According to an estimate, Pakistan’s population is expected to double in the next 30 years. There is an urgent need to provide basic reproductive health information, especially to couples. It is important that they are aware of family planning methods that connect directly with women’s health and well-being. You! takes a look…
As I was going into marriage, I had very limited access to information about options in Pakistan. I went to a gynecologist who was intent on telling me that in the beginning, I should focus on having children after marriage instead of not having them. I went to a few different doctors and I felt I was being judged for asking this question at an early stage. Then, even after I had my first child, no one guided me about spacing between births. There is also a sense of fear and guilt instilled in women by people around them that if you take contraceptives and there are fertility issues, it would be the woman’s fault,” shares Ibtisam, a young mother of a toddler. According to Ibtisam, girls should be taught about reproductive health and contraceptives in schools.
Saniya, a Pakistani-American mother of two says conversations related to family planning are a taboo in the Pakistani society. While there is no sex education in schools, it is worse even at homes. Mothers feel a sense of shame and embarrassment in talking about sex, contraception, childbirth or postpartum depression with their daughters. “Years later, when I read about postpartum depression, I realised that I had it and while I was experiencing it, I had no idea what was wrong with me. It was the worst, most isolating feeling. I wish I had known,” expresses Saniya. “This conversation is long overdue in our society,” she adds.
Recently, we reached a milestone in human development as the world population reached 8 billion. On this occasion, Antonio Guterres, Secretary General of the United Nations, said that we should also consider our shared responsibility for the planet. As we approach New Year, let us discuss our shared responsibility related to global population and women’s health. We must highlight the important role of women in family planning discussions as this is closely linked with women rights and women health.
In the context of a developing country like Pakistan, there are several challenges to family planning including lack of awareness, limited access to contraceptives, misconceptions related to cultural and religious traditions, and personal and social barriers to the use of contraceptives. Family planning, which means choosing if and when to have babies, can directly impact physical and mental well-being of women. Therefore, women must empower themselves with important knowledge related to family planning to take control of their health and their family’s well-being.
Pakistan is in the list of top 5 most populous countries in the world with a population of more than 230 million people and annual growth rate of around 1.9 per cent (2021). The fertility rate in our country is 3.8 children per woman, which is 31 per cent higher than the recommended rate. According to UNFPA, 1 in 5 married women in Pakistan, who want to avoid pregnancy are unable to access effective methods of contraception.
The government and international agencies are working towards addressing the family planning challenge in Pakistan. The United Nations Population Fund (UNFPA)’s new representative for Pakistan, Dr. Luay Shabaneh, recently joined in September and in his message said, “I would like to acknowledge, with appreciation, the Government of Pakistan’s tireless efforts to meet the urgent needs of the population, particularly women and girls, by providing access to lifesaving sexual and reproductive health and gender-based violence services.” He will lead the 10th Country Programme Cycle (2023-27) in Pakistan, aiming to reduce preventable maternal deaths, dealing with issues related to family planning and gender-based violence and harmful practices, including child marriage in Pakistan.
According to an estimate, Pakistan’s population is expected to double in the next 30 years. This will not only lead to economic issues but also threatens lives of women. There is an urgent need to provide basic reproductive health information, especially to couples as they embark on a new chapter in their lives. It is important that they are aware of family planning and the issues associated with sexually transmitted diseases and ways to prevent and address these problems that connect directly with women’s health. They need to know necessary information and available services related to contraceptives such as pills, implants, surgical procedures, injections, barriers and natural methods.
Family planning tools can also save women from sexually transmitted infections and deaths. Lack of control leading to closely spaced pregnancies can lead to high maternal and infant mortality rates. It is harmful to both, mother and child. In Pakistan, maternal mortality is around 186 deaths per 100,000 live births. On the other hand, delayed pregnancy decreases the risk of pregnancy-related anemia, and allows women to maintain necessary stores of iron and other nutrients.
Family planning not only affects women physically but it can also impact women’s psychological well-being. According to recent studies, women who experience unintended pregnancy and unplanned childbirth are more likely to experience depression, anxiety and lower reported levels of happiness than those who plan pregnancy. 1 in 8 women report symptoms of depression after giving birth. Postpartum depression can last months or years after giving birth and it is important to diagnose and manage this for both, mother and baby’s better health. Unplanned pregnancies can also harm babies and can lead to issues related to low birthweight, premature birth, and infant death.
Certain situations aggravate the problem of population control. During crisis, for example, the recent devastating floods in Pakistan, we should remember that the threat to women’s health increases and chances of unintended pregnancies increase due to disrupted access to contraceptives and because of sexual violence. In such times, all the stakeholders must focus on women’s right to reproductive health by making this accessible.
Attitudes and behaviour as a society also influence family planning and population growth. In Pakistan, our society often equates marriage with having children. Motherhood should be a conscious decision instead of a default setting associated with women. Girls in child marriages with much older men tend to have little education and power, and many are unable to exercise any reproductive choice. According to UNFPA, in situations of domestic abuse, women are 53 per cent less likely to use contraception, and twice as likely to report an unintended pregnancy.
According to a study, 1 in 9 new mothers experience postpartum depression. Experts say that the risk is higher in some women, including those who had an unplanned or unwanted pregnancy. Feelings of sadness are normal after giving birth but if the feeling lasts over two weeks then you may have postpartum depression and should seek medical help; it can be treated with talk therapy, medicines or both.
Unfortunately, a lack of awareness on issues related to childbearing leads to dismal situations for women. Maryam, a psychologist who worked at a mental heath institute in Lahore recalls, a woman was brought in by her husband claiming she was possessed by jinns (evil spirits) after delivering her fourth child. There is a complete lack of understanding about challenges after giving birth including postpartum depression and an extreme form, postpartum psychosis. Women suffer unnecessarily because they are not aware of these possible issues and because their families are not prepared to provide proper care and necessary support system.
Tehmina, a magazine editor and a mother of two boys, says that from pregnancy and after birth, the constant care and sleep disturbances take a huge toll on a woman’s body and mental health. People around should acknowledge the challenges and show support to help new mothers. As a society, we should build a narrative that supports adequate spacing between births. Your body needs rest in between children. There are various nutrients that need to be replenished such as iron, calcium and vitamin D. Two children should be the optimal choice if you want a mother physically and mentally healthy. Another area that we can improve to support new moms is our healthcare system, which makes accessing care difficult. Even private care has a lot of problems where doctors are overburdened and do not seem to have enough time to show compassion and give due attention to all patients. The facilities in the public health sector are even more limited. “Don’t keep trying to conceive and risk your health because of societal pressure, for example, for a specific gender. It is alright to prioritise your health,” stresses Tehmina.
Amina is a home-maker and mother of five. She has four sons and a daughter. She always wanted a daughter so she kept trying until she got one. This was a rare case where preference of gender was a personal choice as opposed to societal pressure or family’s pressure to produce a male heir. However, this choice meant a lot more than two children. Unless women become active participants of conversations related to family planning, any personal preference related to reproduction will remain a partially-informed choice.
Usually, parents from underserved communities often face the choice between educating their children or getting them employed as soon as they are able to perform chores. Abida is a house help and has four young children. When she got married, her husband was working at construction sites and they kept moving regularly, almost living like nomads. Even when they did not have a concrete roof over their heads and had to live inside make-shift tents, limiting the number of children was never an important subject. More children meant more future earning hands for them. Then, her husband found a different job where his new boss convinced them to send these children to school instead of throwing them in the ruthless world of child labour. Encouraging education for young girls lowers the chances of teenage marriages and teenage pregnancies, creating a pathway to reach their full potential.
Zubaida is now a grandmother. She has seven children. “For my generation, it was normal to have six or seven children. The idea was prevalent that children are Godsent and He will take care of them. Then, these children will become each other’s support system and will also become a source of strength for parents in their old age,” elucidates Zubaida. Nevertheless, it certainly took a toll on her body. Her bones were affected and became weak. While most women around her had many children, the next generation, her children, have few offspring. In total, Zubaida has 16 grandchildren. This is just a glimpse of one family and only in three generations we can note the impact of family planning.
Clearly, time is changing and people are more aware of family planning and to have few children. However, there is still a long way to go. It seems that the majority of arguments in favour of more children are generally at the expense of women’s health or without any regard to the potential negative impact on women’s overall health. As individuals and as a society, we should not act selfishly or casually about women’s health. As they say healthy women are at the core of healthy societies.
The writer is a LUMS alumna and a community social worker with special interest in public health, philosophy, and human rights.
