ACCORDING to the Pakistan Demographic and Health Survey 2006-07, the country's population growth rate has fallen to 1.9 per cent from a record high of 3.7 per cent per year in the 1960s.
The survey also gives the total fertility rate (the average number of children a woman would have if she went through her entire reproductive period, 15-49 years) as 4.1 which has been reduced considerably from 5.4 in 1990.
The population welfare authorities are naturally pleased with these results. But a veil of silence shrouds some more statistics related to reproductive health. It has been left to the National Committee on Maternal and Neonatal Health (NCMNH) to shed light on the unpleasant realities of the demographic sector in Pakistan.
Releasing the findings of a survey conducted with the cooperation of the Guttmacher Institute, New York, in 2002, the NCMNH disclosed the other day that an estimated 890,000 induced abortions were performed in Pakistan that year. Since abortion is severely stigmatised in our society women are reluctant to talk about this issue. Many of them do not even seek professional help. A large number have their pregnancy terminated clandestinely by untrained, back-alley midwives.
Inevitably this leads to complications that place a heavy load on the healthcare system. Thus in 2002, 197,000 women had to be hospitalised for post-abortion complications and a tenth of them died of sepsis, excessive bleeding and other abortion-related disorders. These maternal deaths are only one aspect of the picture. It is not known how many women suffer from infertility, long-term disabilities and the economic costs of poorly performed abortions.
While such surveys scientifically confirm what has generally been known, the need of the hour is to look into this matter seriously rather than hush it up or condemn the women who are driven to seek recourse to abortion. The plain fact is that every abortion performed is a story of failed contraception. The DHS places the unmet need for contraception at 25 per cent. In other words one in four women is saddled with an unwanted pregnancy which she could have avoided had she had access to reliable birth control methods.
The question that has intrigued demographers is how Pakistan's population growth rate has been falling when contraceptive prevalence has not increased proportionally. The NCMNH and Guttmacher fact sheet answers this question succinctly. “The disconnect between low contraceptive use and a relatively small average family size suggests that women are relying on abortion as a method of controlling their fertility.” Unsurprisingly, the more backward a province the lower its contraceptive use and the higher the abortion rate.
As is generally the case in issues related to reproductive health, the problem is rooted in the poor status of women in our society. This time one cannot even blame the law, the prevailing myths notwithstanding. The abortion law as amended in 1990 to better conform to Islamic teachings is quite liberal. In fact, no one has been known to have been prosecuted under this law.
The problem lies in the policy that denies many women easy access to contraceptive cover. Strangely, men have been absolved of all responsibility in family planning matters. As a result the onus of finding a solution rests on women, and their stories are heart rending. At the NCMNH meeting Dr Saadiah Pal presented a number of case studies of women who opted for abortion, some of them dying in the process. But could they be blamed? One who was pregnant for the 12th time was the sole breadwinner of the family and her husband was a drug addict. Another had eight children and was a beggar. And the stories went on.
These are the stories the population welfare department should be listening to. The gynaecologists and obstetricians are familiar with them as they have to bear the brunt of abortions that go wrong. They know what is needed and this was reiterated at the meeting mentioned above. Their recommendation to show the way forward was, “Prevent unintended pregnancy to reduce abortions. Ensure availability of quality family planning services. Increase health and population budget to six per cent of GDP.”
These words sum up in a nutshell what is missing in our population programme that is not making any headway. There is a total absence of political will especially at the highest level and an utter failure to comprehend how basic a slowdown of population growth rate is to the success of our economic development. The strategy adopted to achieve the goal of replacement level birth rate by the year 2020 is also counter-productive.
As is our wont, a National Population Commission, headed by the prime minister, and four provincial population councils have been announced. But not much is heard of them.
The population strategy focuses entirely on women who now understand the importance of planning their families. But the cooperation of men is not being enlisted. What better proof is there of missing male participation than the data for contraceptives? In January 2009 the use of condoms fell by 18.6 per cent as compared to January 2008, when in the same period overall contraceptive use registered an increase.
The government speaks of cultural sensitivities, unaffordability of contraceptives and the marked preference for a male child as hampering progress in achieving population goals. Mercifully, the negative role of religious leaders has not been advanced as a major factor because as confirmed by the experts at the NCMNH meeting the clergy is no longer a vociferous opponent of family planning. But it still has to emerge as a staunch advocate as it has in other parts of the Muslim world.
Dr Sadiqua Jafarey, president of NCMNH, is spot on when she observes, “Many Pakistani women are paying with their health — and even their lives — to avoid births they cannot afford or do not want.” She also believes that the maternal mortality rate can be drastically reduced if women are helped to avoid unintended pregnancies.