteration of the model, and create a model that can be appropriately embedded within our larger service delivery packages.

IRD launched 5 'Mobile Immunization Vans' in high-risk areas of Karachi to address immunization challenges by offering a door-to-door service in difficult-to-access locales. However, the conventional health worker model is unsuitable for providing SRHR counseling to young women aged 18-25, because unlike immunization, SRHR discussions require confidentiality, which cannot be achieved in traditional engagement settings. Thus, the mobile counseling van for SRHR is a prototype designed to adapt the successful principles of community outreach while incorporating human-centric design principles in a university setting. 

Taking learnings from the immunization vans further, IRD also launched its Mental Health program’s Wellness Centers that provide safe spaces. These easily transportable refurbished containers cater to various spaces and offer holistic mental health services, including one-on-one counseling, wellness workshops, patient support groups, and group counseling. Expanding on these safe spaces, we would like to test out these wellness centers' environment and counseling components for our mobile van solution and create similar safe spaces for a more open dialogue among young university women. 

IRD's WellCheck program has been designed to provide customized solutions to physical and mental wellness needs of individuals using mobile vans. It has a proactive and holistic approach to health and wellbeing, providing innovative and engaging solutions, such as vital disease screenings, counseling and capacity building for places such as educational institutes to ensure healthier communities. One of its successes includes engaging over 80,000 students in more than 900 schools for awareness sessions and free-of-cost testing and screening activities for COVID-19 as well as other diseases. 

We offer comprehensive women's health screenings, conducted both at the WellCheck Centre and as part of our integrated TB services for screenings. We have created a safe space for screenings and counseling, empowering women to openly discuss their health concerns. IRD has conducted a total of 556 Women's Health screenings at WellCheck Centre. Seeing as how we have a plethora of information regarding various SRHR topics, we want to shift from a clinical to a counseling, one on one and group setting approach, where these young university women will obtain information regarding their wellbeing in a safe space and have the opportunity to get referred to the wellcheck program for in-depth screening and treatment if required. 

IRD is currently providing testing and screening through its integrated service delivery mechanism for diseases such as Tuberculosis , Hepatitis C , Mental Health, and Covid-19 across three districts in Sindh, Pakistan. We have experience engaging with young people through initiatives like Kiran Sitara in government schools. KS incorporates the Adolescent Health and Leadership Programme into the curriculum, empowering girls in Karachi, Badin, and Bhong. Our team has gathered data on women's health and will conduct needs assessments, including focus group discussions with young female university students and specialists. Our SRHR curriculum will be further informed by our previous work from the women's health program as well as the KS AHLP.

IRD has provided safe spaces, health counseling and referrals through the initiation of multiple mobile vans/trucks and container-based spaces across various communities. The mobile counseling van solution for SRHR issues is thus considered a prototype for services and delivery modalities we want to test in a university setting with young female students.

Our innovative mobile van is strategically positioned in university areas to provide convenient access to SRH information, commodities, and services. This approach is essential because young girls often face challenges accessing healthcare facilities, particularly when healthcare providers do not prioritize their time. In many cases, young girls may lack access to personal devices, and digital solutions may not be suitable, given the curtailment of information by government authorities and the absence of verification.

While digital solutions have their merits, they cannot replace the role of a trusted counselor who can provide one-on-one, in-person guidance. Peer support networks further enhance this by extending support beyond the clinic setting. 

Moreover, young women may struggle to find a safe space to discuss SRH concerns openly. Social pressure and the fear of judgment can inhibit discussions in social settings among peers. Our mobile van offers a discreet and confidential environment for consultations and services, addressing the sensitive nature of SRH issues among youth.

The services provided by Women’s Wellbeing on the Move cover a wide range of SRH topics, including contraception, sexual health education, nutrition and hormonal changes. This comprehensive approach ensures that young people have access to the information and services needed to make informed decisions about their sexual and reproductive health. The referral mechanism linked to our organization's WellCheck program ensures privacy and transparency, avoiding the discomfort and distress often associated with external clinics or hospitals.

The mobile van prioritizes an educational and preventive healthcare component that empowers young people with accurate, age-appropriate SRH information, enabling them to make informed decisions. By engaging with local communities and young people, we gather insights to create a tailored SRHR preventive healthcare model that considers their unique needs.

One of the key advantages of this solution is its cost-effectiveness and ability to reach university sites within a short period. Building infrastructure focused on young people's access to SRH information and services becomes more feasible and efficient.

Our human-centric approach is grounded in research and an understanding of the specific needs, preferences, and challenges of young women aged 18-25 in Karachi's universities. We account for cultural norms, societal pressures, and educational backgrounds to develop relevant and effective educational content. The solution leverages the expertise of sexual and reproductive specialists trained to provide culturally sensitive and relevant information.

Furthermore, Women’s Wellbeing on the Move has the potential to catalyze broader positive impacts within the field of SRHR and beyond. By demonstrating the effectiveness of mobile health counseling vans, we inspire others to adopt similar models, especially in regions with stigmatized discussions around SRHR. This approach has the power to transform how SRHR services are delivered, emphasizing privacy, accessibility, and individualized care, ultimately influencing health organizations, government bodies, and NGOs to invest in similar mobile counseling services.