Abortions have become the method of choice for family planning instead of condoms, prophylactics, the intrauterine device, the pill and vasectomies.
According to gynaecologist Dr Azra Ahsan, hardly 30% of people use contraception in Pakistan even though 96% of people are aware of it. And yet, the fertility rate is declining. “This is because of abortion, which is being misused as a means of family planning,” she pointed out at a seminar on population planning, organised by the Jinnah Post Graduate Medical Centre Saturday. About 890,000 abortions take place annually to get rid of unwanted pregnancies. Unsafe abortion is the fifth leading cause of maternal deaths in Pakistan.
“Data proves that about 43% of women do not have any reason to avoid contraception and believe that if they get pregnant, unplanned, it is ‘Allah ki marzi’ (God’s will),” Dr Ahsan said.
In Pakistan, two mothers die every hour, which, the experts say, is a weakness in the family planning service delivery system. Despite starting about 50 years ago, family planning has declined in Pakistan because of misinformation attributed to religion, disapproval from husbands or in-laws, the subordinate status of women and a lack of knowledge among healthcare professionals.
“[Thus], unwanted pregnanc[ies] may either result in high fertility, leading to a high population or in an abortion, that comes with many risks,” explained Dr Ahsan.
The good news is that 25% of Pakistanis do want family planning services but cannot get access to them. If they did get this kind of help, the country’s contraception use could go up to 55%. International health agencies recommend that there must be no pregnancy before 18 years or after 34 years of age and that a couple should space their children at least three years apart.
The choices for family planning and contraception are wide: female condoms, pills, new progestogens, hormonal vaginal ring, progesterone implants, male pills, reversible male sterilisation, intra-uterine systems and the intrauterine devices. “Of all of these, the oral contraceptive pill that has been is use for the past 50 years is still the best method,” she said. Its safety has been confirmed in one of the largest longitudinal studies involving 46,000 women over 40 years. It found that users are less likely to die prematurely of all causes, including cancer and heart diseases.
Family Planning helps prevent unwanted and high-risk pregnancies, and it also helps improve the woman’s health and lowers maternal mortality. The child who is born is wanted and valued, and has better chances of proper nutrition, care and education. Similarly, for the man, family planning means less stress on meeting the needs of a family and parents can have more time for each other. It is also beneficial for the country as there is less population, poverty and crime and increased resources and economic growth.
Dr Tasnim Ahsan, the executive director of JPMC, shared details of a pilot project of Post-Partum Insertion of Intra-Uterine Contraceptive Device (PPIUCD), which was successfully implemented at the hospital. The project was started by the National Committee for Maternal and Neonatal Health and aims to target family planning right after delivery. The pilot is being carried out at JPMC and Sobhraj Maternity Hospital, where doctors insert the intra-uterine contraceptive device right after pregnancy instead of relying on the old method of asking the mother to come at a later date for discussions. Dr Laila Shah, who oversaw the project at the two hospitals, explained that in six months about 1,900 PPIUCD’s have been inserted. The main purpose of the program is to institutionalise PPIUCD as a means of family planning. Dr Shah said that although they managed 18% results instead of the targeted 30%, it still proved that it can be done.
Published in The Express Tribune, October 14th, 2012.