WOMEN do not stop getting pregnant during a crisis. Take, for instance, Zamira Ikhtiar Ali, belonging to Ibrahim Chandio goth. She is sure she is pregnant. Since she fled the floods, wading through waist-deep water, two months ago, she has not had her period. Zamira has not had herself tested, but the signs are all there. In the last nine years since she has been married, she has had six kids born one after the other, and aged between eight years and four months. She is still suckling her youngest.

It may not be the ideal time for Zamira to get pregnant; she is living a displaced life in a makeshift camp, on the embankment of the Main Nara Valley (MNV) drain, in Dadu, just across her village along with the rest of the villagers. With so many mouths to feed, the one-month ration her family receives is consumed in just 15 days. Already the mother and the infant look extremely malnourished.

“Then why have more kids?” asked Shamira Mohammad, happy with her brood of four — two sons and two daughters. She has had three miscarriages too.

Neha Mankani, a midwife who heads the Mama Baby Fund, and has worked with wo­­m­en like Zamira for many years, knows all too well that many women in Pakistan do not have “that level of autonomy to be able to ar­­ticulate whether the child inside them is a wanted one or not”, or if they even want more kids. Zamira and Shamira were among the four dozen or so women who had gathered in­­side a big red tent, one of the 13 ‘safe spaces’ set up by the Hyderabad-based Research and Devel­o­­pment Organisation for the displaced wom­en and adolescent girls of Ibrahim Chandio goth.

The floods give the government a chance to make good on its FP2030 vision.

They talked about their sexual and reproductive health, including how they were managing menstrual hygiene in the camp, and of urinary tract infections due to the use of contaminated water (for bathing and washing their clothes including their menstrual cloths) from the MNV drain. Pregnant and lactating women shared their own worries.

The floods may have exposed how inadequately Pakistani women’s special health needs have been taken care of. Yet, this hardly comes as a surprise. Pakistan’s maternal mortality ratio (the number of maternal deaths per 100,000 live births) of 186 (it was 276 in 2006-07) is way too high, as are the four million unplanned pregnancies each year. The use of contraceptive methods is a dismal 34.5 per cent. “Approximately 25pc use some modern methods, but 9pc still use the withdrawal method,” said gynaecologist and obstetrician Dr Azra Ahsan, president of the Karachi-based non-profit Association for Mothers and Newborns.

Former SAPM on health, Dr Zafar Mirza, in his column of Oct 7 in this paper stated that the average Pakistani mother bore 3.5 children in 2020. Speaking with these displaced women, it does not seem things have impro­ved in the last two years. And if Pakistan continues to add 5.2m people every year to its population, it will reach 350m by the year 2050. Dr Nighat Shah, a Karachi-based obstetrician, said that having a captive audience in the form of displaced people provided the perfect opportunity for counselling couples about contraception and spacing, especially those who had several kids.

For every 300 to 400 men and women in a camp that she visited, there were over 600 children. “Every couple easily had between four to six kids,” said Dr Shah. What she found heartening, though, was that they were not averse to using contraception.

“The problem is not with them; the realisation that it is difficult to feed so many mouths had dawned upon them much before the floods. The issue is with the supplies,” said Dr Shah. There is also a dire need for midwives and counsellors in medical cam­ps who can provide antenatal care and family planning counselling services respectively.

The unmet need for modern contraception in Pakistan stands at 17pc today. Even in normal circumstances, pointed out Dr Ahsan, this is high and it must have increased for flood-affected couples.

Pakistan’s policymakers make ambitious plans, that look perfect on paper — and rem­a­­in there. The Family Planning 2030’s (FP2030) vision maintaining a “balance (tawazun) between family size and resources and make informed choices” should be brought to fruition. The government has made eight commitments for 2030, including doubling the population welfare and health budgets; increasing the use of contraceptives to 60pc; and ensuring zero stock-outs. But this tawazun can best be achieved when the departments of health and population welfare integrate (also a FP2030 commitment).

Until the FP2030 document is given a shot in the arm, Pakistan will not see much progress in stemming its runaway population.

What better time than now for the government to make good on all the promises it has made in the FP2030 document and send the displaced people home armed with one or the other contraceptive method?

The writer is a Karachi-based independent journalist.
Twitter: @Zofeen28

Published in Dawn, November 2nd, 2022