Abortion in Pakistan: struggling to support a woman"s right to choose

Sonia woke up in dingy room with searing pain in her stomach. All she remembered was being accompanied by her husband to a clinic for an ultrasound. She’d recently found out she was pregnant; her husband had often been abusive and didn’t react well to the news. Today was supposed to be different: he insisted on going to the clinic so he could see the scan and Sonia hoped that reflected a change of heart.

However, slowly Sonia realised she had been drugged and given an abortion without her consent at a private clinic. It took years for her to come to terms with the violence she suffered.

Islamic scholars permit an abortion within 120 days of pregnancy in Pakistan. But despite this framework for permitting abortions, health professionals are reluctant to carry out the procedure. Many women resort to ingesting drugs, using sharp objects, or physically abusing their body resulting in long-term health complications. In 2012, an estimated 623,000 Pakistani women were treated for complications resulting from induced abortions. In Sonia’s case, her ex-husband was able to pay an unqualified provider to conduct a procedure she hadn’t not consented to. Her story highlights the danger to women’s health when the only option for is an unhygienic facility clinic with untrained staff.

In such dangerous circumstances, who is filling the gap? Saba Ismail, co-founder of the Pakistani women’s group Aware Girls, launched an abortion hotline in June 2010.

Aware Girls has received US Aid funding in the past but now will have to depend on grants from European foundations after President Trump reinstated the global gag rule which prohibits US funding to NGOs which provide information about abortions.

“We have not heard any donor withdrawing our funding on this basis yet, but we will become automatically ineligible for US Aid and other state department grants on this basis, and that’s the challenge,” says Ismail. “We fear that Trump’s decision will affect Pakistan because any organisation, hospital or clinic working on abortion will not be able to get any US funding.”

A woman told us to stop talking about abortions or contraceptives and instead educate women on how to be better wives

Saba Ismail, co-founder of Aware Girls

US Aid spent $ 54.1m dollars funding family planning and reproductive health in Pakistan in 2015 and Marie Stopes International, the family planning NGO which receives funding from US Aid says that its work in Pakistan over the past decade has “averted 4.6 million unintended pregnancies, 1.9 million unsafe abortions and 6,000 maternal deaths”.

Aware Girls provides an anonymous toll-free service called “Saheli” (Urdu for “friend”) to educate on abortions and contraceptives: “When we first launched the helpline we were told that we were promoting murder; that abortion wasn’t about choice but about murder. This stigma and taboo is what bothered us the most.”

Over the course of six years Ismail and her colleagues have faced harsh criticism and threats. “In the beginning we started with 30 calls a month and now we average about 180 calls,” she says. “This is because we went into the communities and spoke to women about their health informing them about the helpline. At one of the events a woman approached me, identified herself as a representative of the Taliban, and told us to stop talking about abortions or contraceptives and instead educate women on how to be better wives to their husbands.” This didn’t stop her, although threats forced them to temporarily close down for six months in 2014.

Ismail’s helpline follows the World Health Organisation’s guidelines on safe methods of abortions that can be performed at home for women under nine weeks pregnant. Misoprostol, a drug used to induce abortions, is available over the counter in many countries including Pakistan because it is also used to prevent stomach ulcers. Ismail’s staff asks women to provide details about their health and verify the length of the pregnancy, and takes them through the process of abortion.

“People think that most women that call us are sex workers or unmarried women. While we do not judge and only ask reasons for abortion for our research purposes, I can tell you that the we get a large diversity of calls. From women aged 17 to 50, women that are married, who have recently given birth, who already have a lot of children and even women who have been raped by their own family members,” Ismail recalls the story of 21-year-old Sameena who was raped by her own cousin and was refused help at a hospital.

An extensive women’s health report conducted in 2012 found that of the 9 million pregnancies in 2012, 4.2 million were unintended; 54% of these unintended pregnancies resulted in induced abortions and 34% in unplanned births.

I attend to calls even when I am in a family gathering, in a funeral or anywhere, I never miss a single call

Tahira Khan, helpline counsellor

The vast majority of the helpline’s calls are about abortions, only 4% of the callers ask about contraceptives. Nonetheless, each caller receives information on the use of contraception. The contraceptive prevalence rate is low in Pakistan – out of a population of more than 190 million, only 35% of women aged 15–49 use it. The reasons for this range from lack of sex education and awareness, and the fact that contraception is still considered a taboo and, in some places, seen as a western concept. Last year, Pakistan banned advertising for contraceptives.

The counsellors on the helplines are young women with no medical background who are trained with the WHO’s clinical handbook [pdf] on safe abortions. Tahira Khan says the helpline has now become more than just a job: “This hotline is a part of my life now, I attend to calls even when I am in a family gathering, in a funeral or anywhere, I never miss a single call, I always call back. When I help women, I feel satisfaction and happiness. Before starting counselling, I thought I could never do it, but with the passage of time, I am now an expert.”

The hotline has received over 25,000 calls so far and this is increasing by the day. Ismail’s organisation can only help women who are under nine weeks pregnant, but in some cases they have to provide referrals for surgical abortions at selective clinics that conduct these procedures under hygienic and medically approved conditions.

Ismail is determined to continue her work but she knows she is treating a symptom rather than a root cause. “My fight is against the taboos that tell women that their bodies aren’t theirs,” she says. “Unless women are seen as human beings who have a choice and right to their own body nothing will change.”

Some names have been changed.

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Abortion in Pakistan: struggling to support a woman"s right to choose

Pakistan polio vaccinator"s murder by militants raises well being workers" fears

A Pakistani well being worker marks the finger of an Afghan refugee kid after giving her a polio vaccine. Photograph: Muhammed Muheisen/AP

The uncommon evening-time kidnapping and brutal murder of a female polio vaccinator in the troubled Pakistani city of Peshawar has heightened fears amongst well being employees struggling to stamp out the virus in the face of violent opposition from militant groups.

The entire body of Salma Farooqi, a thirty-yr-outdated who had been concerned for many years in Peshawar’s battle against polio, was recovered from a area 4km (two.5 miles) from her residence on Monday, a day following armed males stormed her property, tied up family members members and took her away.

Police mentioned the mom of 5 had been tortured and repeatedly shot.

Attacks on vaccination teams, a lot of of whom are drawn from the country’s 100,000 sturdy army of “Lady Health Workers”, are typical, with far more than 30 killed in the last two many years. But attacks at their homes are virtually unheard of.

Loved ones members said armed men entered the house at about 1am on Sunday morning, right after some of them climbed in excess of the boundary wall of the creating in Gulozai village on the edge of the frontier city of Peshawar.

“Salma was rapidly asleep following to me when the men came in, beat me and tied me and the youngsters up,” explained her husband, Mohammad Karim Khan. “It took us an hour to totally free ourselves and then we saw that Salma had disappeared.”

A kid held by his brother receives a polio vaccine from a Pakistani overall health employee on the outskirts of Islamabad, Pakistan. Photograph: Muhammed Muheisen/AP

Ihsan Shah, the police inspector responsible for the neighbourhood, said it was premature to speculate about the attainable motives of the attackers.

But Tariq Khan, an uncle of the dead lady, mentioned he was convinced she was targeted for her function.

“We have no enmity with any individual, but she had been taking element in the polio vaccination campaign for many years,” he stated. “The government only provide security for the duration of the vaccination function because they are being paid millions of bucks by the worldwide local community.”

The day before her violent abduction, Farooqi took part in a polio campaign, part of a huge effort by the government of Khyber Pakhtunkhwa province to stamp out the crippling condition.

Peshawar was not too long ago named by the Planet Health Organisation as the “greatest reservoir of endemic polio virus in the globe”.

Every weekend for 3 months up to 8,000 vaccinators are trying to give oral polio drops to almost every child aged below five in the city.

As in other components of the nation, the threat of attacks by militants has forced wellness workers to be accompanied by armed police as they go door-to-door seeking for young children to inoculate against a illness that has been eradicated in virtually each and every other country in the planet.

Militants are deeply suspicious of the vaccinations, which have been demonised by radical clerics as supposedly component of a western plot to sterilise Muslim youngsters.

They also dread the campaigns could be utilized as a cover for spies. In 2012, Taliban commanders in Waziristan, a tribal location bordering Afghanistan, banned polio teams until finally US drone strikes came to an finish.

Mohammad Tahir, a national spokesman for the country’s Lady Wellness Employees, mentioned a committee had been launched to investigate no matter whether Farooqi had been killed because of her work.

“The killing has produced an even higher sense of worry,” said Tahir. “We have to have greater protection.”

Pakistan polio vaccinator"s murder by militants raises well being workers" fears

Pakistan to shell out parents in new polio vaccination drive

A Pakistani schoolgirl receives polio vaccine drops from a overall health employee. In Peshawar, eight,000 overall health staff will hit the streets to vaccinate practically 800,000 children in a single day. Photograph: Muhammed Muheisen/AP

Dad and mom in one particular of Pakistan’s most troubled provinces are to be paid to vaccinate their kids against polio, the crippling illness the planet is tantalisingly near to eradicating.

It is hoped some 2 million kids from some of the most disadvantaged places of Khyber Pakhtunkhwa (KP), the north-western province wracked by Taliban violence, will benefit from the scheme.

Mother and father will be entitled to declare one,000 rupees (nearly £6) for every single little one who completes a 15-month programme of vaccinations that will protect them against a quantity of diseases which includes measles, hepatitis and polio.

It is the very first time the nation has resorted to financial incentives, which are hardly ever utilized around the globe.

Public well being officials battling childhood diseases face immense difficulties in KP, where militant attacks are a every day schedule, poverty is entrenched and many folks are deeply suspicious of programmes enthusiastically backed by western powers.

“It has to be a excellent sum of cash to be eye-catching, even in the extremely poorest districts of the province,” explained Janbaz Afridi, deputy director of the province’s expanded programme on immunisation. “If it is a success we will lengthen it to every single little one in the province.”

KP’s government, backed by UN agencies, is at present on a war footing against polio in certain simply because Peshawar, the province’s teeming capital, has turn into a international well being issue.

The historic frontier city is 1 of the last remaining redoubts of polio, the virus that cripples and kills children and which has been eradicated in every single nation except Pakistan, Afghanistan and Nigeria.

Situations from all around the planet, such as China and Syria, have been genetically matched to the Peshawar strain.

Last month the World Wellness Organisation declared the city the “greatest reservoir of endemic poliovirus in the globe”, a problem caused in component by the city’s open sewage channels and broken water pipes. Polio is spread through make contact with with human faeces.

Inside the neighbouring tribal areas, Peshawar acts as a central exchange and an “amplifier” for a condition carried in and out of the city by the tens of thousands of folks who pass through every day, which includes a huge population of refugees who fled Afghanistan in the 1980s.

“The difficulty with Peshawar is that we often have circumstances there,” explained Bilal Ahmed, a senior Unicef official in the city. “In other districts the virus comes and goes, but it in no way leaves Peshawar, which tells us it’s the source.”

The WHO says a lot more than 90% of circumstances all around the nation and in neighbouring Afghanistan are genetically linked to the city.

Of the world’s three polio-endemic nations, Pakistan is the only one in which the situation is receiving worse and circumstances are rising.

India, which this yr acquired its difficult-earned status as polio-cost-free, now turns away travellers from Pakistan unless of course they have a certificate proving they have been vaccinated. Other countries could adhere to suit.

The most recent push in Peshawar is an attempt to give polio vaccine drops to virtually every single little one below the age of five each and every weekend for 3 months.

It needs eight,000 wellness workers to hit the streets with the aim of vaccinating virtually 800,000 children in a single day.

4 thousand police officers will escort them to defend them towards the gunmen who have killed scores of polio vaccinators close to the country in current many years.

Throughout vaccination sessions, total neighbourhoods are place into lockdown, with motorbikes banned from the streets.

One particular risk is from the Taliban, who have utilised the international campaign to eradicate polio as a chip in their battle against the US.

In 2012 insurgent commanders in the restive tribal locations of North and South Waziristan banned polio teams from their territories in what they mentioned was retaliation for US drone strikes. Some religious clerics argue the drops are portion of a foreign plot towards the Islamic world to make Muslim kids infertile – a perception arguably created worse by international interest in the concern.

It really is a major problem for a campaign officials say needs to reach 97% of children to stand a chance of eradicating the ailment in the city.

Polio teams carry booklets of “fatwas”, or religious decrees, by well-known scholars who argue there is nothing wrong with the drops.

The government has also known as on large-profile clerics to assistance the programme.

“In public the mullahs are all on the same page now,” said one health official. “A lot of still will not like it but they will not preach openly against vaccination anymore.”

Some vaccinators say that whilst fewer dad and mom are refusing the drops for their children, several hide them indoors on vaccination days.

Public antipathy is even now easy to discover. Amir Zaada, a father going to the city with his three children from a distant element of the province, explained the vaccination programme was “just a game”.

“There are other fatal ailments, so why is the government only talking about this,” he asked, also raising the case of Shakil Afridi, a medical professional who ran a hepatitis vaccination campaign in the town of Abbottabad.

The programme’s motivation was not public well being but an elaborate scheme by the CIA to learn no matter whether Osama bin Laden was hiding in the town. His unmasking confirmed the worst suspicions of individuals inclined to see vaccinators as a western conspiracy.

Zaada mentioned he had no regrets not vaccinating his youngsters.

He explained: “Search at them. They are fine and in great wellness. Only God keeps them protected and healthier.”

Pakistan to shell out parents in new polio vaccination drive