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The population challenge

Rising population poses a serious threat to Pakistan’s progress. Here are a few suggestions by experts to stem the crisis

The population challenge
 The biggest issues facing Pakistan are the booming population growth and the lack of awareness across the board regarding how big a threat this poses to the country’s progress. Simply put, the country has too many people and not matching resources in the spheres of food, health, education, and employment systems. Conferences are held and experts join their heads in exasperation to think of policies and projects that can manage this unbridled growth. Yet, the most basic of problems is often overlooked — raising awareness.

If enough efforts are not made to slow down Pakistan’s population growth rate, the population will likely increase from the current 189 million people to 310 million by 2050 (UN DESA, 2015). But this is a conservative estimate. According to President Population Association of Pakistan and Chairman Punjab Higher Education Commission Dr Nizamuddin, the country’s population would cross the 395 million mark by 2047. He said this at the recently held Eighteenth Annual Population Research Conference, Population Growth and Investing in Human Resource Development, in collaboration with Government College University Lahore. With just three years left to achieve its FP 2020 targets, Pakistan’s high growth rate of 2.4 per cent depicted in Population Census of 2017 asks for serious efforts.

Speakers at the conference gave different and relevant solutions to how the challenge can be met. Dr Aziz Rab of Greenstar Marketing emphasised on a number of ideas, all aimed at raising general awareness among people regarding family planning, like a toll free number where people can get guidance regarding FP, as well as free air time for the purpose. However, all of this would need political will and support from the government.

If enough efforts are not made to slow down Pakistan’s population growth rate, the population will likely increase from the current 189 million people to 310 million by 2050 (UN DESA, 2015). But this is a conservative estimate.

Dr Attiya Inayatullah, Chairperson Rahnuma Group of Pakistan, pressed upon the need for public-private partnerships to achieve the desired targets. She expressed the need to bring the private sector on board in all FP efforts, as well as leveraging men to become allies in this endeavour. Stalwarts of the field like Dr Mehtab S. Karim, Executive Director, Centre for Studies in Population & Health, Dr. Zeba A. Sathar, Country Director, Population Council, and Dr. Farid Midhet, Vice President, Population Association of Pakistan & Country Director, Jhpiego Pakistan, participated in the conference.

A panel discussion on Pakistan’s 6th population census results, organised by Jhpiego and the Population Association of Pakistan, had experts debating the methodology of the population census 2017. Journalist Zofeen Ebrahim who was invited as a panelist at the session, said that now that Pakistan has a fair idea of the numbers “we need to focus on planning for the people in earnest instead of quibbling over the methodology of the census”.

As Dr Inayatullah pointed out, Pakistan has the know-how and can achieve the targets. What it needs right now is a reality check, she said. “There are two gaps: Implementation is key for which we must get down to the grass roots. And secondly, where do we find a political leader who will speak out boldly in an upfront manner about this?”

A possible solution

While moots like the aforementioned conference give the much needed impetus to the issue at the top of the pyramid, doctors working at grassroots level like obstetrician Dr Halima Yasmeen at the Jinnah Postgraduate Medical Centre (JPMC) Karachi, feel that growth rate cannot be slowed down till awareness is raised. For this, dedicated counselors who can talk to women and convince them to use contraceptives can play a core role.

“It is an evidence-based fact that introducing a cadre of FP counselors shows better results when it comes to use of contraceptives. These counselors should be there at hospitals 24/7, just like nursing and janitorial staff is there round the clock. And their job should be only to talk to people,” she said, emphasising the importance of convincing people to use contraceptives.

“Our doctors are fulfilling their own dreams, and are on autopilot mode. What they are not doing is fulfilling the needs of this country as a whole,” said Dr Azra Ahsan, gynaecologist and consultant at the National Committee for Maternal and Neonatal Health (NCMNH). Dr Ahsan, while talking to The News on Sunday, expressed that the key to solving this problem lies in sensitising healthcare practitioners. “Every healthcare provider should know about providing family planning (FP) services. But they are not taught how to do it properly even in medical colleges. They don’t even know how to manage post-partum hemorrhage, because there is no glamour in this kind of healthcare service,” she says.

With mobility restrictions and traditional barriers, women don’t readily come to hospitals and clinics. However, the rates of women opting for deliveries in hospitals or healthcare units has gone up considerably, and this allows a great opportunity to convince them for post-partum contraception. “Most women do not come back for follow ups, which means that they will not get contraception-related advice in time,” says Dr Ahsan, commenting on golden opportunities that keep slipping through the net.

A project of NCMNH involved stationing two to three dedicated FP counselors in selected hospitals in Karachi, and this strategic placement multiplied the number of women opting for contraceptives like Intra-Uterine Devices (IUDs). “The day the counselors didn’t come, we saw that no women opted for contraceptives,” says Dr Ahsan.


Surah Yusuf – The Best of Stories – Reflections

Surah Yusuf, Chapter 12 of the Quran, is the most engaging, timeless, and complete story ever. It was relevant back then and it is relevant today.

Prophet Yusuf (as), known for his miraculously good looks, was beautiful both inside out. Often people advise pregnant women to recite it to have a beautiful baby. This tradition is not proven by any verse of the Quran or hadith. This is also is certainly not what the Surah is meant to be used for.

The real impact of this Surah is how it helps beautify relationships, and teaches invaluable lessons in times of difficulty and ease.

The Quran itself calls the true story of Prophet (Yusuf) “the best of stories”. It is the story of the life of Yusuf (as). Here are a few reflections on this Surah:

·         There are disadvantages of announcing your plans and showing off blessings – the evil eye (Nazr-e-Bad) and jealousy. Do not share plans till they materialize. For example initial pregnancy, intent to marry someone, the initial job interview that went well. Don’t also announce good dreams. (12:5)

·         Three elements of Sabrun Jameel (beautiful patience): Don’t announce your suffering all the time. Don’t complain to everyone. And don’t imply that you are perfect and free of faults. (12:18)

·         Maturity does not come without having gone through difficult times. Tough times have a way of making us stronger and hopefully wiser. (12:21)

·         The credit goes to Allah if we do something good and are able to ward off a temptation. The biggest temptation is narcissism and vanity. (12:24)

·         People don’t listen to our tableegh if we have not developed a relationship with them. See the example of Yusuf (as). He had developed a bond with the other inmates in jail. That is why they listened to him. Point: Work on relationships with sincerity.

·         Effects of your a’amaal (deeds) reflect on your face – both good and bad. In a world where you have to keep marketing yourself, humility becomes difficult. But it is important for tazkiyah (purification) of the nafs (self) to not announce your achievements all the time. However, undue humility can hamper you getting the deserved position. Therefore, maintain a balance. Tell when necessary & offer your services where needed. Undue modesty will stop you from doing the duty Allah assigned you. Be like Yousuf (as) – humble yet confident, but giving Allah credit for everything good. (Reflection of qualities of Yousuf {as})

·         To be a ‘mohsin’ – one with a beautiful attitude and nature – Sabr (patience) is inevitable. A reactive, inflammable personality cannot be a mohsin. (12:56)

·         In the era of Facebook and Instagram where we share every joy and share every plan with hundreds, we need to remind ourselves that Nazar-e-Bad [evil eye] is a reality. Safeguard yourself against it with prayers, especially the last 2 chapters of the Quran. Also do not announce your plans and every achievement and joy. (12:67)

·         “Do not grieve yourself over what they did” – Beautiful advice Yousuf (as) gave to his brother Bin Yameen. Reminder to self: Stop focusing on the few people who are a test for us and bother/hurt us. Instead, focus on those who are the coolness of your eyes, and are good to you. Ramadan is the best time to let go of this baggage of “I am hurt by him/her”. (12:69)

·         There is someone more knowledgeable than you, always. There is always someone who is better than you even in the things that you are good at. And the most Knowing and Perfect is Allah. So stay humble. You are not the ultimate. Never. (12:76)

·         Allah Knows the reality of people’s intentions and situations. Therefore stop judging people. You do not know their journey. You have not traveled their path. (12:77)

·         A sure shot test of whether you are a “mohsin” or not – check your behaviour with those who are under you or you have power over them. As a parent, as a senior at work, as a ruler, as someone who has house help. How are you with those who don’t have power over you? (12:78)

·         There is patience. And then there is what the Quran calls “Beautiful Patience” – Sabrun Jameel. Another sign of beautiful patience is that you stop assuming things about others and control your habit of judging others and commenting on them. (12:83)

·         Complain of your pain, heartache, and hurt others cause only to Allah. Allah can help. Those whom you gossip to cannot help. (12:86)

·         Give people the benefit of doubt. And at times even if you know they intended to harm you, do not announce in front of them that you know. Sometimes it is wiser to hold your peace. (12:89)

·         If someone hurt you a long time ago – it could even be a parent, a sibling, a friend – don’t think to yourself ‘I can never forget/forgive what he/she did’. Let go! Forgiving is healing for yourself more than anyone else. (12:92)

·         Sometimes grief leads to happiness, and failure leads to success, in the long run. Sometimes the very person that caused you great distress will become the cause of happiness. The situation will get better. Hang in there. (12:96)

·         Your company leads you to become the person you are. Therefore choose your company carefully. Good company in this world will lead us to be in the company of the righteous in the Hereafter. Choose wisely. (12:101)

Day 8, Day 9 & Day 10 #Ramadan #Quran #Verseoftheday #Paradise #Charity #AngerManagement #Forgive #Chastity

– Day 8, Day 9 & Day 10
Forgive and be Forgiven  

And hasten to forgiveness from your Lord and a garden as wide as the heavens and earth, prepared for the righteous.

Those who spend [in the cause of Allah] during ease and hardship and who restrain anger and who pardon the people – and Allah loves the doers of good.


And those who, when they commit immorality or wrong themselves, remember Allah and seek forgiveness for their sins – and who can forgive sins except Allah? and (who) do not persist in what they have done knowingly.

How beautiful is Islam, full of hope, for the door to forgiveness is always open till the last breath.

These verses from Surah Aal-e-Imran have multiple inter-related themes. Here I am, marveling at each verse and each word and each letter that is meaningful beyond comprehension. With gentle love and care, our Merciful Rabb shows us the path towards salvation, guiding us each step of the way, motivating us, telling us what to do.

The surface of the key subjects in these 3 verses can be at best barely touched upon as under:

  • Verse 133: Allah (swt) is using the word “Saa-ri-‘oo” – rush, hasten, run, compete towards Allah’s forgiveness. The word implies that we must not delay, for each moment is precious. Allah’s forgiveness is the only thing that can lead us to the unimaginable Paradise that He has lovingly prepared for the God-conscious. What fascinates me is the fact that the Quran recognizes that even the God-conscious or “Muttaqeen” who may eventually end up in Jannah with His Mercy, will make mistakes, but with effort and sincere intention to improve, they may attract Allah’s forgiveness. The people of Jannah are not perfect. But they accept their faults and strive to improve, and do good deeds that may wash away their sins. #Hope
  • Verse 134: SPEND – One of the sure shot ways to wash away your mistakes. And spending not conditionally only when you have lots to give, but spending in times of difficulty and financial restrain. Spending what we love. Spending even when we do not have a lot of “extra” to spend. Spend on those who live on earth, and He will forgive you and shower blessings on you from the heavens.
  • Verse 134: CONTROL ANGER – Anger in all its forms. Both inner and outer. Outer anger manifests itself as abuse, violence, taunts, sarcasm and harming the other. Inner anger manifests as grudges and ill feelings. The word “kaazimeen” is so apt – to suppress. Meaning the anger IS there, and in all probability is justified, and the person we are angry with may have hurt us or wronged us. Yet, true strength lies in controlling this negative emotion.
  • Verse 134: FORGIVE: Wow! So if we want Allah (swt) to forgive us, we have to forgive those who have harmed us. So many times, even if we are somehow able to suppress anger, the seething pain and the grudges towards those who have hurt us remain. They do not harm that person, mostly. These ill feelings damage the heart that is housing these ill feelings. Allah (swt) is telling us to let go of whatever it was. After all, if it is Allah (swt) on whom we have tawakkul (reliance), we have to trust that He Knows who hurt us and harmed us and scarred us. If we want to heal, this is the only path – forgetting may not be possible but forgiving (with a lot of hard work) is a possibility. So let go of that anger…..forgive…for inner peace. For Paradise will be home to those who have found inner peace 🙂
  • Verse 135: BEGGING FOR FORGIVENESS: Yes, even those who will eventually, InshaAllah, enter Paradise, make major mistakes and commit major sins….sins that come under immorality, indecency, and go against the command to guard their chastity. When they do so, they have wronged no one but themselves. The inner impressions such sins leave harm our soul, bit by bit. The verse addresses those who have harmed themselves. Recognizing that one has erred and accepting that it is we who harm ourselves is the first step towards forgiveness. When they ask Allah (swt) for forgiveness, Allah (swt) showers His forgiveness on His slaves. But the one condition this verse puts forth is this: Do not insist on repeating a sin when you realize it is a mistake. Strive and aim to ward it off, and ask Allah (swt) for the strength to be able to resist the temptations. And its beautiful when the verse says who can forgive but Allah (swt)? The piles and mountains of our sins can only find forgiveness in our Rabb, the Magnanimous and ever Merciful.

As the beautiful Hadeeth-e-Qudsi says:

On the authority of Anas, who said: I heard the messenger of Allah say:Allah the Almighty has said: “O son of Adam, so long as you call upon Me and ask of Me, I shall forgive you for what you have done, and I shall not mind. O son of Adam, were your sins to reach the clouds of the sky and were you then to ask forgiveness of Me, I would forgive you. O son of Adam, were you to come to Me with sins nearly as great as the earth and were you then to face Me, ascribing no partner to Me, I would bring you forgiveness nearly as great as its.” (Tirmidhi)

In this most special of months, let us forgive and beg Allah for forgiveness.

Love in War – The love story of a Syrian refugee

Published: December 20, 2015

Tracey and Ahmed are waiting to begin a new life in Sweden once Ahmed gets legal residency in the country. PHOTOSCOURTESY: TRACEY SHELTON

Tracey and Ahmed are waiting to begin a new life in Sweden once Ahmed gets legal residency in the country. PHOTOSCOURTESY: TRACEY SHELTON

He is thousands of miles away from his home in Aleppo, Syria, in a refugee camp in Bastad, Sweden. The Nordic winter is bitterly harsh here in December. The journey as a refugee has been long and winding. “We travelled mostly on foot; it was dangerous,” says Ahmad Al Haj, one of the more than four million Syrian refugees who have had to leave home in quest of safety. But Ahmad says it was all worth it in the end, as in the midst of war and displacement he found the love of his life.

For Tracey Shelton, now Ahmad’s wife, the wait for her husband to get legal residency in Sweden is not easy. “It has been really tough being forced to stay apart for so long, but hopefully it will be coming to an end soon. His asylum has been approved; we are now undergoing what seems like an endless wait for them to issue his papers,” says the Australian journalist and photographer who has spent years covering conflict in volatile regions, including Iraq, Libya, Syria and Lebanon. She is presently living in Istanbul, Turkey, in what she calls a “limbo”, waiting to move to Sweden to start a new life with Ahmad.

Families grieving outside a hospital in Aleppo province after identifying the bodies of their loved ones following a government airstrike that killed civilians.

Images of those affected by the Syria crisis and painful headlines about the spillover effects of it tell much about the situation on ground, but millions of stories behind the images and headlines remain untold. Ahmad and Tracey’s love story is one of them.“Her work and her understanding of the situation in my region,” is one of the things Ahmad mentions when asked what drew him to her. By reporting on conflict and internal displacement, mostly within the Middle East, an affinity with Ahmad came naturally to Tracey. “After six years of working largely on frontlines and with Arab families, it’s hard for me to fit back into life in a Western country,” says Tracey.

The couple met socially when Tracey was living in Syria. “We met through a mutual friend. Ahmad and I got along really well from the beginning and became close friends. Things developed from there,” explains Tracey, adding that one of the reasons Ahmad took the trip to Europe was so that they could establish a life together.

Getting married was another obstacle for the two of them. Here were two people wanting to start a life together, and the proverbial man-made laws restricting them from doing so. “In Turkey it is illegal for a Sheikh (Muslim clergyman) to perform a nikaah (religious marriage) without a legal marriage so we couldn’t find anyone to do it there,” says Tracey. “Although in Islam, marriage between a Christian woman and a Muslim man is permitted, the Sheikhs did not want to accept the responsibility. We eventually found someone (to perform the nikaah) in Sweden, but we are still waiting for our marriage to be registered.” After trying for six months, the couple got married in June this year.

Protest against the Syrian government during a rally in Syria.

The couple has been living apart since Ahmad left Turkey for Europe earlier this year; they only get to meet sporadically when Tracey visits him. “Since he’s been in the camp, it’s harder for me to visit.”

While Ahmad has dreams of a secure future with Tracey, the ordeal has been traumatic. “Life was normal in Syria before the revolution. I never thought I’d be a refugee one day. I was still studying at the time and thought I’d go on to develop my career in IT,” reminisces Ahmad, son of a civil engineer and businessman and the eldest among three brothers and a sister. “The fighting in our area turned intense. It became hopeless to stay there. It was difficult to even get food and medicine. Our entire family left Syria together,” he recalls.

The Al Haj family, today, is spread all over, and none of them have yet acquired asylum anywhere. Ahmad’s father returned to Syria to try to sell some of his property, while his mother, brothers and sister are in Southern Turkey. “The displacement affected us in every way possible. I don’t have any legal status anywhere. On paper, technically, I didn’t exist. You have no rights, no identity, no work, and no way to study again,” says Ahmad, who now spends most of his time in the camp fixing everyone’s phones and laptops.

A boy holds up a piece of shrapnel during a protest in the town of Kureen in Syria.

Despite the situational difficulties and a mostly long distance relationship, the two of them lighten up when asked about each other. “He is intelligent, funny, cool, sweet and charming. He cares about me and looks after me in a way I never dreamt of. He is also excellent with languages. He speaks three languages expertly,” says Tracey. Ahmad’s easygoing charm worked on her, as he was easy to talk to, she shares. “He has a lot of knowledge and a deep understanding of things. I love talking with him and listening to his ideas.” For Ahmad, what attracted him to her was “how she treats people. Her personality. And her beautiful eyes”.Tracey recalls when she met him twice en route to Greece and Serbia. “The soles of his feet were just two huge blisters from walking, just cushions of liquid. I don’t know how he managed to walk on them. But from there they had to keep walking through to Hungary.”

According to Sweden’s migration agency Migrationsverket, the applications for asylum received by Sweden in January 2015 were 4,896. By November 2015, the number rose to 36,741, and more than 25,000 of these are males. So far this year, more than 120,000 people have applied for asylum in Sweden.

While the future looks bleak for Syrian refugees, they have certain advantages, according to Tania Karas, an Athens-based journalist covering migration and refugee issues. “Syrians in particular tend to be middle-class, educated and technologically literate,” she says, adding that while this may be a slight generalisation, it does mean that Syrians, more than other refugees, have an easier time navigating their journeys and assimilating into European society. “Another advantage is that Syrians are considered ‘prima facie’ refugees because there’s an active war going on in their country so they are highly likely to be granted refugee status,” says Karas, who has been actively working with Syrian refugees in the Greek island of Lesbos. More than half of the refugees and migrants who have reached Greece this year have landed at Lesbos. Some 3,460 lives have been lost crossing the Mediterranean, reveals data provided by the United Nations Refugee Agency (UNHCR).

The number of Syrians arriving in Europe seeking international protection continues to increase. However, according to the UNHCR, it remains low compared to Syria’s neighbouring countries, with slightly more than 10% of those who have fled the conflict seeking safety in Europe. Sweden which has had a very relaxed system in the past, where refugees could enter the country unobstructed, is now introducing border checks. The laissez-faire might not be feasible for Sweden any more, considering the very real security threats following the attacks in Paris. The situation, thus, seems poised to make life even tougher for the refugees. And a solution seems nowhere in sight.

An earlier photograph of Syrian rebel fighters praying before launching an anti-government attack near Idlib city.

UN High Commissioner for Refugees António Guterres acknowledges that this is the biggest refugee population from a single conflict in a generation. “It is a population that needs the support of the world but is instead living in dire conditions and sinking deeper into poverty,” Guterres says. According to the UNHCR, Syrians in exile face trials such as living in sub-standard shelters and below the poverty line in countries like Jordan and Lebanon. “Having to leave behind their family and friends and not knowing when they will see them again or whether they will see them alive are the prime difficulties Syrian refugees face,” says Argentina-based correspondent Kamilia Lahrichi. It’s tough for refugees to adapt to a new culture because of cultural barriers, she adds.While Ahmad appreciates European countries opening their gates for the refugees, and acknowledges that they try their best to help refugees and keep them comfortable, he is very clear when asked what he sees as a solution to the Syria crisis. “All of the outside countries — USA, Russia, Iran, Saudi Arabia — need to back off and let us solve our own problems. Foreign powers have made Syria their playground, trying to prove their strength,” he says. Tracey echoes the sentiment and expresses dismay at what started as a revolution has escalated into a regional proxy war. “Everything in Syria has become so complicated with too many players. I honestly don’t know what the solution is anymore.”

But for Ahmad, “the most difficult thing is being apart from Tracey” at the moment. “Until Ahmad’s final residency decision, everything is up in the air. Once it’s finalised Ahmad can start working here in Sweden and I can join him. We hope to start a family too,” says Tracey. Till then, love must wait.

Farahnaz Zahidi works as a senior subeditor at The Express Tribune. She tweets @FarahnazZahidi

Published in The Express Tribune, Sunday Magazine, December 20th, 2015.

We need to stop treating menstruation as a ‘fault’

Published: May 28, 2015

The bloody taboo refuses to be broken. Recently, an urban affluent woman was overheard commenting that advertisements for these products should be banned. PHOTO: FARAHNAZ ZAHIDI

“So what do you do when you… you know… have your monthly period?” I said to my domestic helper, after my mouth-gaping-open-in-shock reaction was over and I found my voice.

For an urban woman, what she was telling me was unthinkable. I was truly scandalised that many women in Pakistan’s underprivileged parts walk around with no sanitary cloth or napkins when they have their menstrual period. Others do use folded pieces of cloth, she told me, but even then the hygiene conditions she was describing were hardly satisfactory.

The year was 2010. Pakistan had been hit by one of the worst natural disasters in the country’s history – floods that affected the lives of some 20 million people. My friends and I were collecting donations and sending them off to remote villages and affected areas. Those working on ground were asking us to send dry food items, bedding, medicines, clothes and basic items like soaps and sanitary napkins.

“People here are breaking out into skin infections due to the stagnating dirty water. Women need their supplies for menstrual hygiene,” was the message we got.

Yet, here was a Pakistani woman hailing from a rural area, educating me in a basic reality – that even if we did send sanitary napkins, would those women, for whom even seeing a midwife in pregnancy is a luxury, know how to use it?

But then, realistically, is menstrual hygiene even a priority to ponder about for people living below the poverty line, unable to even get two square meals? It is all good, noble and convenient for me and my likes, to sit in our comfortable homes in the cities and talk down to poor women about how filthy is the way they handle something so basic. The reality is they have not had the exposure, nor the access to things we take for granted.

As the world celebrates Global Menstrual Hygiene Day on May 28, how far is Pakistan, in reality, from providing its female citizens the means to go through a natural physiological process with dignity?

Research points out that almost 50 per cent of Pakistani girls in rural areas and underprivileged circumstances miss school during their menstrual period, and absenteeism in school can improve drastically if they have access to protective material and proper toilet facilities at school. Yet, sanitary cloth and napkins remain not a basic need but a luxury for Pakistan’s daughters who cannot afford them, or are simply unaware. The problem becomes even gorier when faced by displaced women living in slums, camps for IDPs or in nomadic setups.

To go through their monthly cycle hygienically and in a dignified manner, girls and women need access to water and proper sanitation. Privacy is needed to change; water and soap is needed to wash their hands and the cloths if they are using those, and means to either dispose used materials or a private place to dry them in case of reusable cloths.

Poverty, however, is not the only issue here. The bloody taboo refuses to be broken. Recently, an urban affluent woman was overheard commenting that advertisements for these products should be banned. Giving credit where due, advertisements for sanitary napkins are actually now more decent than many other ads, and are actually more educative in nature in an attempt to raise awareness.

A two-pronged approach will, therefore, have to be adopted to help women of Pakistantriumph against the lack of a basic human right. For starters, they will have to be educated about the health-related consequences of not maintaining menstrual hygiene management(MHM). As a society, we will have to learn more about it. Systems have to be evolved for disposal of the waste cloths and napkins to not make it an environmental hazard, as well as let women have the dignity to dispose it respectfully.

Secondly, access to products that help women at a low cost is something we need to think about. Whether it be clean cotton or rags, or affordable napkins, women everywhere should have the right to procure them and use them. We need more initiatives to address the problem.

It is time the world stops treating menstruation as a fault for which women continue to pay a price by facing embarrassment and helplessness.

The poor woman’s disease: Living in pain for 25 years, Sursan Bibi smiles again

Published: May 22, 2015
The midwives of Koohi Goth Hospital. PHOTO: COURTESY FAISAL SAYANI

The midwives of Koohi Goth Hospital. PHOTO: COURTESY FAISAL SAYANI

QUETTA / KARACHI: For 25 long years, Sursan Bibi guarded a secret, one that she has only told her husband, Musa Khan, about. Sursan had an obstetric fistula, the pain of which is only exacerbated by the sense of shame that comes with leaking urine uncontrollably.

The prospect of treatment only came up recently, when a flyer about fistula and its treatment reached her village. Travelling 400 kilometres from Harnai district, her eldest son Hazrat brought her to Quetta. While her surgery was successful, Sursan, now 65, regrets the years of her life that were wasted.

Known as ‘the poor woman’s disease’, the obstetric fistula develops in prolonged labour when the mother cannot seek proper medical care or reach a trained midwife in time. “The baby’s head may get stuck in the birth canal and if it keeps pushing against the thin wall between the birth canal and the bladder or rectum, it causes a tear,” explains Dr Suboohi Mehdi, a surgeon at Karachi’s Koohi Goth Hospital, Pakistan’s most well-known hospital for the treatment of fistula. The result is urine or stool incontinence. For such women, who leak waste continually and are ostracised from society, normal life becomes a distant dream.

Sursan, married too early, gave birth to five children at home with the help of a dai (traditional birth attendant). In her village, the women are allowed to leave their homes only to visit relatives or take cattle for grazing; they are not allowed to seek medical help without being accompanied by their male relatives.

A day after her third child was born, she started to leak urine. The smell was unbearable. The dai told her husband that it would get better in a few days but days turned into decades, during which she bore two more children. Unlike most women suffering from this condition, Sursan’s husband didn’t abandon her.

Parts of Balochistan, like most underprivileged parts of Pakistan, have a high incidence of fistula. United Nations Population Fund (UNFPA) provincial coordinator Ahsan Tabasum, talking to The Express Tribunein Quetta, says that the UNFPA and Pakistan National Forum for Women Health (PNFWH) are working together to eradicate this disease from Balochistan.

“We have centres for fistula treatment in three hospitals in Quetta, where the patients are treated free of charge,” he discloses. Around 515 patients have received treatment here since 2006, with a success rate of over 90 per cent, while the UNFPA has helped over 5,000 women in Pakistan with surgical treatment for the disease through its seven regional centres in the country.

A lot of women travel all the way from all provinces to Karachi to get treatment at Koohi Goth Hospital. Surgeons here are trying to salvage 33-years-old Gulzada Zaman’s bladder. But for Gulzada, it may already be too late. “If only a skilled midwife would have told her in time that her next delivery should be surgically done, this girl’s life could have been saved,” laments Noor Gul, a midwife who has been serving at Koohi Goth since nine years. “The lack of awareness, and how easily the disease can be avoided, is very frustrating. Doctors cannot always reach far flung areas, so the key is having trained midwives in every part of Pakistan,” she says.

Noor and her colleagues have to not only bathe and clean the patients who arrive after strenuous journeys, but also have to psychologically counsel them and make them believe that they are not “unclean”. Complicated cases require more than one surgery, and treatment and rehabilitation can take months.

Another kind of fistula, fast increasing in number, is the iatrogenic fistula which develops when an unskilled surgeon performs a surgery poorly due to malpractice and lack of training.

UNFPA has supported more than 5000 women to receive surgical treatment for fistula in Pakistan through their seven regional centres in the country. The campaign involves three key strategies – prevention, treatment and social reintegration of survivors. Yet, more needs to be done. According to Tariq Nisar, Media Coordinator for PNFWH, “an estimated 3000 to 5000 year new cases develop each year in Pakistan.” Women like Sursan who suffer from obstetric fistula are usually among the hardest to reach, and are often illiterate and with limited access maternal and reproductive health care. With gender and socio-economic inequality, lack of schooling, child marriage and early child bearing already holding back Pakistan’s underprivileged women, patients smelling due to the fistula suffer from further marginalization. Even when cured, the psychological impacts remain, and many are abandoned by families too.

Meanwhile, Sursan Bibi’s smile has returned. “I will not advise any woman in my village to go to the dai,” she vows. “Instead, I will urge them to visit the gynaecologist.”

Published in The Express Tribune, May 23rd, 2015. 

Women empowerment: Educating the girl to become a strong woman

By Farahnaz Zahidi

Published: May 3, 2015

The university recently signed a memorandum of understanding with the All Pakistan’s Woman Association. PHOTO: REUTERS

LAHORE: “Being a woman doesn’t mean I am less than a man in any way,” Hiba Hassan, a 22-year-old student at the Lahore College for Women University (LCWU), says. The young head girl of her class speaks of a sense of motivation and empowerment that she attributes to sensitisation regarding gender equality that she and her fellow students have been exposed to at the university.

The university recently signed a memorandum of understanding with the All Pakistan’s Woman Association (APWA), one of the first partnerships of its kind for gender equality. Together, they organise workshops and trainings for students and teachers to increase an understanding of gender equality. Part of the objective is to include women in peace processes at all levels and celebrate them as agents of peace.

Professor Shireen Asad, the student affairs director at the college, says, “We have more than 12,000 students studying up to PhD level. As an institute we feel that women’s empowerment is a basic pillar of progress.” Asad, an expert in psychology, says she believes that it is important to expose girls to ideas that could help them develop confidence and self-worth.

Durre Shahwar, the programme director at the APWA, echoes Asad’s sentiments. “I work on programmes to protect the girl child from exploitation. I believe in raising awareness in children’s formative years.” Shahwar has been working with the APWA to educate young women and men students about gender equality.

She says boys studying at the Ahmed Hassan Polytechnique College are being educated about these basics as part of their efforts. “We are working on another project with 200 girls from Kinnaird College. They will be involved in community service and will become agents of change,” Shahwar says. Recently, the association held a national conference titled the Role of Women in Promoting Peace and Harmony for a better Pakistan. The conference aimed to provide a platform to key stakeholders to come together and highlight the importance of women in peace and development. More than 200 students distributed pink scarves with messages of peace and equality painted on them. The scarves were made by students themselves. “Equality is not possible without economic empowerment,” says Shahwar. She says the APWA has been working on micro-finance projects aimed at helping out financially underprivileged women.

Published in The Express Tribune, May 3rd, 2015.