Unplanned pregnancies are leaving women vulnerable to diseases and untimely death in Pakistan. Efforts are now being made by the governing bodies to make family planning a health need for mother and child, and not just for controlling the family size.
Karachi: Health experts in Pakistan are now concentrating on getting women from all strata of society to space births.
Pakistan encouraging birth spacing to protect mother and child/ Photo credit: IPS ''Birth spacing gives the woman time and opportunity to recover from the nutritional deficiency caused by repeated pregnancies. Studies show that short birth intervals of less than 24 months increase the risk of neonatal mortality," says Dr. Sadiqua Jafarey, president of the National Committee for Maternal and Neonatal Health.
New research points to the benefits of having the first child late and spacing the next child until after three to five years. Curiously, it is women from the less affluent sections who are keen to follow these prescriptions.
Family planning in Pakistan
One reason is that family planning (FP) programmes have, for years, been active among the lower-income communities, completely ignoring the educated and affluent who may be aware of hypertension, diabetes, heart problems and lifestyle ailments, but are often ignorant of the risks of poorly timed pregnancies.
"Family planning information should be widely available so that all pregnancies are planned and no one has to resort to abortion""True, these FP programmes are in the public sector and funded by donors whose mission is to serve the poor," explained Dr. Rehana Ahmed, an internationally-known consultant.
Ahmed said the affluent turn to specialists and the commercial sector. However, education and correct FP information should be widely available so that all pregnancies are planned and no one has to resort to abortion.
Motherhood and health
According to Ahmed, short birth intervals can lead to the ‘maternal depletion syndrome’ which results in anemia. In the event of complications like bleeding, anaemic women are at higher risk of dying in childbirth.
Pakistan’s maternal mortality ratio (MMR) is estimated to be 276 per 100,000 births, although the figures are known to be much higher in the remote, rural areas.
Sara, mother of two, aged six and five, had just finished her architectural studies when she got married. Juggling a furniture business, in between picking up her daughters from school, taking them to ballet and piano classes and making sure they attend a madrassa (Islamic religious school), has kept her busy."The seven years seem like a blur,"
Sara had her first daughter a year after her marriage, and two years and two months after the delivery she had her second one."I thought I might as well become a mother, get over child bearing and then begin my career,"she says.
Child birth
Several women gave various reasons why they wanted to have shorter interval between pregnancies. These included:
"Grandparents are younger and so can help in childrearing; a woman’s biological clock is ticking and so childbearing has to be speeded up; and the children can be better playmates to each other."
Career-minded women like Sara also said they wanted to get through the whole rigmarole of feeding, nappy changing and sleepless nights quickly and thought it was just as easy to handle two infants as one.
"Fewer children mean better food and education for the children that are already there"Women from the lower-income group appeared more pragmatic. Kulsum Sharif, 35, a domestic worker, was just 17 when she got married. Like Sara, she too did not space her first two children, a son and a daughter, now aged 19 and 18 respectively.
"I was feeding my first child, so I couldn’t go on the pill as the doctor had suggested it would decrease my milk flow. Also, my neighbour told me I wouldn’t get pregnant as long as I am breast-feeding," Sharif said.
Sharif had a third "unplanned" child after a seven-year gap. She wanted to have just two children and while she wanted to space her pregnancies she did not quite know how.
"The poor cannot afford to have many children given today’s spiraling food prices. Fewer children mean better food and education for the children that are already there,"she said.
Asked if she thought closely-spaced births affect the mother’s as well as the child’s health, Sharif responded in the affirmative."More work, less rest, disrupted sleeping patterns and not able to give enough time to the husband."
Contraceptive
Unlike Sara who was aware of all the methods of contraception, but did not like any of them, Sharif said she was, at that time, too young and not well-versed with the available FP methods.
"FP messages need to be changed from 'do bachay hi achay' to 'waqfa bahut zaroori'"In fact, while Sara planned her children and Sharif did not, neither knew the virtues of birth spacing.
Over the years the Pakistan government, too, has realised that FP messages need to be changed from "do bachay hi achay" (two children are better) to "waqfa bahut zaroori"(spacing is necessary).
The emphasis now is to promote FP as a health need of both the mother and child rather than controlling family size, said Jafarey.
A significant factor in women not using contraception or spacing birth is lack of awareness and fallacies attached to various available contraceptive methods. Despite years of government promotion campaigns, they are yet to be demystified.
In fact, the reasons Sharif gave for not using contraceptives are resonated in all strata of society and not just among the less educated. "I have heard that the pill and the IUCDs (short for intrauterine contraceptive devices) cause heavy periods," said Sara.
"All women must space pregnancies because every woman needs to recover from the physiological changes that occur during pregnancy"These misconceptions need to be cleared and addressed, says Ahmed, adding that contraception is many times safer than pregnancy.
But why should women like Sara, who do not have economic compulsions and have ample support in the form of domestic help and extended family, are well-rested and eat well, resort to birth spacing?
"All women must space pregnancies because every woman needs to recover from the physiological changes that occur during pregnancy and delivery and she should breastfeed the child," says Ahmed.
Research has shown that the optimum time between pregnancies is kept between three to five years is healthy. "Over five years of spacing is also not healthy," Ahmed said.
According to the most recent Pakistan demographic and health survey 2006-07, carried out by the National Institute of Population Studies, around 20 percent of women in Pakistan want to space their pregnancies.
The major stumbling block to their wish, according to the survey, was unavailability of FP services for a large number of married couples.
Pakistan saw a surge in contraceptive use in the 1980s and 1990s. But it has peaked in recent years. Twelve percent of couples used contraceptives in 1990-91. This increased to 28 percent in 2000-01, and has since remained at around 30 percent.
Major hurdles towards promoting birth spacing include social norms such as son preference and fear of using modern contraceptives. "Often, the girl has to prove that she is fertile," said Ahmed.
According to the specialist there was a need in Pakistan to present birth spacing as a survival strategy for the child as well as the mother.
"In Zimbabwe, they say, if children are born close together they burn each other. So the concept of birth spacing is age-old. We need to find a way to convey it to our people in local terms."
source:southasia.oneworld.net
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