How my driver said yes to contraception

My driver, Qasim, beamed at me in our car’s rear-view mirror: "We did it! We got permanent contraception!"

My driver, Qasim, beamed at me in our car’s rear-view mirror.

“Kara liya! Hum nay baccha band kara liya! Main nay apni biwi ka bachadaani operation say nikalwa liya”

(We did it! We got permanent contraception! I got my wife to get an operation to get her uterus removed).

I beamed back - the two of us, partners in glory. Strange conversation with a driver indeed.

I settled in to my seat and thought back over the past few years. My mother was the first one to tell me about Qasim’s wife - pregnant with their eighth child, her listlessness and apathy had scared Qasim into bringing her to the hospital from their goth, a village about one hour’s drive from the airport.

My mother, a pathologist, took one look at his wife’s paper white hands and recognised her to be severely anemic and in need of a blood transfusion. At home that evening, she fumed at the needlessness of that poor woman’s suffering, of her continued childbearing and how Qasim, a typical insensitive Pakistani man, had done nothing about it until the last minute.

Back then, I was a final year medical student at the Aga Khan University (AKU) and in the middle of our community month - a truly exceptional rotation in which the students spent time working at Edhi clinics, Sabz Sitara centers and the like.

I was fired with the will to create change. Qasim was my buddy, my favorite driver - he had been working with us since I was ten-years-old. I could not see him as a bad husband, and after all, one of the strongest messages given to us in our community month had been of empowerment, to not judge a book by the proverbial cover. Instead, give knowledge, educate people about choices and show them alternatives - while respecting their beliefs and choices.

So, during our next car drive, I asked Qasim:

"How many children do you have? How many are sons?"

He smiled proudly and told me that he had eight children, four of them sons.

I tentatively asked him why another one and, if he had thought about permanently stopping having children or at least having control of when to have a future child. I told him about vasectomy being a simple clinic procedure with no effects on his masculinity and on his ability to be a good husband. I talked as professionally as I could and told him of the health and economic advantages of preventing his already sizable family from expanding further. He said he would talk to his wife and tell me what she thought.

The next time we talked, he replied - the prototypical harassed husband - his wife had scolded him. She did not want him to even consider the procedure, saying that she would become the laughing stock of the womenfolk in the village!

I was astounded. I asked him if she had thought about the cost of maintaining so many children and if she had thought about her own health.

My father was not increasing Qasim’s salary per child born, and with simple mathematics, with every new addition to the household, the rupees spent per person on food, clothing, education etcetera diminished. Qasim got it, he is a smart man, but he was like putty in his wife’s hands.

I told him of the non-permanent contraception options available commercially, of surgical options for his wife and left it at that. I had realized that my audience was not receptive; I gave him a few Sabz Sitara brochures, told him of where he could get free surgery for his wife and stopped badgering him.

This is not an ideal story - I did not follow up with him; I did not meet his wife at their home. My mother did keep talking to him about their options, but I don't think even she can claim responsibility for what eventually happened.

But you know what? His wife was not dumb either.

Sometimes it takes but a kernel of information, a small show of support, a realisation that what has happened for eons need not happen again. I'm not sure what made his wife change her mind. All I know is that a woman was empowered enough to make a decision that will forever change her and her family’s life.

What amazes me is that there was no outcry of religion by him or his wife. The initial hesitation was cultural and more about what people would say, followed by a final decision that had to have stemmed from her connecting the dots: her health, her existing eight children, their desire to provide for their family and the finite amount of finances.

So here’s to common sense, talking to our drivers, maids and cooks and realising that a little bit of empowerment goes a long way.

[[http://www.youtube.com/watch?v=BOfX6U0SVcM&feature=player_embedded]]

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