Fatal conception: Stilled life

For the millions of Pakistani women who do not have access to quality healthcare, the birth of a new baby is not a moment of joy, but something that can lead to terrible complications and even prove fatal

Had you seen her from a distance, perhaps you would have mistaken her for a hunching teenager. Up close however, you would have realised that this frail and barely 5 feet tall woman was in her mid-20s. From her stunted physique, your focus would have shifted to her weathered face, which carried the weariness of a woman twice her age and contrasted strangely with her youthful and defiant eyes.

Unfortunately, the following story of Shumaila* isn’t an unusual one. As is often the case of young women born into a family of few means, she was married off at a young age to a man incapable of supporting a family. Under pressure from her husband and in-laws, Shumaila became pregnant often, yet only had one living child by the time she reached her mid-20s. This young boy was Shumaila’s life, and accompanied her to Karachi where she worked several jobs as a maid in order to support herself and her husband.

The world had been cruel to Shumaila and as a result she lashed out often with her barely contained frustration. Sadly, life was about to grow harsher. Less than a year ago, this young woman became pregnant once again, and recently was about to give birth to her second child; a baby girl.

The dai in her village warned Shumaila’s in-laws that the pregnancy was heading towards complications, and that she should be immediately taken to a hospital. Unable to afford the expenses of a professional delivery, her family convinced the dai to handle the birth. She agreed, but tellingly only did so after having Shumaila’s family sign a disclaimer.

Married at a young age, most of Shumaila’s pregnancies ended in stillbirths. Until one claimed her life

Three days after giving birth to her second child Shumaila passed away; it came as a shock to those who had known her.

Alarmingly, Shumaila is one of many Pakistani women who die due to complications in pregnancy and childbirth. As Dr Noshin Tariq, a gynaecologist with tons of experience at a maternity hospital explains, women such as Shumaila lack nutrition, knowledge, and access to basic health care, “Hospitals in rural areas are overburdened, poorly managed and lack resources, resulting in disturbingly high infant and maternal mortality rates. The typical issues that these women suffer from are postpartum haemorrhages and anaemia, as well as other complications and deficiencies. Some women also lack knowledge about healthcare, for example they may not know that they need iron supplements even after giving birth.”

Dr Noshin claims the government needs to take a greater initiative in rural areas through an awareness programme that is planned well.

As of 2012, it was estimated that Pakistan had the highest maternal mortality rate in South Asia and one of the highest in the world. Meanwhile, statistics available from Unicef using data gathered from 2010, state that the lifetime risk of maternal death in Pakistan is one out of 110.

Dr Noshin says that aside from providing better health care the best way to combat this problem is education, “These women simply lack knowledge as to their special needs during pregnancy. There is nothing unhealthy about a woman giving birth to several children, and women of better economic means don’t suffer from the same issues. There is no harm in it. Problems occur when women don’t have access to proper facilities and nourishment; frequent multiple pregnancies take a toll on their bodies as they lack a lot of support and are facing abuse through being overworked. As they grow older they lack other kinds of support and have to look after a lot of children alone.”

A department head at her hospital, Erum Riaz-Ghazi is currently pursuing her PhD from the Institute of Clinical Psychology at the University of Karachi, and has also been associated with the NGO called Health Education & Literacy Programme (HELP), where she recently consulted Dr Amara from HELP to lend some psychological insight into the maternal mortality issue.

“Hospitals in rural areas are overburdened, poorly managed and lack resources, resulting in disturbingly high infant and maternal mortality rates. The typical issues that these women suffer from are postpartum haemorrhages and anaemia, as well as other complications and deficiencies.’’

Erum believes that men pressurise their wives into pregnancy largely due to insecurity, “The way one can prove their manhood is through child-bearing once they get married. It is imperative that one starts reproducing otherwise the whole clan makes it their business to pointedly ask why the new bahu (daughter-in-law) has not conceived, making sympathetic clucking noises and casting suspicious glances at the man. This can prove to be traumatic for the newly married couple. The woman bears the onus of responsibility for not only conceiving, but also ensuring that a male is produced notwithstanding the fact that it is the husband’s chromosomal uniqueness which determines the gender of the child. Women in our culture are taught to be submissive. I still remember hearing my elders discussing at the time of the IrishtaI setting ‘make sure there is an age gap and that the girl is younger, too old and she will be (heaven forbid) independent and will do as she pleases; and you know men never age it is the woman who ages faster’.

According to Erum, in-laws resort to all sorts of tactics to push their daughter-in-law into pregnancy. These tactics range from psychological such as guilt manipulation and threats of second marriages, to acts of physical violence. It is difficult for young women to resist this pressure due to a lack of empowerment and an inability to separate themselves as an individual from the family dynamic. The women who do rebel tend to use contraceptives in secrecy. Reportedly, Shumaila’s own family had been insisting that she leave her husband, but, for reasons best known to her, she did not in spite of her hardships.

Dr Noshin adds, “Women are unable to resist the pressure of their husbands because they have nowhere to go. Due to the stigma associated with divorce, women are encouraged to stay with their husbands [who may not have their best interest at heart], rather than go back to their own families.”

Here, Erum elaborates more on the family dynamic, “The Pakistani culture is very collectivistic and family oriented, here the group is more important than the individual. Societies which are collectivistic such as India, Bangladesh and Pakistan put a lot of value on the family paradigm. Which means the family comes first, and the value system of the family and society is of paramount importance. Where the people hold an interdependent view of the self as part of a larger network which includes one’s family, friends, neighbours, co-workers and others to whom one may be socially connected. The values and beliefs thus become set in stone, and need to be adhered to maintain equilibrium and a status quo. Independent thinking, rebellion and trying to realise one’s dreams becomes of secondary importance.”

Dr Noshin does feel that mindsets can be changed. She gives the example of a poor family that has been under her own family’s employment for generations. Although they were initially resistant to the idea of family planning, with time they have come to accept the wisdom of planned pregnancies. Dr Noshin claims the government needs to take a greater initiative in rural areas through an awareness programme that is planned well, “We have to not only educate women but their husbands as well. But you can’t expect things to change overnight. In Pakistan, politicians aren’t willing to change, so then how can we expect these rural people so set in their ways to change their thinking so quickly?”

Erum agrees that the best way to tackle the problem is through education, “The key figures in their communities, the religious scholars, need to explain the importance of having small families and of birth control. Part of the responsibility falls on their shoulders of educating the masses, and this can be done easily, when the whole city congregates in various mosques for their Friday prayers. This is an ideal platform to teach basic human rights and how to have healthier and happier families.”