Multi-Media Feature published in dawn.com:
Mushtari, aged 40, looked tired. It was 10 in the morning but it seemed as though she had just completed a day’s load of chores. As we walked towards a small room, where I wanted to sit down with her and record an interview in relative silence, she dragged her way in.
Life is too heavy a burden for this woman, who got married at the age of 14 and has given birth to 10 children. Her youngest daughter (six) tugged at her mother’s shirt as she revealed that never in her 26-year marriage, had she used any form of contraception.
Living in a village called Islamabad Karuna in the Khyber Pakhtunkhwa province, Mushtari is yet another Pakistani woman who faces severe health hazards as a result of bearing too many children. Her story is a reminder of a basic right that a staggering number of Pakistani women are denied – the right to choose when and how many children to bear.
After going door-to-door and woman-to-woman in the village and inquiring about the forms of contraception they use, if at all, it was evident to me that Pakistanhas a major problem – an “unmet need” for contraception. These are the ‘needs’ of women who want to delay or stop childbearing and are potential users of contraception, but do not use contraception. It is often a problematic challenge for advocates of women’s empowerment, who work towards providing women a better quality of life.
The Demographic Health Survey (DHS) 2006-07 indicates that the median age of Pakistani women at the time of the first marriage is 19 years. Yet, in the deeply traditional KP, the age of girls at the time of marriage is often much younger. A lack of awareness about contraception, illiteracy and deeply entrenched social conditioning that associates a higher social status with a greater number of children (especially sons), makes contraception taboo. Although a majority of Islamic scholars agree on use of non-permanent and less invasive forms of contraception, orthodox beliefs convince people that contraception is against religion.
“Our Contraception Prevalence Rate (CPR) has been stuck at 30 per cent for more than a decade. The definite unmet need shows that people, particularly women, do want to use contraceptives, but we have failed to deliver,” says Dr Azra Ahsan of National Committee on Maternal and Neonatal Health. According to the DHS 2006-07,Pakistan has a 24.9 per cent unmet need for contraception.
In the entire village, Alishba’s house was the only one where any form of contraception had been used. Alishba, five, is the youngest of the six children of a lady, who preferred to be called “Alishba’s mother”. She was the only woman who had used an Intra-Uterine Device (IUD) as a contraceptive method, thanks to the support of her husband.
“The main issue in KP, when it comes to unmet need, is a lack of awareness. And since male dominance is a norm, women do not have a right over their own bodies and have no right of decision-making when it comes to deciding on the number of children,” says Dr Nasreen Ruby Faiz, Head of the Department of Gynecology at Lady Reading Hospital in Peshawar.
While in the terrorism-ridden province, access to contraceptives remains one of the core problems, social, cultural and religious traditions as well as poverty and lack of awareness are bigger hurdles in practicing birth control.
“Women’s purpose of life in these areas is producing babies and cooking,” says Dr Zahida Begum of the Lady Reading Hospital, who is in-charge of the contraception unit. In Dr Zahida’s experience, if at all they come to a health centre for contraceptive advice, they have already had five to six children.
In the same village, 27-year-old Parveen has been married for ten years and has already been pregnant six times. She has never practiced contraception, because her 68-year-old jobless husband doesn’t approve of it.
Besides health hazards caused by having an uncontrolled number of children with no spacing, unsafe abortions are used as a form of family planning when an unwanted pregnancy occurs.
“I wish I had been to school and knew about this. But now, I plan to take charge, and seek help so that I can concentrate on a better future for my children,” she said.