27 Sep 2017/Wednesday   

Thirty-six year old Sadaf Saeed, mother of a toddler was both “relieved and saddened” by the “extreme step” of terminating her pregnancy.

She was on the pill, as she was not planning on having a second child and therefore completely devastated after she found out she was pregnant. “We were at a complete loss,” she admitted.

The “decision” was the “most difficult” Saeed said and hopes “I hope I don’t ever have to do this again,” she said.

And so before she left the clinic where she got her abortion carried out, she had an implant — a thin rod the size of a matchstick — inserted under the skin of her upper arm. The other long acting reversible contraceptive (LARC) method is the intrauterine contraceptive device (IUCD) both considered to be 20 times more effective than the pill, last several years and are reversible.

Every month, on an average between 10 and 15 women come to the same clinic that Saeed went to, in the heart of Karachi, seeking abortion in a safe environment, at the hands of trained healthcare providers.

“What is even more unfortunate is that a large number of the female clients are the same old faces who come for repeated abortions but stubbornly refuse to take the simpler and more cost-effective birth control route, we offer”

“We get call girls, domestic workers who have been impregnated either by the male help or some male member of the family, girls who have been raped, but more than them, a vast majority are married women who do not want to have any more children,” said one of the nurses who has been working there for the past five years. She has six kids but after joining the clinic she too, is taking the pill.

“What is even more unfortunate is that a large number of the female clients are the same old faces who come for repeated abortions, but stubbornly refuse to take the simpler and more cost-effective birth control route we offer,” said the nurse. Their main objection against family planning (FP), she said, was the weight gain that will occur.

According to the recent Pakistan Demographic and Health Survey (2012-13), even when women (26 percent) do use an FP method they discontinue and the rate is shockingly high at 37pc, and within 12 months of their initiation. Ten percent of episodes of discontinuation occurred because the woman experienced side effects or had health concerns.

Little wonder then that in Pakistan 48pc of pregnancies are unintended, of which 54 pc are terminated in an unsafe way.

Ethical and religious dilemmas by healthcare providers, an unresolved moral battle raging in the mind of the woman seeking termination makes the decision to terminate pregnancy very difficult.

“Fears about confidentiality, stigma, not knowing the law, expenses and most importantly because public hospitals don’t entertain these clients,” are some reasons why women continue to seek abortions by unskilled providers said Dr Laila Shah, director of the Sukh Initiative at Jhpiego, which is promoting LARC in 42 public health facility hospitals in four towns of Karachi.

But, along with these very real concerns are the myths around contraception that continue to brainwash the women. “On several occasions, women have told me that they do not want the IUCD (or challa as it’s known locally), inserted as it will go up their stomach, liver, or even brain.” We’re just not able to overcome this fear from them,” she said while acknowledging that in olden times, the device, if inserted by an untrained provider, may have perforated the uterus and caused a complication.

Every year in Pakistan 9,700 mothers die according to UNICEF. “Based on global estimates, over 1,200 or 13pc are estimated to be attributable to unsafe abortions,” said Dr Agha Xaher Gul, heading the business strategy unit at Marie Stopes Society, fearing they may be much higher.

The complication rate due to an unsafe abortion is also quite high, since 68pc are conducted by a dai (traditional birth attendant), 49pc by lady health visitor as opposed to just 10pc by a gynaecologist.

What is sadder still is that each and every death and injury, as a result of unsafe abortion, is preventable through the provision of safe abortion services.

In addition, a lack of awareness and knowledge of the law and fear of backlash from extreme right has made talking about, as well as seeking safe abortion more difficult.

But those who are working on women’s reproductive health and rights insist neither laws nor policies to prevent access to abortion can act as a deterrent for women seeking abortion. If it doesn’t happen in a health facility by a trained provider, it’ll happen elsewhere and perhaps unsafely, they say.

“And these will only increase the incidence of unsafe abortions which may cause higher incidence of injury and in some cases, death,” said Dr Sadiah Ahsan Pal, consultant obstetrician and gynecologist in Karachi.

At the same time, she said, it has not been proven that countries where abortions are permitted, the rate of abortion has increased. “They just reduce the number of unsafe abortions,” said Pal.


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