THE impact of the US supreme court’s decision to overturn Roe vs Wade, the landmark court case that allowed legal abortion in America, will have far-reaching implications for women all over the world. Surprisingly, this includes Pakistan, the fifth-most populous country. But how will the repeal of a controversial law in a far-off Western country have a direct impact on Pakistan?

Roe vs Wade was a watershed legal case in 1971 in which the US supreme court ruled that the constitution protected a pregnant woman’s right to have an abortion without excessive government restriction. This effectively legalised abortion in America, a goal for which women’s rights groups had been campaigning over many decades. Too many women had endured horrific injury and death from illegal abortions; equally at stake was the freedom and autonomy for a woman, not the state, to decide whether or not she would bear a child.

In Pakistan, abortion has been legal under certain circumstances since 1990. The rules have been kept deliberately vague in order to appease conservative religious and social groups; the procedure can be undertaken if the mother’s life is at risk, but it appears that it’s up to the mother and her healthcare provider to decide that, not the state.

Most Pakistanis do not know that some Islamic scholars are of the view that abortion is allowed in religion under special circumstances, and within a certain time period — 120 days, or before ensoulment under religious belief. A huge stigma remains both against abortion and contraception; the latter is also considered unIslamic by social and religious conservatives.

Overturning Roe vs Wade has implications for Pakistan.

According to a Foreign Policy article in 2021, only 35 per cent of Pakistan’s women use contraception or other methods of spacing out children; the majority of those are from upper socioeconomic strata. When poor Pakistani women, usually married and already the mothers of several children, find themselves pregnant, they often use abortion as a means of birth control. Not because they don’t want to be mothers, but because they can neither afford another child nor can their bodies endure yet another pregnancy.

NPR reported in 2018 that Pakistan has one of the highest abortion rates in the world — in 2012 it was found to be four times higher than that of the US. Because of the stigma against abortion, many legitimate medical providers will not administer to them; desperate women either self-administer them using traditional means, or turn to a dai or a backstreet abortion provider. Many women in Pakistan end up in the hospital from a botched abortion, or die. Meanwhile, the Pakistani government’s 2020 commitment to increase spending on family planning to $2.50 per capita has not been met yet, and the FP2020 goal of universal access is woefully behind schedule.

In 1965, when Pakistan began its family planning programme, this was in large part funded by the US, with as much as 40pc of the supplies being provided by America. But conservative and religious pressure in the US against abortion brought about the Mexico City Policy, in 1985, which blocked federal aid for NGOs around the world for counselling, education and access to abortion, or that worked to decriminalise abortion. This ‘global gag order’ has been successively repealed by Democrat governments, then reinstated by Republican ones, most recently by Donald Trump in 2017, who expanded the scope of the block on funding.

For decades, local and international NGOs in Pakistan have been running programmes that educate women on how to plan their families, or distributing different methods of birth control. Pro­viding safe abortion services and legal training for doctors about Pakistani laws reg­arding pre­gnancy terminations is also a part of these programmes. The progress has been slow but steady; a consistent flow of funding from foreign donors has helped the programmes achieve modest success over the years. But the political situation in the US and its effect on the global gag rule has interrupted aid to Pakistan’s family planning programmes and forced NGOs to curtail their programmes; it is Pakistani women who suffer as a result.

Already, foreign funding for Pakistani family planning has slowed to a trickle, with one of the biggest donors, the Bill and Melinda Gates Foundation, diverting aid to Africa that they used to send to Pakistan. With Roe vs Wade struck down by the US supreme court, Pakistan’s family planning organisations won’t just lose more funding; anti-choice movements will be emboldened all around the world, and the risk and stigma will increase against trained midwives, Lady Health Workers, and ob-gyn doctors who already provide much of the education and care for pregnant and child-bearing women. It’s not too late for the Pakistani government to wake up; now it must fulfil its funding commitments to population control, for the health and dignity of all its citizens.

The writer is an author.

Twitter: @binashah

Published in Dawn, May 10th, 2022