This was highlighted in a 2012 national study on post abortion care (PAC) on the desperate and unsafe measures women resort to in order to contain their family size. Conducted by Population Council, an NGO that works on improving women’s reproductive health, the findings show that an estimated two million abortions took place in 2012. This was calculated as 50 per 1,000 women aged 15 to 49 years, almost double of what was recorded in 2002. The proportion of pregnancies that were unintended rose from 38pc in 2002 to 46pc in 2012.
In 2002, Population Council had done a similar study and found that 890,000 women had undergone induced and often clandestine abortions in the country. The abortion rate then was calculated to be 27 per 1,000. While post-abortion complications stood at nine per 1,000 in 2002; by 2012 the figure had risen to 15 per 1,000.
Infection, perforated uterus, fistula, retained products with sepsis, bleeding are just a few of the health complications arising from an abortion gone wrong. Abortion is legally permissible in Pakistan, but in very limited circumstances when the mother’s life is at risk. But despite an increasingly conservative climate coupled with lack of clarity on the law (and misgivings within the mind of the healthcare provider), there is a huge demand for this procedure and backstreet clinics where such services are offered are tolerated. So why do so many women want to terminate their pregnancies despite the health consequences? Public health specialists call it a family planning failure and say these studies point to an increased desire among couples to limit their family size. Thus while couples want to have fewer babies the increase in contraceptive use has been slow.
According to the Pakistan Demographic and Health Survey (2012-13) the use of contraceptive methods by Pakistani couples is just 35pc, a modest jump from 30pc in 2006-07. In fact, Pakistan continues to have the lowest indicators when it comes to the use of modern methods of contraception in the region, second only to Afghanistan at 26 (increased from 22pc) in the same period. But what is even more discomfiting is that where women use a method, the discontinuation rate within one year is as high as 37pc. India, Bangladesh and even Nepal fare better at almost 50pc in the use of modern methods. Back in the 1980s, the number of babies a woman would have over the course of her reproductive life averaged at six; today it is down to 3.8.
On average, Pakistani couples still have one child more than they desire. The result is unintended and unplanned and unwanted pregnancies for which women resort to induced abortions. Policymakers should heed the overwhelming and compelling evidence that investing in sexual and reproductive health is a cost-effective strategy to spur development. Improved access to quality contraceptive services should be an urgent priority, especially in the rural areas. This will not only save precious lives but can significantly lower the expenditure needed for maternal and newborn care and lighten the load on the health system. Along with the provision of services, family planning counselling should be made a routine part of PAC in both public- and private-sector facilities. Next should come the training of additional healthcare providers, including doctors and mid-level providers in safer methods of treating post-abortion complications. Essential supplies — such as manual vacuum aspiration kits and disinfectant equipment — must be made consistently available.
Women’s Day, that is being celebrated today, is a key moment to remind our leaders to invest in girls and women. They make high-profile political and financial commitments to improving women’s health. It is time to remind them to walk the talk. In 2009, the ministries of health and population welfare had pledged to institutionalise PAC in policies, guidelines, protocols and standards for health facilities at the national level. In 2010, PAC was included in the draft of the national health and population policies but little headway has been made after devolution. It is also relevant to remind those at the helm of the promise they made of raising the contraceptive prevalence rate to 55pc by 2020. The one thing which is doable, given that we have a brigade of Lady Health Workers, is to pledge to include and maximise contraceptive services and make them accessible to Pakistan’s women. The enormous economic and social benefits from channelling funding for family planning would soon be visible.
The author is a freelance journalist. Zofeen28@hotmail.com