Lady health workers in Pakistan have incredible stories to tell—stories of hardship and illness, but also of endurance. However, when the Taliban gained control of the valley of Swat, their stories became ones of extreme violence, persecution and death.

School of Public Health researcher Zubia Mumtaz set out to hear their stories—and discovered she almost wished she hadn’t.

In 1994, the government of Pakistan launched the National Programme for Family Planning and Primary Health Care to provide family planning and primary health care to rural areas. The Programme included a network of over 100,000 lady health workers (LHWs), who were tasked with providing family planning counselling, health education, polio immunizations, treatment for minor illnesses and facilitating antenatal care.

When the Taliban invaded Swat in 2006, health infrastructure was one of the targets of their attacks. Later, Mumtaz and her team set out to discern the extent of these attacks against the LHW program.

In 2010, her master’s student, Iftikhar Ud Din, conducted 30 in-depth interviews with LHWs, supervisors, coordinators and others in the district headquarters of the program. Because of the threat of Taliban re-emergence, data collection was particularly difficult. Mumtaz and her team were unable to speak to the LHWs directly affected, because many had resigned and cut ties with the program. Data collection itself was cut short by two months because of the instability of the region.

Despite these challenges, the result is the first research of its kind documenting the targeted and systemic nature of the Taliban’s campaign against LHWs. The findings have recently been published in the British Medical Journal.

Analysis of the data revealed the brutal nature of the Taliban’s attacks. Religious laws made it illegal for women to work for wages and decreed that Muslim men were obligated to kidnap the LHWs and force them into marriages or sexual slavery. A daily radio program publically named and shamed them. And, physical violence against the LHWs or their families by the Taliban became commonplace.

“Because the LHWs are the only ones providing care in these remote villages, they thought these attacks were only happening to them,” Mumtaz says. “Nobody could compile the evidence to look at how organized these attacks were, because the LHWs never talked about it. It’s an extremely important area that hadn’t been explored.”

As a result of the Taliban’s campaign, many LHWs and their families suffered from physical and mental problems that varied from marital issues to physical ailments and even death. Approximately 15 per cent of LHWs officially resigned, and many simply stopped working. As a result, the mental and physical health of residents quickly and severely declined, as polio cases and maternal deaths increased. 

However, Mumtaz was not shocked by the attacks or their implications.

“It wasn’t actually shocking to me at all, because it’s part of the routine there,” she says. “As horrible as the attacks were, you become so desensitized. That’s what the Pakistanis do; that’s what they have to do.”

Although Mumtaz is emphatic about the importance of this research, she acknowledges that it has been a dangerous undertaking for all involved and has decided not to pursue it further at this time. 

“We really struggled with whether to continue,” she says. “Providing evidence of the violence they face is the key to protecting the LHWs, but participating in our interviews put the lives of our subjects in danger, and the knowledge that has come out of it could put our lives in danger.”

“So, how far do you go with research if you’re putting yourself and others at risk?”