The conditions under which these abortions are carried out are horrendous. PHOTO: REUTERS
She had no remorse on her face as she sat in front of me sharing the story of her third induced abortion she had gotten done a few weeks earlier.
“I already have five children. I am working for your mother in Karachi. My family is in a village near Rajanpur. Who’d look after the baby?” said Sughra, my mother’s maid, when I asked her why she kept having abortions.
“In my village, it’s a done thing baji. Every woman gets it done. All married women. The daai (midwife) takes Rs 300. She uses dawaai (medicines) or any sharp instrument. I nearly died in the second one, I bled so much,” she shared the details as I looked on in horror.
I had my first detailed one-on-one meeting with Sughra amongst the one million Pakistani women who have unsafe abortions every year. Over the years, as a journalist working on maternal health issues, I have met scores. The stories have multiplied. The commonalities are many. And it sends shivers down my spine every time. These women are lucky to be alive to tell their stories. Others are not so fortunate. The conditions under which these abortions are carried out are horrendous. They ingest chemicals. They jump and skip ropes. They let unskilled hands plunder their most sensitive organs. They often bleed uncontrollably. They develop complications that often lead to near fatal problems.
Out of the 30,000 maternal deaths yearly in Pakistan, a substantial part is related to unsafe abortions. Yet, it goes on. In shady places. At homes. In small so-called clinics.
Breaking many stereo-types, Sughra taught me a lot that day. For starters, mostly unsafe abortions are used as a form of contraception. Instead of a precautionary method, they think of getting rid of the foetus once it has been conceived. Ironically, many feel it is against religion to practice contraception, but go ahead with an abortion which is strongly discouraged in most religions, while temporary contraception is not prohibited. Other reasons for avoiding timely Family Planning (FP) are husbands refusing to use condoms, myths about contraceptive pills and other forms of contraception, a lack of awareness or simple laziness.
Needless to say, after visiting some of the small abortion clinics, my research left me quite worried. The unhygienic surroundings, the very obviously untrained women posing to be doctors or nurses, and the sheer number of patients are cause for concern. I have walked into such clinics, with the natural advantage of being a woman, and quietly observed what goes on, without having to lie that I am a patient. All this goes on openly. It is known. But not much is done about it.
And this happens across the board, though 96.1 % of the women getting induced abortions in Pakistan are married. The list includes unwed mothers-to-be, commercial sex workers, rape victims and victims of incest. Inevitably, it is the woman’s body that suffers and her soul.
There has to be a solution to this insanity, I always think, frustrated, every time I meet such a woman, or the family of a woman who lost her life or developed a lifetime debilitation. Little Sajid, five-years-old, had lost his mother to an induced abortion in a village in the Bhit Shah vicinity. If only she had practiced contraception in time, Sajid would not be motherless; I thought as I looked at his pale face that had deprivation scribbled all over it.
The answer lies in awareness at many levels. People need to be sensitised to the fact that religion does not prohibit temporary contraception, which includes most forms. Those forms of FP need to be talked about. An example would be the cycle bead rosary which has worked in many developing countries – a simple rosary like string of 28 beads that allows a woman to calculate her fertile days. The shame associated with talking about contraception even within married couples has to be tackled. The mutual decision of birth spacing should be taken by the couple, not the mother-in-law as happens in a lot of families. For this, the men of Pakistan will have to be brought on board.
A holistic solution includes training midwives and traditional birth attendants to perform procedures hygienically, guide families about FP and refer them to the nearest health facility in case of complication.
But to me, the central piece of the puzzle lies in the women prioritising their own health, especially in their child bearing years, and making very careful choices when it comes to their reproductive health. The woman of Pakistan needs to know that she is the most important person in her life, and live her life that way. Only then can she be the backbone of her family.