Not wanting to lose count, or simply having exhausted all her favourite baby names, a woman in interior Sindh named her 21st child “Icki” – the number 21 in Sindhi.
Icki was born in 2011 during the floods in interior Sindh.
The name sounded less than peculiar, in fact even more common than one would have thought, to a group of doctors and midwives working in the flood-affected areas of Sindh.
The story, however, highlights the unmet challenge of family planning in Pakistan. According to the latest Pakistan Demographic Health Survey (PDHS 2007), 25% of married women opt for family planning but are unable to access it due to various reasons.
This often results in unplanned pregnancies, many of which end in unsafe abortions and maternal deaths.
According to the Population Council 2004, an estimated 890,000 abortions are performed in Pakistan each year.
Usually, women who opt for abortions are married with four or more children, and have exhausted their economic constraints. For them, abortion seems to be a family planning method rather than using effective contraception.
According to the PDHS 2007, unsafe abortion accounts for 5.6% of maternal deaths. Higher figures are quoted from larger tertiary hospitals all over Pakistan. Increased contraceptive use would reduce the number of unsafely performed abortions and resultant deaths.
The Contraceptive Prevalence Rate (CPR) is 30% in Pakistan – a figure that has virtually remained the same over the last decade – which is considerably low as compared to other Muslim countries. Iran has 74 % CPR, Turkey 71%, Morocco 63%, Indonesia 61%, Egypt 60%, Bangladesh 56% and Malaysia, 55%.
Out of the 30% in Pakistan, only 2% use the most highly effective modern methods, such as hormone contraceptive pills, implants and injections or the Intrauterine device (IUD). These methods have the least chances of failure (less than 1%) and are highly reliable, safe methods. Out of those women who opt against contraception, 28% choose to do so by “leaving it to God”. This reason is closely followed by opposition from husbands, fear of side-effects and lack of knowledge. Only 5% have a perceived religious prohibition.
Modern and highly effective contraceptive methods are freely available in the large cities of Pakistan but not in most of the rural areas where they are needed the most and where women are least empowered.
Every doctor and nurse is fully updated and conversant with all the modern and effective contraceptive methods, including emergency contraception.
A pre-marital visit to a trained family/general physician or gynaecologist should be mandatory in Pakistan as there is no formal sex education in schools and colleges.
Contraception counseling (to prevent unplanned pregnancy) should be made available before marriage. This should be combined with health advice and screening; Blood group (to prevent Rhesus incompatibility), Rubella (to prevent German measles in pregnancy), Thalassemia screening and Human Papilloma Virus (HPV) Vaccination (to prevent cervical cancer). These suggested measures have already been implemented in other countries with success.
They should be made compulsory by the government for all couples before marriage, in order to control the population of Pakistan, which has already been projected to be the fourth most populated country in the world in 2050.
The writer is a consultant obstetrician & gynaecologist
Published in The Express Tribune, September 26th, 2012.