A right often ignored...

By Adeela Akmal
Tue, 07, 19

The right to decide the number, spacing and timing of children has a profound impact on the life of a woman. This week You! highlights the importance of family planning and talks to a few women in this regard...

The right to decide the number, spacing and timing of children has a profound impact on the life of a woman. This week You! highlights the importance of family planning and talks to a few women in this regard...

Family planning is central to a woman’s empowerment and sustainable development. Today, more than 300 million women in developing countries are using contraception, but more than 214 million women who want to plan their births do not have access to modern family planning. Much more needs to be done to ensure a world in which all individuals can exercise their basic human rights, including those that relate to the most intimate and fundamental aspects of life.

There is no denying the fact that family planning is a basic human right. One in five married women in Pakistan who want to avoid pregnancy do not have access to effective methods. Reasons for this include: limited choice of methods; limited access to contraception, particularly among young people, poorer segments of populations; fear or experience of side-effects; cultural or religious opposition; poor quality of available services; users and providers bias; gender-based barriers.

Tooba Khan is a professional artist and mother of two toddlers who had to put her life on hold due to unplanned pregnancies. “I believe that everything needs some planning especially after marriage. You need to be mentally prepared to have a child. An unplanned baby can be very overwhelming and stressful for the mother. I conceived my first child just after a month of my marriage. I was only trying to adjust into my new married life and develop a better understanding with my husband when this big change came my way. And before I could get a grip on things, I gave birth to my second son just after 10 months. Rather than being happy for another child, I was really upset. I wanted my elder one to be at least four before I had another baby. My elder son was being ignored and there was no one to look after the children while I could work. So, to look after my kids, I had to put my work life on hold. During my first pregnancy, I could handle getting some work done but after the second one it was impossible. You can somehow manage things during the first unplanned pregnancy but a second one is truly very difficult. Your body needs rest,” explains Tooba.

While Tooba and her husband have been taking contraception, it didn’t work for them. “We tried condoms, which didn’t work. Later on, I also started the pills but they had side-effects and I was gaining weight. Healthwise, I had a lot of stiffness in my body which affected me emotionally as well. I was given drips for iron during both the deliveries. And to add to that, Postpartum Depression (PPD) was too much to handle and I was very aggressive during this time. Our society is very dismissive of PPD which makes it harder to overcome it. One needs to have a supportive family in order to get over this ordeal. So, when I had delivered the second time, I opted for the coil - Intrauterine device (IUD) - and my husband was supportive of me. However, after having two sons, I now hear that I should have a daughter. Having kids is easy, but you should also be able to provide for them adequately. You should have the right to choose how many kids you have and not follow a ‘tradition’ blindly,” she expresses.

The right to decide the number, spacing and timing of children has a profound impact on the life of a woman. It enables people to make informed choices about their sexual and reproductive health. Moreover, it represents an opportunity for women to pursue additional education and participate in public life. This is resonated in Farwa’s story, who is a mother of a four-year-old, pursuing her M.Phil in marketing and working at the same time. “Family planning is very crucial considering the economic structure in the present scenario. To educate a child, to concentrate on his upbringing and to give a comfortable lifestyle, you need to control the number of kids you have. Either you provide equal opportunities to all your children or limit the number according to your affordability. This is what we believe as a couple. Our child was planned. We discussed about the doctor, the hospital and went for the best. When we were considering the gap, one major reason was the health of the mother. Firstly, you need to give at least two-year gap before having another child, so your body can recover. Also, your child, up until the age of two, needs a lot of attention. I’ve been using IUD - commonly referred as coil - since women in my family had been using it and had good things to say. We opted for this because we didn’t want to spend a lot on good quality condoms as there were other expenses and I was not comfortable with taking pills. I haven’t had any issues so far and since the contraception were subsidised by the government then, it was pretty cheap as well,” elucidates Farwa.

“Personally, we planned to not have a kid for at least four years; but now that he will be turning five next month, we’re considering other things like affordability, lifestyle and our career choices. Our child is old enough to have a sibling and we’re both healthy but we have decided to not have a baby right due to other responsibilities. It’s a human right, a couple’s right and a woman’s right. My husband has a right to ask me for a kid but at the end of the day, it’s my call because it is my body that will go through the process,” she stresses.

While there are efforts being made by the authorities to make family planning accessible to all, a more vigorous approach should be taken. There are still a lot of taboos and myths associated with family planning which often makes it hard for young couples to make informed choices. “Family planning to me is like having your own say in your life. Speaking of our society, young couples are often pressured into having babies which is unfair to them. The couple should be able to decide if they are financially stable and mature enough to bring a new life into the world. It is high time that we make family planning a norm rather than be hush-hush about it,” voices Jamila, a 25-year-old who works as a content writer.

“I have been married for around three years and we have been using condoms and the pull-out method. So far, it has been working for us even though condoms are not 100 per cent effective, but it all comes down to you and your partner. There should be consent and the willingness of both parties. For us, we have to keep mum about it since there is a lot of pressure to have children; especially from our immediate family. Unfortunately, we don’t have the space to make that choice openly so we’d rather be known as ‘the couple trying to conceive but failing’ than the black sheep of the society. I don’t know much about contraception even though I am educated. Whatever I do know about it is through Google. I know about the copper coil but I’m scared to death to try them. I blame this on the lack of sex education we have. We hardly have proper medical check-ups and I go to the gynaecologist only when I need to, because it costs money. I would suggest that every girl must consult a gynaecologist at least before getting married. Women have limited access to such facilities and the men are as clueless to these issues. It all comes down to our education and taboos associated with family planning, which need to be dealt with,” concludes Jamila.

Types of contraceptives available in Pakistan

Birth Control Pills: These pills are a type of female hormonal birth control method and are very effective at preventing pregnancy. They are small tablets that you swallow each day. These are specifically for women and you need start taking a regular dose at least 20 days before having sexual intercourse. This is not for short-term use and you must consult your doctor and talk to them before consuming any medication.

IUD (Intrauterine device): This is the most effective form of contraception with the least amount of side effects. An IUD is an intrauterine device made of plastic and/or copper that is inserted into the womb (uterus) by way of the vaginal canal by a medical professional. They are used to prevent pregnancy and are considered to be 95-98% effective. This is not for a short-term use.

Injectibles: Injectable contraception is birth control medicine that is given as a shot. The shot is usually given once every 3 months on day 1 to 5 of your menstrual cycle. The medicine may decrease blood loss and pain during your period.

Plan B/Morning After Pill: This emergency contraceptive (ECP) pill is extremely cheap and widely available. This pill is to be taken when your choice of contraception fails, and this may help prevent unwanted pregnancies if it’s taken within 72 hours after unprotected sex. However, it is a very high hormone dose and cannot be used as a form of regular contraception. This is why it’s called ‘Plan B’.

Condoms: A condom is a sheath-shaped barrier device, used during sexual intercourse to reduce the probability of pregnancy or a sexually transmitted infection. There are both male and female condoms. It’s the most easy-to-use contraceptive that is widely available. They are also recommended along with other birth control as they are effective in preventing STDs (Sexually Transmitted Diseases).

World Population Day

‘The World Population Prospects 2019: Highlights’, which is published by the Population Division of the UN Department of Economic and Social Affairs, provides a comprehensive overview of global demographic patterns and prospects. According to this report, the world’s population is expected to increase by 2 billion persons in the next 30 years, from 7.7 billion currently to 9.7 billion in 2050. The study concluded that the world’s population could reach its peak around the end of the current century, at a level of nearly 11 billion. As for Pakistan, it is one of the eight countries that will make up more than half the projected growth of the global population.

The uncontrollable increase in the population of Pakistan is impacting the economic development of the country drastically. According to the Annual Plan for 2019-20, Pakistan is constantly facing the grave problem of overpopulation, whereas our resources are scarce as slow economic growth does not cater for the needs of our people. It stated that the fruits of the economic development were swallowed up by the increasing population, living standards of people were not improving as required and every economic and social sector is badly affected. Even though Pakistan was the pioneer in Asia to start the ‘Family Planning programme’, but sadly, the political elites and policy makers of Pakistan overlooked its importance.

Not only our growth rate but also the fertility and contraceptive prevalence rates are undesirable. About 41 per cent of the children in the country are stunted and this is the third highest percentage of stunted children in the world. Pakistan stands at the 150th place in human development index among 189 countries according to UNDP’s latest survey, released in September 2018.

World Population Day is observed globally on 11th July, every year. This day was initiated to combat the issue of growing population and raise awareness among the public. Population issues include things like family planning, human rights, right to health, the baby’s health, gender equality, child marriage, use of contraceptives, sex education, knowledge about sexually transmitted diseases, etc.