KARACHI: Sarafa Bazaar located near Boulton Market, is crowded. The shops are squeezed together as though they grew in like mold in dingy and dark conditions. The shops sell all sorts of clothing on wholesale. The men yell out to no one in particular, chew tobacco, spit and then laugh with each other. It is all business in Sarafa Bazaar.
Amid the hustle and bustle, a white-bearded Abdul Sattar Edhi quietly sits in his office surrounded by paperwork on his desk – a sign of hope for many in Pakistan.
In 1951, Abdul Sattar Edhi and his wife Bilquis Edhi established the Edhi Foundation and redefined humanitarian efforts in Pakistan. The not-for-profit organisation currently provides medical services, shelters for orphans and adults, assistance for disabled persons, education, blood bank, air and ground ambulances, research centres, drug rehabilitation centres and much more.
Despite being accustomed to working in Pakistan’s volatile and often unpredictable conditions, some things still manage to surprise the couple.
“In a month, five to six kids are left abandoned at my centers. Simply because of poverty, they don’t have a source of income, or cannot handle having children,” said Edhi.
According to Bilquis, every month 15-20 woman walk in, sometimes accompanied by strange men but most with their mothers, to ask if they could be helped with getting an abortion.
“I don’t know what these girls are doing nowadays,” said Bilquis. “These girls have mobile phones before any common sense.”
This trend is occurring not because women do not know their religious boundaries, or have no morals or income – it is happening to all types of women, regardless of their circumstances, mainly due to lack of family planning in Pakistan.
“Most women know about family planning, at least 96 per cent,” said Dr. Sadiqua N. Jafarey, Professor of Obstetrics and Gynaecology department at Ziauddin University, during a workshop on family planning. However, she stated, there is a big gap between what they know and what they use.
The current maternity mortality ratio is 276, which basically means that for every 100,000 live births, 276 women die. Consequently, one maternal death occurs every 30-40 minutes in Pakistan, according to the 2007 Pakistan Demographic and Health Survey (PDHS), which assist in development of evidence based policies and monitors progress towards the UN Millennium Development Goals.
Dr. Jafarey said that one third of all maternal deaths can be avoided if simple family planning methods such as delaying motherhood, pacing births and avoiding unwanted pregnancies, are candidly counseled.
Between the ages of 15-49, an estimated 96 per cent ever-married women, who have at least been married once, know of at least one modern method of contraception, 49 per cent have used a method at least once, 30 per cent are current users of a contraceptive method and 22 per cent use any method of contraception.
An estimated 43 per cent of married women, who do not intend to use contraception, gave the following reason to justify their choice; fear of side effects, opposition by husband or family, infertility and faith (leaving things“up to God”). Yet, most married women, almost 70 per cent, are getting abortions according to the PDHS.
Dr. Jafarey explained that many married women have an unmet need for contraception, and when they become unexpectedly pregnant – they choose abortions as a contraceptive tool – mostly an unsafe but preventable option.
Typically, a lower contraceptive rate leads to a rise in abortions rates. Contraceptive rates that were higher in Punjab, 33 per cent, and Sindh, 27 per cent more developed provinces had lower abortion rates when compared with Balochistan, 14 per cent, and Khyber-Pakhtunkhwa (formerly known as NWFP), 25 per cent, where abortion rates were higher.
Dr. Jafarey said that a large number of women die as a result of unsafe abortions.
Globally, two thirds of abortions are performed on women between the ages 15-30 years. South and Central Asia are known to have the highest rates of unsafe abortions, according to the World Health Organization 2005 report.
“Awareness and [family-planning] is the first thing, but if it is too late there are safe options for women,” said Dr. Nighat Shah, consultant for Obstetrics and Gynaecology at Aga Khan University Hospital.
Every year, an estimated 890,000 induced abortions occur in Pakistan. More specifically, for every 1,000 women, 29 get an abortion, according to a 2004 Population Council report. Experts believe that the numbers have only increased in the past six years.
“When we say the A word – abortion, a lot of people become passionate about it – it’s a religious issue, it’s a social issue, but for [the medical industry] it’s a health issue,” said Dr. Shah, “I think it is sensitive topic but it needs to be talked about more.”
Dr. Shah explained that the correct medical terminology for a fetus that is expelled before 24 weeks (168) is an induced miscarriage, regardless of the circumstances. Despite the use of the word abortion in judicial and Islamic laws, which recognise any expulsion of the fetus, before or after 120 days, as an abortion.
Although many, including medical professionals, assume that induced abortions are against government and Islamic law, this is not true – abortions are legal under certain circumstances, according to the Shariah and judicial laws of Pakistan.
In 1990, after a revision of the Penal Code of 1860, abortion laws were conformed under Islamic laws. Currently, abortions are permitted if it will save a woman’s life, or if a medical professional deems it as a “necessary treatment.” To date, no doctor or medical professional has been accused or convicted for performing an abortion in Pakistan.
“In the medical profession, we tend to attach our moral values to the patient. Why should I help after she has sinned? We end up forcing her into a death cell. This is what we are doing,” said Dr. Shah.
An unsafe abortion can cause many medical complications and in some cases it leaves women permanently disabled. Almost 11 per cent of induced abortions resulted in death in 2002, where an estimated 197,000 women were hospitalized for complications from unsafe abortions in Pakistan, according to a 2007 study.
“These young and sometimes little girls might have had something unfair happen to them, sometimes rape, incest, etc. They are taken to these houses, sometimes hidden. [Doctors] call these places ‘toilet hospitals’ that have mushroomed all over. They do not have proper tools and are unhygienic.” said Dr. Shah.
Yet, women often choose not to make their physical health a priority.
“I meet educated women, even sitting at Aga Khan University, some of my female married residents have no knowledge of contraception – they do not think that this is my fertility, my life, and it should be in my hands,” said Dr. Shah. “Women in Pakistan take fashion seriously, they take make-up seriously – but not their health.”
“At the end of the day – it is her body, this is not the right of the lawyer, not the right of the government, not the right of the media, and it is not even the right of the doctor. A mother’s right should not be taken from her unjustifiably at any point.”
While medical professionals such as Dr. Shah and Dr. Jafarey, among others, spread awareness on family planning among the masses, back in Sarafa Bazaar, Abdul Sattar and Bilquis Edhi have no time to wait when people are in need.
Bilquis is sorting through left over goodwill clothes to hand over to other charities while Abdul Sattar Edhi is sitting in his office sorting through his never-ending paperwork.
“Someone left an eight-year-old boy here just the other day and he is too old to stay here – we will have to put him somewhere else,” said Abdul Sattar Edhi, shrugging his shoulders.
Edhi lets out a long and tired sigh, “As long as the public is uneducated – people will not understand. Until then, I have to do it.”