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I killed my unborn baby because I have too many

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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/

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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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