Condemned by society

October 02, 2013

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FOR 40 years after independence, Pakistan did not have a law governing abortions that it had formulated itself.

Until 1997, abortions in the country were governed by the Pakistan Penal Code, developed by the British colonial government. According to provisions developed in 1860, abortion was a crime unless performed in good faith to save a woman’s life.

Amended 130 years after its inception, by lawmakers who sought to bring it under the auspices of Islamic law, the abortion law was divided into two sections depending on the stage of pregnancy.

It allows abortion only in the early stages of pregnancy to save the mother’s life or to provide necessary treatment. It does not address the question of exceptions based on rape, incest, or abnormalities found in the foetus. In fact, it does not mention any of these issues at all.

The provisional law governing abortions was implemented in 1990. In 1994, an International Conference on Population and Development (ICPD) was held in Cairo. The ICPD called for all women to be given access to treatment for abortion-related complications, post-abortion counselling, education, and family planning services, regardless of the legal status of abortion in the country.

Having signed on to the ICPD agenda, Pakistan was required to take a number of measures to ensure implementation. In 2000, a draft reproductive health policy based on the principles outlined by the ICPD was presented. However, this policy never received much attention and was not approved by the Ministry of Health or the Ministry of Population Welfare.

Last week, the Population Council issued a report on the consequences of this inattention. Titled Post-Abortion Care in Pakistan: A National Study, the report was a follow-up to one conducted in 2002. Its findings are expectedly dismal and provide insight into the layers of discrimination, neglect, and pure misinformation that govern the provision of abortion and post-abortion care in Pakistan.

According to the study, which is available on the Population Council’s website, nearly 700,000 women sought treatment last year owing to complications from induced and spontaneous abortions (or miscarriages). Most complications resulted from the use of unsafe methods or the performance of an abortion procedure by an unskilled healthcare provider.

The most common method of abortion in Pakistan remains dilation and curettage (D&C), a highly invasive and dangerous procedure that involves significant risk of post-procedure complications. This procedure is being used even though safer and drug-induced methods are available.

Unsurprisingly, the situation is most dismal in the rural areas. The data collected reveals that rural poor women who visited an untrained person or a dai (midwife) had a nearly 68pc chance of developing complications.

A number of women in both rural and urban areas were still trying to induce abortions themselves, using archaic and dangerous methods such as vigorous exercise, heavy massage to the abdomen, and ingesting herbs. Nearly a third of the abortions in rural areas were attempted by these means.

Even if a woman does make it to a healthcare facility, the report concludes, the staffing levels there are highly inadequate, with the absence of gynaecologists and anaesthetists being the most glaring.

Of the healthcare providers surveyed, 40pc reported that the medical personnel treating patients often have a negative attitude towards women seeking abortion or post-abortion care. Similarly, 40pc of healthcare providers who treat women for post-abortion care were reported to believe that abortion is simply not permitted in rape cases.

The cumulative picture that emerges from the Population Council report is one of a dark and dismal reality in which Pakistani women suffer alone, take incredible risks with their health, and die owing to the inaccessibility of post-abortion access.

Despite the fact that 92pc are married, only a third are ever accompanied by their husbands, suggesting that the burden of a complicated pregnancy falls entirely on the woman who may have little control otherwise.

The absolute lack of education in reproductive and maternal health (nearly 80pc of rural women are uneducated) exacerbates the problem.

With little information on how pregnancies can be prevented and often faced by uncooperative spouses and family structures, women are the scapegoats of a system that seems to see them only as breeders and not as humans.

The issue of lives lost as a result of poor post-abortion care gets little attention and does not inspire any efforts to reform the system.

The twin taboos — lack of clarity on the legality of termination of pregnancies resulting from rape and incest, and lack of education available regarding the requirements of safe abortions and post-abortion care — make a woman facing an unwanted or complicated pregnancy in Pakistan one of the most unfortunate in the world.

If the unwanted pregnancy is the result of rape or incest, she is even more condemned. If a married woman becomes pregnant and loses the baby from natural causes, she may still face discrimination if she chooses to visit a healthcare facility to ensure that no complications arise from a miscarriage.

Like so many other issues, the absence of services for post-abortion care and condemning women to the devices of uneducated midwives or discriminatory medical staff reveal how the moral burdens of controversial issues are borne solely by those born female.

Even while the government has officially committed to providing post-abortion care to all women under the terms of the ICPD, the reality of what Pakistani women can actually avail is a picture painted in the dismal shades of neglect, misery, ignorance, and, ultimately, cruelty.

The writer is an attorney teaching constitutional law and political philosophy.

rafia.zakaria@gmail.com