KARACHI: Several eyebrows rise whenever anything close to the topics of planning or abortion come up. Still taboo, placing family planning at the centre of the entire abortion debate could be too much to ask for. It is not because the dispute has lost its worth; it is because no one is willing to pay attention.
In 2015, the abortion rate in Pakistan surged because couples were opting for it as a primary contraception measure instead of as a last resort while using safer methods of family planning, and now in 2017, the situation has not changed much, regardless of which segments of society is observed.
Are you ready to expand your family? If a woman can answer this simple question, most of the couple’s concerns related to family planning will be solved. Unfortunately, in a typical Pakistani family, everyone but the woman in question takes decisions about family planning, for instance, when is the best time to have a baby? Or should one have a family at once or there should be spacing between babies?
Ideally, women should have the right to determine how many children they want to have in their family based on their personal, medical, and financial well-being. But let’s admit that they are not so privileged.
Women in Sindh have long been complaining about deteriorating health issues because of unintentional pregnancies
“It is my body, my life. It should be my right to determine whether or when I should bear a child. But I was barred by my husband from exercising my right to plan motherhood,” said 43-year-old Saima who is currently a mother-of-six.
Saima lives in a posh neighbourhood of Karachi and her husband is a doctor. She has been suffering from obesity, palpitation and elevated blood pressure since the time her third child was born 15 years ago. Her husband, Saima says, has been ignorant about the matters related to her mental and physical health.
“He [Saima’s husband] always behaved like a conventional male of our society and rejected the idea of family planning. His mother also supported him,” she said.
Family planning perhaps is the most unloved component of women’s health in Pakistan and if the situation can be this bad in cities like Karachi, one can only shudder to imagine, how woman cope with the consequences of frequent pregnancies in rural Sindh.
In Pakistan, the concept of family planning becomes an issue for many because a woman rights to conceive or postpone her pregnancy collides with the tradition of having large families. What they do not know is that family planning ensures a secure, healthy and happy life apart from controlling their finances, which big families cannot otherwise guarantee.
Women in Sindh are eager to learn about family planning, but they cannot do so without proper medical guidance. What they need is called a professional advice about contraception before they resort to an abortion.
“Medical counselling will change the fate of Sindh women by improving the contraceptive prevalence rate (CPR). Women need proper guidance to adopt the modern contraceptive method. A Costed Implementation Plan (CIP) is currently targeting improving the CPR rate from 30 to 45 per cent,” said Sindh CIP Technical Adviser Dr Talib Lashari.
In a bid to assist women, CIP is now also refocusing on the role of Lady Health Workers (LHW) on family planning.
“LHWs being trained in Hyderabad and Badin will be redefined into family welfare workers (FWW), stationed at some 961 family welfare centres across Sindh for counselling on modern contraceptive methods and for regulating the supply of contraceptives to the target users,” said Dr Lashari.
For gynaecologist Dr Nighat Shah, CIP’s counselling initiative is a lifesaver. She believes most Pakistani women have no safe way to terminate an unwanted pregnancy and are likely to take desperate and dangerous measures.
“Family planning prevents unwanted pregnancies, regulates birth spacing and ensures pregnancy at the correct reproductive age,” Dr Shah said.
At present, Sindh’s projected population is not very desirable and if it continues to swell at the same pace, it will wreak havoc, even at a stagnant rate of two per cent, from the present 45.9 million to 60 million in 2020. This means that with increased socioeconomic demands, poverty, malnourished children and water scarcity, 49 million people will be left without proper sanitation facilities, said reports.
As per Dr Lashari, in Sindh, particularly in rural areas, low CPR is due to high illiteracy and unawareness about the benefit of birth spacing. Sindh’s CPR, however, he added, remained stationary at 29.5 per cent with only 24 per cent modern methods and a trend of discontinuity in contraceptive usage. The unmet need in the province is still at 21 per cent.
Abortion and risking Sindh women’s life
Now, the misconception around abortion should be clear. Abortion is legal in the country and a consensus exists among Islamic scholars on its permissibility in certain conditions of saving a life and to carry out necessary treatment.
Coming back to the topic, since there is no planning of family planning, couples sometimes opt for abortions – often life-threatening and unsafe – as their last resort to overcome complications.
It also needs to be understood that abortion is absolutely not a good method of contraception.
According to a report, nearly 100,000 women had abortions in 2001, which swelled to 174,908 in 2013. Nearly 15 per cent of women undergoing the procedure in Sindh died.
Several factors are forcing abortion cases to increase in Sindh. Reports suggest that the demand for different kinds of contraceptive products in the province is high, but its supply is low. Most hospitals in rural areas keep birth control pills and other medication in storage and were not distributing them to the public.
Keeping an eye on the CIP targets, the provincial government needs to promote the idea of family in Sindh, and simultaneously, must ensure that accessibility and availability of contraceptives including the most popular method – condoms.
Family planning as a part of Sindh’s abortion argument can be a reality if education on the various methods of contraception, their side effects, and the option of a legal period of abortion be communicated to couples, especially prior to marriage when family planning can be structured best.
Shazia Tasneem is a journalist, critic and a right activist. Her work has appeared in leading Pakistani publications.