A strange paradox

To say that we live in a patriarchal society would be a cliché, but how else can we describe a society where women can’t even make decisions regarding their own body, and regarding when and how many children to have.

Feminists have for years been advocating for equal rights for women not only in education and health but in all spheres of life. And when it comes to women’s rights, reproductive health is an important segment where women need to make informed decisions. Unfortunately, according to the State of World Population 2019 report, Pakistan’s maternal mortality (death due to pregnancy-related complication) rate was still as high as 178 women per 100,000. Though it has improved from 276 in 2008 and 375 per 100,000 in 1995, it is still quite high, as compared to other countries in the region.

One of the reasons for the high maternal mortality rate is lack of family planning, both due to lack of information and access to services. The desired number of children in our population is said to be four, while the average family size is six children, which means on average each family has one or two children which the families did not want or plan. Many families think of using family planning methods only after they have 5-6 children. It is a sad fact that often when an unwanted pregnancy occurs the woman seeks an abortion.

Abortion is considered a stigma in our society and, despite there being a law that allows abortion in certain cases, especially to save the mother’s life or for necessary treatment, safe abortion facilities are hardly available and where they are available the providers are often reluctant. In this case, those seeking abortion have to resort to unsafe practice in back street clinics, through traditional birth attendants (TBAs).

If family planning facilities are properly utilised the number of unwanted pregnancies can be reduced, thus reducing the need for unsafe abortion. As per a national study of the Population Council, out of 4.5 million unwanted pregnancies each year, about 700,000 ends up in post-abortion complications and 500 women die because of unsafe abortion, accounting for 5-13 percent of the maternal mortality rate in Pakistan.

While women’s empowerment is one way to enable women to make informed decisions about the use of family planning, involving men as equal, responsible and active partners is an important step to promote reproductive and sexual health. Since traditional gendered roles for men and women often deny women the power to make decisions about family planning, etc, experts recommend educating both women and men on the importance of gender equality and reproductive rights to create a world where women can take control of their reproductive rights.

It is a strange paradox. While ours is a patriarchal society and men take all the decisions, family planning is very women-centric and men don’t feel bothered to even be concerned about it. It seems men have been filtered out from playing any role and all the responsibility has been placed on women’s shoulders.

Experts believe that men need to be engaged in reproductive health, not only when it comes to making decisions about family planning, but from adolescence, if not pre-adolescence, as behavioural norms of men form at the early stages of adolescence, till they have completed their family. If men are involved in a wide range of reproductive health services as equal partners, better outcomes can be expected in reproductive health indicators such as the use of contraception, safer sexual behaviours, utilisation of reproductive health services, and reduction in maternal mortality and morbidity.

Given the importance of the role men play in improving reproductive health, efforts are being made to counsel men so that they understand their role in ensuring the wellbeing of their partners. Programmes to train men in counselling have been initiated at the community level. It is believed that this initiative will equip men with the correct information and knowledge about family planning and post-abortion care, and will guide and support women to seek appropriate family planning and contraceptive services.

Now that it has been realised that the involvement of men is important and efforts are being made to make them a part of the process, it should not, in any case, be at the cost of women’s empowerment and stop them from making decisions.

There are a lot of misconceptions in our society – for example, most people do not want to delay the first child and wish to start a family immediately after marriage; they are also not clear about the return of fertility, which happens 8-15 days after abortion, according to the WHO’s ‘Family Planning – A Global Handbook for Providers’. Post-abortion family planning is a highly missed opportunity; if a woman does not receive information on family planning after an abortion, she is prone to another unwanted pregnancy which can end up with unsafe abortion. This is where men can play a role and help the women to choose and decide about the method of their choice.

It has been observed that men prefer short-term family planning methods as they want their wives to be healthy and begin the reproductive process again. They think it is a natural process. They don’t realise that the continuity of the reproductive process will further compromise the health of the woman. This is why a comprehensive male engagement strategy is the need of the hour.

During a recent virtual session organised by Ipas on the subject, it was emphasised by the reproductive health champions that there is a need to educate our communities to reduce the social stigma associated with post-abortion care and family planning.

Ipas has taken the initiative of arranging training programmes for sensitising male community intermediaries, such as family welfare assistants (FWAs) and social mobilisers (SMs), to provide information about family planning and contraceptives to the men in their communities, especially about post-abortion family planning. These community intermediaries could be the best source to mobilise the community men towards the uptake of family planning methods.

It should be kept in mind that it is young people that need to be worked with if we need to bring any meaningful changes in the population landscape, contraceptive prevalence rate and unmet need, as there is a youth bulge in the country. However, unfortunately, young people are the ones who have the most unmet need and the lowest contraceptive prevalence. This area needs to be brought under the radar and worked on.

The writer is a freelance journalist.

Twitter: @naqviriz