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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.

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Reproductive health: ‘Healthy mothers mean a healthy nation’

Published: September 12, 2014

Research shows that when a mother dies, the children that are left behind are more likely to grow into adults with psychological issues. PHOTO: SHIRKATGAH

KARACHI: If you ask me what the government is doing about maternal and reproductive health of women and family planning, my answer will be ‘nothing’, said Planning Commission of Pakistan population section chief Shahzad Malik.

Malik – along with members of provincial assemblies, government officials, gender activists and members of civil society – said this at an event held at the Beach Luxury hotel on Wednesday. Organised by the Shirkatgah Women’s Resource Centre, ‘Next Steps: Achieving universal access to sexual and reproductive health and rights through a coherent post-2015 framework’ was a national consultation with stakeholders.

The discourse remains relevant as ever, with an estimated 30,000 women dying every year due to birth-related mishaps. While Maternal Mortality Rate (MMR) in Pakistan may have improved – dropping from 490 in 1990 to 260 in 2010 – a lot still needs to be done. MMR is the number of women per 100,000 live births who die of pregnancy and childbirth related complications. A staggering number of abortions – somewhere between 800,000 and 900,000 – are carried out in Pakistan every year, and most of them classified as unsafe abortions. Lack of contraceptive facilities and absence of timely family planning are the major reasons, as most women getting abortions are married women getting rid of an unwanted pregnancy.

Representatives from each province shared their experiences and problems. Balochistan’s representation was sorely missing as the speakers could not make it to the event. However, some jarring issues came to the fore in the discussions, such as the fact pointed out by moderator Imran Shirvanee. “Only two political parties bothered to talk to health experts when designing the public health manifesto, before the 2013 general elections,” said Shirvanee, refusing to divulge the names of the parties.

Punjab MPA Dr Najma Afzal Khan shared information about positive reproductive health initiatives and headways made in the province of Punjab. “The Punjab chief minister is committed to improving maternal health,” she said.

“In Punjab, there has definitely been progress,” said Dr Zafar Ikram, provincial coordinator of the Maternal, Neo-natal and Child Health Programme, Punjab. “However, problems such as unmet need of family planning methods persist. Gestational diabetes is on the rise and there is hardly any emphasis on post-menopausal cancer.”

The problems in Khyber-Pakhtunkhwa (KP), as pointed out by MPA Arshad Umerzai, are mostly to do with the security situation. “Also, while the policies of the provincial government in KP may be commendable, a lack of coordination and strained relations between the federal and provincial governments hinders progress.”

Issues related to governance and social and demographic dynamics were also discussed, and recommendations were made to improve the situation. Some of the problems pertaining to funding owe to the confusion that still exists between provincial and the federal governments after the 18th Amendment.

As the participants pointed out, it is time for maternal health to be taken seriously, especially since research shows that when a mother dies, the children that are left behind are more likely to grow into adults with psychological issues. Such issues, experts shared, are likely to fall into extremist behaviour as well.

Published in The Express Tribune, September 12th, 2014.

Junaid Jamshed and the ‘maternal instinct’

By Farahnaz Zahidi / Photo: Ameer Hamza

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A side to this man shrouded from public eye has to do with his work as philanthropist whose focus is maternal health. PHOTO: AMEER HAMZA

A side to this man shrouded from public eye has to do with his work as philanthropist whose focus is maternal health. PHOTO: AMEER HAMZAA side to this man shrouded from public eye has to do with his work as philanthropist whose focus is maternal health. PHOTO: AMEER HAMZA

Who would have thought that the pop-icon turned televangelist who irked women with the statement “it is better if women are not taught to drive” has invested the last ten years trying to save the lives of underprivileged women of Pakistan

Junaid Jamshed — the name brings to one’s mind an image of two juxtaposed pictures: one of a drop-dead handsome young Junaid, the other of a seasoned man with a long beard and a mellower face, beckoning people to come towards Islam.

Yet, there is a side to this man shrouded from the public eye. And that has to do with his work as a philanthropist whose focus is maternal health. Once known as the darling of female fans, Junaid is still very connected to women — he is helping save the lives of thousands of them in Pakistan. The man continues to surprise us and challenge stereotypes.

At the Muslim Charity fund-raising dinners in Manchester, Birmingham and London May 31 to June 2, 2013. PHOTO: MOHAMMED RAYAZ

Yet, he does not reveal this side to his life readily. The first of a series of interviews, as he agreed to talk to The Express Tribune, revolved around Vital Signs and his metamorphosis into the world of preaching. Sitting in Shahi Hasan’s studio, his fingers, a couple of times, delicately traced the contours of the guitar strings. But an inner commitment is stronger than the temptation. He hummed a few lines, but stopped. The darling of the Pakistani masses is no longer a balladeer. The passion has been channelised towards a higher love. His songs formerly talked about how to woo a beloved… his nasheeds and naats still do. But the Beloved has changed. JJ has evolved.

The second interview was hard to schedule. His travelling is incessant, more for philanthropic work and less for proselytising, contrary to popular belief. “I think I am ready to talk in detail. It is time people hear my side of the story. I may come across as someone who has something against women. I’m NOT!” he said on the phone while he was at the site of a model village of 200 houses near Rahimyar Khan built with his support for flood-hit people.

Meray oopar bohat zimmedari hai. As a human, a Muslim, a Pakistani, a person whom people know. I cannot turn away from these responsibilities; that would be [ingratitude]. Being grateful increases blessings and being ungrateful sucks them away,” he said at the second interview, sitting in his comfortable home in DHA, Karachi. He had just returned from a trip to the UK to raise funds for charity.

A suitcase is forever ready for the globe-trotter. It is pertinent to wonder how he balances family life and his added responsibilities. “I try my best to balance. Whatever time I give to my family is quality time. Ayesha and the kids will vouch for it,” he said. Any conversation with him is incomplete without periodic mention of his wife Ayesha. But he does agree that there is a price to his philanthropy. “The life of this world and the Hereafter are like two wives of one man. If you please one, the other will be upset. It’s a choice you have to make. Fact of the matter is that when we struggle for the Hereafter, Allah is pleased. And when Allah is pleased the life of this world improves automatically. Theek hai na?” he said, smartly interspersing an element of preaching in the interview. He never lets go of that opportunity.

 Muslim Charity has established five hospitals in Pakistan in Jhang, Faisalabad, Mangani,  Rawalakot and in Lahore. PHOTO: MUSLIM CHARITY

“Pakistan’s women should not have to go through this.”

“The year was 2003. I remember reading somewhere that a woman travelling from Jhang to Faisalabad on a tonga in full-term labour died because no maternal health facility was close by. That story shook me,” said Junaid.

At the Muslim Charity fund-raising dinners in Manchester, Birmingham and London May 31 to June 2, 2013. PHOTO: MOHAMMED RAYAZ

Comparing it with the comfort and facilities which are available to women in the cities, like his wife at the birth of their four children, he felt deeply disturbed at why so many women in Pakistan had to go through this. “It was during that time that I came to know that this organisation called ‘Muslim Charity’ was working to improve the state of maternal health. I contacted them to ask how I could help in my small way. I have been affiliated with them since then.” Junaid now works as the vice president of Muslim Charity, and uses his public influence, talks and naats to raise funds for the causes.

Till now, with his support, the charity has managed to make five hospitals in Pakistan mainly focusing on maternal health. As a global initiative, the charity works on improving maternal health the world over.

The masjid schools

A fascinating project Junaid has been working on is an interesting attempt at consensus-building between the clergy in Pakistan’s rural areas and those who believe in literacy as the answer to Pakistan’s problems. “How we do this is simple. We identify impoverished rural areas and broken-down mosques. We then reconstruct mosques and construct small houses for the village imams. In return, we request them to allow use of the mosque from 8 am to 12 am,” he said.

Part of this project is to sensitise locals and persuade them to send their children to these schools. These are regular schools where the children have the option of also learning the Quran. “The idea is to get these kids off the streets. We make them realise that they have a responsibility towards themselves. With mentorship, they realise that education is their path to a better life. Our aim is to produce peaceful and responsible citizens.”

In Sindh alone, up till now, they are responsible for putting 3,500 children back in school, both boys and girls. “One of them recently sat his CSS exam. I had tears when I heard this,” he said.

On men, women and balance

“It is sad how women are objectified. Rights to women have been given by the Creator. There is no problem with women working. Didn’t Hazrat Khadija (RA) work?” he said almost defiantly when asked about his views on women and their rights, adding that limits have been defined by God for both men and women. “Women should not be coerced in any way. A man needs to be more sensitive towards his wife. A woman’s biggest insecurity is loss of control.”

A Muslim Charity tent city in Dadu in 2011. PHOTO: MUSLIM CHARITY

He admitted candidly that Pakistani society was, according to one view, chauvinistic and male-driven. It is a place where men often oppress women. “For the sake of family honour, Pakistani women continue to suffer. Divorce may have been considered an unsavoury thing in the time of the Prophet (PBUH) but [it] was not a taboo, unlike [in] today’s Pakistani society!” he said. “In a society where [the] male-child preference still exists and women are blamed for producing too many daughters, will men not stand up for them? I have always felt strongly about the rights of women.”

When asked why families seem to be falling apart, he has a simple formulaic solution. “Damage control lies in this: men should control their tempers and women [should] think before they speak.”

Junaid Jamshed and Ali Haider performing at the Spiritual Chords Nasheed concert held in South Africa in August 2011. PHOTO: MUSLIM CHARITY SOUTH AFRICA

So is Ayesha allowed to drive?

“I knew you’d ask this!” he said with a chuckle. “Before I got married, I was visiting my father-in-law with a friend. My father-in-law mentioned that my wife-to-be was learning how to drive, and I was happy to hear that. But my friend, a senior, advised me, as experienced friends do: ‘Don’t teach your wife how to drive’. That was what I mentioned light-heartedly in that show.”

Junaid Jamshed helped raise funds for the charity that was involved with the building of Doha village in Sanjarpur, Rahimyar Khan. PHOTO: MUSLIM CHARITY

After he got married, he tried to teach her to drive but couldn’t because of a paucity of time. “She never insisted and never learnt,” he added. “It never really was an issue for us.” Wary of calling himself a scholar, he is clear that he is in no position to pass a verdict about women who drive. “But my personal opinions, likes and dislikes are my own. I have a right to them.”

The crossroad and the road less traveled

It was around 1999 when his solo album Uss raah par was released. The main track of the same title was conceived metaphorically by Shoaib Mansoor. “He knew that something had changed in me,” said Junaid, recalling the lyrics: hum kyun chalain uss raah par jis raah par sub hee chalain. Kyun na chunain wo raasta jis par naheen koi gaya. In a very Robert Frost fashion, the song talked about the road less traveled, which, in JJ’s life, did make all the difference.

“The transition in me had started. That song was about my journey. But at that time we couldn’t have showed it in the video. People were not ready for it.” He had not gone public with his change then. But he had started visiting religious scholars for his own inner healing. “I had everything — fame, money. But I did not feel complete. Being in a masjid made me feel at peace. Masjids still have the same effect on me. It is the place where we discover humanity. I confess that I had no plans of leaving music at that time. But I could feel I was changing. I couldn’t run away from it.”

And does he miss his past life? “Naheen yaar. No withdrawal symptoms of my past life. I own and cherish my time with Vital Signs. I am happy that as a singer I contributed to my country in a positive way. I lived that part of my life to the fullest. But now that is the past,” he said, with a direct look, again defying the pre-conceived notion that he no longer talks to women directly or makes eye contact with the opposite sex.

Ramzan offering

This Ramzan he will be seen again on TV every day, all through the holy month, sharing what he knows. “It will be different,” he said, alluding to an approach that relies on more outreach as opposed to sermons. He agrees that people should be sensitised about civic responsibilities through religious shows. “Breaking a red signal, parking a car behind someone’s, evading taxes: I consider all of these major sins. Religion IS about being a better, more considerate human.”

While Junaid is armed with Islamic study and training, he stops people from calling him amaulana. “It is a compliment when people call me that but I don’t think I am worthy of that.” His pet peeve is “When people use the word mullah or maulvi in a derogatory way.” For now, it appears that he is neither and defies being pegged as one thing or another.

Making a difference

We highlight three other people who are acting much in the same way as Junaid Jamshed to help those around them

Sarfaraz Rehman

The CEO of Dawood Foundation smiles a guarded smile, instantly commands respect, has a command over literature and poetry, and completely owns the floor when he begins public speaking. He is best known for being associated with CSR (Corporate Social Responsibility). “Religion is more than just spiritual and ritualistic attainment. It is a code of life intertwined with a belief in Allah, which then helps one live in a fair, calm, equitable manner and makes the plank of value addition to the community a major goal,” says the man who uses religion to support his mentoring and academic activities. The Dawood Foundation just finished a city campus for the Karachi School for Business & Leadership, a graduate management school, established in strategic collaboration with the University of Cambridge, Judge Business School.

Hina Shamsi Nauman

With infectious energy, this mother of three wants to contribute to society. You can find her planting mangroves with her students to fight delta flooding, or selling hand-crafted environment-friendly stationery made by physically challenged people. She teaches Quranictafseer to groups of women, and teaches business ethics and what Islam says about that at university. From a traditionally religious family, she studied Islam in-depth by choice at a more mature stage, and feels that “a leap of faith is what it takes to discover oneself. But it was not easy coming out of the closet about it”. A teacher for the past seven years, this business grad decided to bring religion to her university students, breaking the taboo that religious discussions are only for the madrassas.

Aly Balgamwala

They call him “disco maulvi” and he fits the bill, happy with the description. He tweets incessantly, has his hand in a lot of social causes, and blogs. An entrepreneur by profession, the tech-savvy Aly’s niche is activism for social causes through social media, be it the cause of a better Karachi or raising civic awareness. As a founding trustee of Ihsaas Trust, a not-for-profit set up to provide Islamic Microfinance along with other charitable work, he and his team “use this platform to advocate husn-e-khuluq (good behaviour/ethics) as taught by Islam within the context of business and personal life.” Aly has been a volunteer teacher at “Active Saturdays”, a Saturday class for young men aged 10 to 15 years.

Published in The Express Tribune, Sunday Magazine, July 21st, 2013.

Dignity restored: The blessing of being ‘dry’

Read this & realize your blessings! You can save a woman’s life by donating to Koohi goth Fistula Hospital Karachi.

https://www.facebook.com/pages/Koohi-Goth-Hospital/460865483924659

Published: June 30, 2013

Only 30 surgeons in Pakistan can treat the condition. PHOTO: SARAH MUNIR

KARACHI: It is 99.9% a disease of extremely poor women. Nobody from the affluent families will suffer from it. So long as its poor women, no one cares, says Dr Shershah Syed, the man responsible for setting up Koohi Goth Hospital, the only primary healthcare facility for women suffering from the condition called fistula.

He has made possible the treatment of 10,000 women suffering from the unthinkable medical condition. Yet, it’s not enough. Every year, the list of women who are suffering from a fistula increases by 5,000 approximately, and trained surgeons in Pakistan who can perform the surgery that can cure them are just 30! Yet, there is light at the end of the tunnel.

Selling goats to get treatment

Nineteen-year-old Noorbano from Khuzdar, Balochistan, is one such woman. She walks slowly towards the dining area from her bed in the recovery ward of the Koohi Goth Hospital. Her wounds are still raw. She has had three surgeries and has three more to go. “I developed the fistula during the birth of my second baby who did not survive. I would keep leaking all the time. Nobody even wanted to sit next to me,” she explains with the help of a translator. “It’s my husband who supported me. He had a few goats which he sold for my treatment. We travelled from Khuzdar to Hub and from there to Karachi. It was worth it,” she says with a smile.

As fistula is directly related to poverty and lack of resources, Balochistan has the most patients, followed by rural areas of Khyber-Pakhtunkhwa and Sindh.

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Pakistan’s understated scandal

“Is it not the biggest scandal that 30,000 young women are dying every year due to pregnancy-related causes and no one cares?” says Dr Shershah.

The women suffering from obstetric fistula develop the condition when child birth is not done by trained medical persons and the nearest hospital is at times hours away in rural Pakistan with no infrastructure or money to travel. “If the labour is prolonged, which is mostly when the woman is having her first baby, the baby’s head may get stuck in the birth canal in a way that it keeps pushing against the thin wall between the bladder or rectum and the wall of the birth canal, thereby causing and tear,” says Dr Suboohi Mehdi, one of the surgeons at Koohi Goth Hospital.

Another way a fistula may be formed is when an unskilled surgeon performs a surgery and by mistake causes a cut in the bladder or rectum.

Apart from treating women at the Koohi Goth facility, completely free of cost, a midwifery school is training midwives to help women deliver safely. Surgeons are trained to perform the surgeries, and teams then setup small units all over Pakistan. The patients are taught life skills and vocations during the long rehabilitation process. The hospital relies on donations for its running.

The answer lies in efforts for better maternal health for the women of Pakistan.

“The dream is very simple – that every woman has a right  to basic obstetric care, in case of an emergency, at her doorstep, free of charge. And it can be done,” says a hopeful Dr Shershah.

Published in The Express Tribune, June 30th, 2013.

http://tribune.com.pk/story/570321/dignity-restored-the-blessing-of-being-dry/

I killed my unborn baby because I have too many

39 minutes ago

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.

 

http://blogs.tribune.com.pk/story/17936/i-killed-my-unborn-baby-because-i-have-too-many/

Unsafe abortions: Risky business

Published: June 25, 2013

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Nearly a million Pakistani women resort to abortions annually due to absence of timely contraception. PHOTO: FILE

Nearly a million Pakistani women resort to abortions annually due to absence of timely contraception. PHOTO: FILEA view of a shady clinic located in Lahore. PHOTO: SARAH MUNIR/EXPRESS

LAHORE: The beads of the tasbeeh in her hand are beginning to move faster. She wipes off sweat from her forehead with her lawn dupatta, due to anxiety and the intense 48 degree heat of Lahore, with load-shedding in its 5th hour in a house in Safanwala Chowk.

The dark magenta bedspread seems to intensify the heat in this bedroom on the second floor that serves as a makeshift waiting room for families of “patients”. What is allegedly an “operation theatre” is a tiny claustrophobic room constructed on the roof.

“It’s been almost an hour. Safaai normally doesn’t take so long,” says the worried middle-aged mother, looking out of the semi ajar window overlooking a lane off Temple Road. Her 27-year-old daughter is a mother of five, getting an abortion done. The infamous abortion clinics of this area still exist, but most have been relocated into lanes to avoid attention of the media and health officials concerned. It was after an hour of asking around and driving in the area that a shopkeeper in a secretive manner guided The Express Tribune team in. Immediately, a female gatekeeper locked the gate from inside. “We don’t want anyone to know this is a clinic,” said the over-worked woman who introduced herself as a doctor, but had no degree, certificate or anything that confirmed that she is a medical doctor. The clinics of this area have had thousands of abortions take place in them, some as late as in the 5th month; while the clinicians advise against abortions at an advanced stage, they oblige for some extra money.

Tales of Horror

Timely FP could save lives of not just the unborn foetuses but a multitude of Pakistani women. A national survey of public-sector health facilities estimated that about 200,000 women were hospitalised in 2002 alone for abortion-related complications. “We get cases of perforated uterus, guts, intra-abdominal complications, all complications of unsafe abortions,” says Dr Nadeem Khalid of Family Health Hospital, Lahore.

The methods used are unthinkable. Ingesting large doses of drugs, inserting a sharp object into the uterus, drinking or flushing the reproductive tract with caustic liquids, vigorous movements like jumping or physical abuse, and repeated blows to the stomach are some of them. Incidents have been reported where bowels of the patient are pulled out by mistake through the reproductive tract.

If the woman survives, she can suffer from long-term disabilities and infertility. Incomplete abortion, hemorrhage, trauma to the reproductive tract or adjacent organs and sepsis (bacterial infection) are common. Post-abortion complications, experts say, account for a substantial proportion of maternal deaths in Pakistan.

Numbers and reasons

Out of the 2.4 million unwanted pregnancies in Pakistan in 2002, some 900,000 were terminated by induced abortions (Studies in Family Planning 2007). The actual number is definitely higher, considering the unaccounted for cases. In a country where only an estimated 30 percent women use contraceptives (NIPS study: 2006-2008), induced abortion is used as a form of contraception. Contrary to popular belief that most abortions are the last resort of promiscuous women, a Population Council study shows that a staggering 96.1 percent of the women who get abortions done are married women.

The abortion rates in the more urban provinces of Punjab and Sindh are substantially lower than those in the Khyber-Pakhtunkhwa and Balochistan. In urban areas, the contraception rates are higher.

The reason why shady clinics and unskilled women end up performing these abortions are two, the main one being simple economics. A doctor in a lower income area would charge an average of Rs2,600, whereas a traditional birth attendant (TBA) would charge as less as Rs770, says a study by Marie Stopes Society, 2008.

Secondly, most certified medical practitioners avoid performing an abortion not just because of religious reasons, but also because they are afraid of legal complications. Under the 1990 revision in Pakistan’s Penal Code with respect to abortions, the conditions for legal abortion depend on the developmental stage of the foetus. Since 1997, under certain circumstances, abortion is conditionally legal in Pakistan to provide “necessary treatment”.

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Women seeking induced abortion

– Highest in age group (30-34) yrs 39.6 % and lowest in (15-19 yrs) 3.9%

– Higher in married women (96.1%) and for single women    (3.9%)

– Highest in women with no education    (62.5%)

– Highest in people with already 5 or more children   (68.2%)

(Source: Population Council) 

http://tribune.com.pk/story/567963/unsafe-abortions-risky-business/

 

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