The doctor brides of Pakistan, bred at medical colleges all over the country, move on to become wives and mothers but give up being doctors. The figures tell the story an Associated Press report published a few months ago asserts that 80-85 per cent of Pakistan’s medical students are women. At Dow Medical College in Karachi, the ratio of female to male students stands at 70 per cent female and 30 per cent male. All these hopeful numbers would be considered indicators of the feminisation of Pakistani medicine and the proliferation of female doctors around the country. Indeed much approbation would be in order for the Pakistan Supreme Court decision that abolished the quota that limited women to only 20 per cent of the seats at medical schools.
All of it could have been were it not for another set of numbers. While no figures are officially kept in Pakistan of the numbers of doctors that are lost to the bridal belt of wife and motherhood, some inkling of the losses can be found in the following. Of 132,988 practicing doctors registered with the Pakistan Medical and Dental Council, 58, 789 are women. Of 28, 686 specialist physicians in the country, a paltry 7, 524 are women. The percentage of female medical students may be high enough, but the bridal market places more urgent demands, promises more stability and social acceptance than the job market.
It is a conundrum of many dimensions and central to it is the question of blame. Does the fault lie with the individual student, who has adequate commitment to the demanding academics of medical education while single, but falters in juggling them when the demands of in-laws and husbands and children are added to the mix? Is it the fault of the Pakistani middle-class culture that has placed value on professional education for girls, but only as an accouterment, a sort of degree dowry whose value does not lie in its actual use? Or indeed, can this waste be pinned to the deeper misogyny in the working world of a patriarchal nation; that begrudgingly tolerates these girls in the halls of learning but is too hostile to allow them to practice without harassment and intimidation in hospitals? Furthermore, wouldn’t reinstating quotas that limit female seats in public medical schools set Pakistani women doctors even farther back than they are today?
These questions are important because they have resource implications. In a poor country, where healthcare is inaccessible to millions, female students, especially those that attend public universities take up already meager resources. When these girls do not practice they take away income generating opportunities from others who would utilise them. On another scale, the lost doctors represent an expenditure on healthcare that produces a net loss in that the benefits of the education are never dispersed into the general population. The problems are not Pakistan’s alone. In post-apartheid South Africa, a country where Indian Muslims present a significant demographic, rumors have been circulating about the application of unofficial quotas that reject applications from female Indian Muslim students because too many of them fail to practice medicine after marriage and motherhood. While administrators of medical schools insist that they do not exist, the issue remains a contentious one even in that country.
In Pakistan, the solution may ultimately rest on what Pakistanis consider the purpose of medical education to be. In an article I wrote last week, I argued that the decrease in international demand for Pakistani doctors and the absence of local labor market able to absorb them, suggests that Pakistan does not need to be producing more doctors. The article was premised on the assumption that in Pakistan, the choice of becoming a doctor is as much, if not more motivated by aspirations to middle and upper middle class status; than to actually provide healthcare. If this is not the case, then all medical students in the country male or female should welcome the implementation of programs that require two years of obligatory service in underserved areas of Pakistan as part of completing a medical degree anywhere in the country. The failure to complete the two years would incur a fine payable by the student or their guardian and prevent the student from graduating.
The increased numbers of girls in Pakistan’s medical schools suggests that ideas do change, if only partially, and that inroads can be made. There was of course a time when the co-educational set up of medical colleges and the limiting 20 per cent quota kept women away. The elimination of the quota created enough of a push from intelligent girls to convince their families that they be allowed to attend despite the presence of male students. While post-feminist interpretations of women’s choice may insist that Pakistan’s female medical students should have the option of saying “no” to a medical career if they wish to, such arguments are simply not valid in a country with such limited resources and a society always looking for excuses to keep women out of the workplace. In this sense, the imposition of a service requirement may well be the catalyst needed for the next step in the transformation and a good way to insure that the doctor bride continues to be a doctor long after she is a bride.