Abortion. Pretend it never happened. Push it under the ever-accommodating Pakistani carpet. Stark, hush-hush, pain-filled, frequently back-street, unhygienic, illicit and dangerous. Abortions are undoubtedly among the dirtiest of secrets of Pakistani society.
And yet, laws exist to permit abortion in Pakistan.
The relevant law to facilitate several categories of induced abortion was passed in 1997. Therapeutic abortion is allowed to save a woman’s life; eugenic abortion, when there is considerable risk to the physical or mental growth of the foetus, social abortion in case of contraceptive failure; and humanitarian abortion when conception occurs as a consequence of rape, gang rape or incest.
This last is particularly important in view of increasing political turmoil and conflict which have triggered parallel increase of crimes against women, many of which can lead to conception, sexually transmitted diseases and/ or HIV/AIDS.
Another crime is incest — endemic, widespread, unrecognised and unacknowledged. It remains confined within the family: alarm signals only arise when the post-pubertal girl conceives, and has nowhere to turn to.
The Population Council probed the matter in 2004 and found that based on hospital statistics alone, 900,000 cases, largely complications of unsafe abortions, were received in hospitals nationwide each year, of which 197,000 were suffering serious health complications. An estimated one in six pregnancies, or 29 abortions per 1,000, end in unsafe abortion. Many die before reaching the hospital — they were brought in too late, adding another 13pc annually to Pakistan’s shockingly high statistics for maternal mortality.
“That’s just the tip of the iceberg,” said. Dr Zeba Sathar, country director of the Population Council. A slight improvement of maternal health care appears to have taken place in 2012, with admissions down to 698,000.
For the public, the abortion controversy has been a clouded, murky one. Contrary to popular belief, abortion is not a risk undertaken by women who have conceived as a consequence of ‘illicit’ extra marital sex, even though that does happen. Rather, the majority of women seeking abortion are mothers with four or more children, who cannot afford more children, and are exhausted with child-bearing and child-rearing. Inadequate access to family planning, especially in far-flung rural areas, contraceptive failure, high son preference, a husband’s or in-laws’ reluctance to permit contraception, all contribute to repeated childbirths that women do not even want.
According to the World Health Organisation, unsafe abortions are described as ‘a procedure for terminating an unwanted pregnancy, either by a person lacking the necessary skills (eg an unskilled dai) or in an environment without minimal medical standards, or both. Presently, in view of the immense need, Pakistan is concentrating on post-abortion care (PAC).
“This law should definitely be publicised,” argues eminent gynaecologist Dr Sadeqa Jafarey. “This view is shared by the Society of Gynaecologists & Obstetricians. Doctors need to study the law and fully understand it — being more aware may help in changing attitudes and practices. It is especially important for NGOs, so that they can advocate for use of safe methods.”
In several surveys, women have clearly voiced a preference for fewer children and regular contraception, but these views are not shared by husbands and in-laws. At other times, the couple may find the cost of contraception too high, or they may be unwilling to risk the side effects of contraception. In desperation, the couple then resorts to abortion.
“The most important point,” continued Dr Jafarey, “is to recognise the essentiality of easily accessible and available family planning facilities, especially in rural areas. Lady Health Workers, who already focus on primary healthcare, can contribute here to great advantage.”
Pakistan has signed several binding UN Treaties, and has agreed to the MDGs, including MDG 5, which promises “improvement of maternal health”. Within this international promise, and within the methodologies described above, are the means to save countless women’s lives — but does this government have the political will to achieve that?