APROPOS Ms Zakaria’s article “Pakistan’s ‘gone girls” (July 1). I absolutely agree with the writer about the issues of gender discrimination and son preference in Pakistan. As a practicing gynecologist in Civil Hospital Karachi I see this day in and day out as almost every woman is a victim of such inequities.

However, there is a serious misconception that I would like to correct about the issue of sex selective abortions and the grossly incorrect figure of 1.2 million female foetuses aborted in Pakistan between 2000 and 2014.

There is no evidence whatsoever to show that sex selection is a significant reason for induced abortion in Pakistan.

The latest National Study on Induced Abortion by Dr Zeba Sathar published in Studies in Family Planning in Dec 2014 and available online at: (http://onlinelibrary.wiley.com doi/10.1111/j.1728-4465.2014.

00004.x/pdf) shows there were 2.2 million unsafe abortions in Pakistan in 2012 which comes to an annual abortion rate of 50 per 1000 women.

This is a substantial increase from the previous figure of 890,000 abortions in year 2002 (27 abortions per 1000 women) reported by the only previous national study on abortion by Population Council in 2004.

The recent study estimated that around 46 per cent of all pregnancies in Pakistan are unwanted or unplanned, with over half of these ending in induced abortions.

None of the above-mentioned national studies on abortion or any other studies on abortion in Pakistan has ever mentioned sex-selection as the cause of unwanted pregnancy and induced abortion.

There is a lot of evidence now that most of the women who go for induced abortions, already have four or more children and they go for termination to limit their family size.

All of the evidence points to the unmet need for family planning to be the main cause of induced abortions and the subsequent maternal mortality. Family planning is the first pillar of safe motherhood as by avoiding unwanted pregnancies, the need for abortion can be minimised.

Second, the writer has suggested that the sex ratio at birth of 105.7 boys to every 100 girls is evidence to show that sex selective feticide is common in Pakistan. In fact, this figure of 1.05 Males per Female is the world average for sex ratios at birth.

The birth sex ratio for the US is also 1.05 M per F and for European Union it is 1.06 M/female (The world Factbook, CIA, 2014). On the other hand, for India the sex ratio at birth is 1.12 M/F and for China it is 1.11 M/F. This shows that sex selective feticide is a phenomenon happening in India and China but not in Pakistan.

Our sex ratios become disordered later on in life. For example at 15 to 24 years, our sex ratio is 1.07 M/F and at 25 to 54 years it is 1.08 M/F, whereas in other countries (apart from India and China) sex ratios are more balanced.

The reason for this missing number of women is we neglect the girls’ health and education and as a result, we are losing our women, which shows in our missing numbers.

Dr Nusrat Shah

Karachi

Published in Dawn, July 6th, 2015

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