Changing the Landscape of Oral Health Sector

The Surge of Female Dental graduates in Pakistan

Prior to 1991, limited number of female quota seats were restricted for admissions in medical and dental colleges of Pakistan. However, in 1991, the Supreme Court declared an ‘Open Merit Policy’ of admission in these colleges. The first batch based on this policy was taken in 1992.

A dramatic change was seen in gender landscape of the medical and dental profession. This trend was especially noted in last quarter of the century. Today, there are two female dentists for every male dentist in the country out of 21,000 plus dental graduates. This gender gap is widening.  

With the admission policy of open merit, female presence dominates the dental colleges. Though, there was an increase of female enrollments in dental colleges, but very few of them continue to pursue their career. This changing scenario caused a downstream effect on trained health manpower/womanpower, just like that of a leaking pipe.

This changing scenario caused a downstream effect on trained health manpower/womanpower, just like that of a leaking pipe.

‘A leaking pipe effect'

In 2014, Pakistan Medical and Dental Council (PMDC) decided to implement a 50/50 quota for boys and girls. This decision was based on the findings that only 50% of the women health professionals take up their careers further. It was due to this trend that a shortage of working health personnel persists. This decision was, however, challenged in the court of law and then later, withdrawn.

Impact on labor market

It is extremely difficult to ascertain labor market outcomes since limited data exists. The population or representative surveys such as Labor Force Surveys are not applicable to implement on this market.

However, an elite sub-group of post-grad students, specialists and teaching professionals can be used to determine labor market outcomes of this segment. By taking postgraduate qualification as a proxy measure for advancement in career, new trends can be studied. It is seen that only 5% of the females compared to 20% of male dentists have postgraduate qualifications.     

Dental Degree only for Display

It is noted that most women dropout after getting their BDS degrees. The reason behind is their lack of interest in specialization. Their dental degree is used to find a suitable marriage match. This phenomenon needs to be addressed in light of social biases and cultural practices of the country.

The main reason for gender gap in work is the social and familial control over women’s decision to pursue a career. In Pakistan, the traditional economic dependence is on men and hence, they have more power to restrict or determine women’s choice of career.

Women's Career dictated by Culture

Globally, majority of female dentist are involved in private practice of general dentistry. As this route gives them the flexibility of time even after starting family. Yet, here in Pakistan, only small minority of women dentists are eager to pursue their career.  Only handful number of woman are present in private dental practice. The reason behind is the issue of establishing a dental practice. This can involve a fair amount of capital investment which families would be reluctant to do. On cultural level, women are seldom trusted with finance, especially in a startup business of their own. With no support from families, women are bound to seek help from formal financial establishments of the country. But they face similar reactions from there as well. Commercial banks disregard women clients due to their preconceived assessments on women’s creditworthiness. Majority of them depend on men for collaterals. This can be either in the form of property mortgage, transaction of small loans or difficulties in establishing borrower’s trustworthiness.

High time to shift focus on Female dentists

In Pakistan, more women are in search of income making opportunities in the job market recently. This is due to high migration of male counterparts from the country.

In recent times, Pakistan has experienced an exponential growth in the middle and lower middle-income segment. It has been declared as an emerging market for healthcare facilities. Government is giving incentives to provide affordable health care to the population. On the other hand, Dentistry is still concentrated in 10 urban districts of the country. The difference in rural vs urban population of dental professionals is stark. Dentistry has evolved as a profession of the elite, with 90% of the dentists are targeting only on 10 % of the population that can afford high end dentistry. While the rest of the population has no awareness regarding dental health.

No opportunities are being created for the 75% of the graduating dentists mainly of women. These women culturally lack entrepreneurial mindsets and confidence to venture into practice of dentistry. Hence, like other women of the country, they lack ownership of productive resources.

It should be realized that dentistry is at the crossroads of the most uncertain and challenging decade. The way we respond to the problem, can control the fate of the future of the dental profession in Pakistan.

- by Professor Dr. Ayyaz Ali Khan