KARACHI: It’s not the worry of getting pregnant for the ninth time and that, too, at the age of 40, which has brought Ms Gul to the gynaecology department of the Civil Hospital Karachi (CHK). Rather, it’s a feeling of acute weakness that forced her to seek medical help.

Waiting for her turn in a crowded ward, she appears troubled and lost. “Since I have gotten pregnant almost a month ago, I have been feeling too much tiredness and anxiety. I don’t even have the energy to force myself to work and feel guilty that I am neglecting my youngest child who is just three years old,” she says worryingly.

Take a look: Beyond Hunger

Married to a man with low income at an early age, Ms Gul regrets that often her husband has to borrow money to make ends meet. Lack of financial resources also deprived her children of getting school education.

Replying to a question about how the couple would meet the needs of another baby and whether the couple really wanted an addition to their family at this time, she said: “It’s God who brings every soul in this world and feeds all His creations. But, yes, it’s not a wanted pregnancy as we didn’t have the desire for more children.”

Sitting on the bench next to her is 35-year-old Razia, expecting her sixth child. Her son, the eldest among the siblings, is 20 years old. “Getting pregnant at an age when you have adult children is quite embarrassing,” she says with a sheepish smile on her face.

Both women, one residing in Landhi and the other in Lyari, have had their experiences with contraceptives that, they say, did help in bringing some gap between births but they discontinued their use after some time. The reason in one case was linked to some side-effects of a birth control method while the other reported contraceptive failures. Their husbands, however, never showed the willingness to use any birth-spacing method.

At the CHK gynaecology out-patient department, according to the staff, around 200 to 250 women daily report, an overwhelming majority of them are poor, pregnant and anaemic.

In the same out-patient ward waiting for her turn to see a doctor is a young woman from Orangi. Looking pale and exhausted, Ms Rukhsana, a health worker, is pregnant with her third child in four years at the age of 20. “I feel I have lost 50pc of my energy levels. At times I have difficulty in breathing, too,” she tells Dawn.

She recalls that she used to have fits due to high blood pressure during her first pregnancy and that she lost one of her twin babies at that time. The one who survived remained weak and still is. “After my second delivery, I asked my husband whether I could use any contraceptive methods, but he strongly rejected the idea, saying that it’s against our tradition and values,” she recounts.

Poverty and pregnancy

The brief stories of these women offer a glimpse into the lives of millions of Pakistani mothers, a majority of them are either completely illiterate or semi-literate and belong to a class that barely earn enough to survive.

Repeated pregnancies without adequate space between births, according to experts, not only endanger life of mother and baby, but also deprive these women of enjoying motherhood in its true sense. Women burdened by large families and battling various illnesses in their productive years fail to realise and harness their potential and are unable to raise their children in a healthy environment.

Pakistan with one of the highest maternal and child mortality rates in the world also faces the challenge of increasing population and is currently the sixth most populous country. These issues are directly linked to a lack of use of family planning methods.

According to a recent study conducted by the Population Council (a non-governmental organisation), there were approximately nine million pregnancies in 2012 in Pakistan, of which 4.2m pregnancies were unintended. Of these unintended pregnancies, 54pc resulted in induced abortions (Sindh and Balochistan had the highest share) and 34pc in unplanned births.

It also says that the proportion of unintended pregnancies rose from 38pc in 2002 to 46pc in 2012 which indicates that contraceptive use have not kept pace with growing desire for smaller families. The decline in the number of births in the country has been slower than in other Asian countries.

Women in Pakistan, it states, have a high level of unmet need for contraception estimated at 20pc in 2012-2013. Contraceptive use — including both traditional and modern methods — has risen slowly from 30pc in 2007 to 35pc in 2013. Among women who use any method, the discontinuation rate within one year of use is high.

“When I ask women whether they discuss with their husbands about the number of children they should have, they look at me with surprise and reply how they could interfere in God’s work,” Dr Nusrat Shah, senior gynaecologist serving as an associate professor at the Dow University of Health Sciences-CHK, shares how women respond to family planning issues.

‘Family planning saves life’

“Family planning is the first pillar of safe motherhood. Although it’s the responsibility of doctors to educate and encourage women, especially those who are admitted for a delivery, to use contraceptives, most of us don’t do their job properly,” Dr Shah admits.

She believes that the major reason why people avoid using contraceptives is because they consider it un-Islamic. “I think the media and the government can play a major role in dispelling wrong concepts. No religion says that a woman should bear a child if she is mentally and physically unhealthy. The religious scholars should also promote birth-spacing as it encourages women’s and children’s health,” she adds.

The second obstacle, she thinks, are the many myths and misconceptions surrounding the use of contraceptives. “Women need to know that side-effects are easy to manage and there are contraceptives that provide birth control support for a long period and are much safer. Failures often occur in birth control pills when the required dose is not taken at the right time,” she explains.

On cases of unsafe abortion, she said that the number of women coming with post-abortion complications at the CHK had significantly reduced.

“Thankfully, the occurrence of unsafe surgical termination of pregnancy has reduced in recent years. It’s likely due to the easy availability of the medication being used to induce abortion. But, the right way is not let the pregnancy happen in the first place,” she says.

Seconding her opinion, Dr Halima Yasmin working as a gynaecology consultant at the Jinnah Postgraduate Medical Centre said that there was a need for a study to look into the causes of a drop in cases of unsafe abortion.

“Not only the numbers have dropped at our hospital, but also the nature of complications has changed from very severe and severe to mild. For instance, now women in such cases report with mild sepsis,” she said.

Published in Dawn, April 6th, 2015

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