abortions are akin to a silent epidemic that claims lives of many women each year in Pakistan
By Farahnaz Zahidi Moazzam
In the heart of the bustling city of Lahore, on Temple
Road, is a small clinic, infamous for being one of the quickest ways to get
rid of an unwanted pregnancy. This is one of the many such clinics on the
street. The clinic’s doors are open to any woman who comes for an abortion.
While its staff promises to do the procedure safely and hygienically, its
claim to fame is quite the opposite: Horrendous tales of incomplete body
parts and remains of aborted foetuses floating past the open drains that run
through the area are well-known.
As one enters, they welcome you warmly. A nurse
introduces the patient to a lady who “claims” to be the doctor, who is
lying on a bench and resting till the next patient strolls in. There is no
way of confirming if the woman is a doctor or not. The first question they
ask is which residential area the patient has come from. If the patient says
she has come from an upscale area, the rates are threefold — Rs12,000 in
the first month and Rs25,000 in the second month… and the rates keep
escalating depending on how far the pregnancy has progressed.
“It is not my concern whether a patient wants to get it
done because she made a mistake with a lover, or wants to abort a female
foetus, or uses abortion as a form of family planning, or is healthy enough
to carry the child to term or not. My job is to clean out her uterus within
hours and send her home. That is all,” says the alleged doctor.
But don’t they know that for an abortion to be legal in
Pakistan, the condition is “necessary treatment” which the health
provider has to decide? Will they not check the woman’s health status? Her
blood counts? And does it matter to them how far the pregnancy has
progressed? The questions are dodged. They say they use “the vacuum method
and other methods” for abortions.
The clinic is definitely not equipped to handle any
post-abortion complication. And this is one of the relatively better
clandestine abortion clinics that carry on with their business quite openly.
In another part of Lahore, the situation is bleaker. This
is Shahi Mohalla, also known as Heera Mandi. Some 1,500 female sex workers
inhabit this area. Contraceptives are not always accepted by their male
clients, resulting often in unwanted pregnancies. Already poor, vulnerable to
HIV and Sexually Transmitted Diseases (STDs) and exhausted, these women may
call for Traditional Birth Attendants (TBAs) or “dais” for deliveries and
abortions. But small abortion clinics are a more popular choice.
“Many of them lose the battle of life due to
post-abortion complications. The methods used in these abortion clinics of
the area are old-fashioned and invasive and often harsh methods that result
in complications,” says Lubna Tayyab, founder of the NGO called SHEED
(Strengthening Health, Education, Environment, Development) Society that is
working for the betterment of sex workers and their children in the area.
Abortions in Pakistan are mostly obtained in clandestine
clinics. Very few of these clinics are properly equipped to carry out
abortions safely. Providers typically perform dilation and curettage
procedures. They almost never used manual vacuum aspiration, a less invasive
and safer procedure.
According to a report by National Committee for Maternal
and Neonatal Health (NCMNH) and the Guttmacher Institute (Ref: http://www.guttmacher.org/pubs/IB_Abortion-in-Pakistan.pdf),
a nationwide study estimated that 890,000 induced abortions took place in
Pakistan in the year 2002. This amounts to 29 abortions per 1,000 women of
reproductive age. Of every 100 pregnancies, 14 ended in induced abortion.
Deaths, long-term disabilities, health complications and
a messed up reproductive system — these are just some of the side effects
of an unsafe abortion. Complications can be incomplete abortion, hemorrhage
or excessive bleeding, trauma to the reproductive tract or adjacent
anatomical areas, sepsis (bacterial infection) and a combination of these
complications. Excessive bleeding may have life-threatening consequences,
such as anemia or shock. Perforations and lacerations may occur to the
vagina, cervix or uterus and may involve injury to adjacent areas, such as
the intestines, requiring surgery with full anesthesia. Hysterectomy (removal
of the uterus) may be required, leaving the woman permanently infertile. If
not treated in time, sepsis can lead to peritonitis (inflammation of the
abdominal lining), septicemia (blood poisoning), kidney failure and septic
shock, all of which can be life-threatening.
Unsafe abortions are carried out by methods that are a
health nightmare. Gulping down large doses of drugs, inserting a sharp object
into the uterus, drinking or flushing the reproductive tract with caustic
liquids, vigorous movements like jumping or physical abuse, and repeated
blows to the stomach are some of them. Incidences have been reported where
bowels of the patient are pulled out by mistake, through the reproductive
According to Population Reference Bureau, Women of our
World, (2005), the lifetime chances of a Pakistani woman of dying from
maternal causes is 1 in 31.
A 1999–2001 university hospital study found that 11 per
cent of maternal deaths that occurred in the hospital during this period were
caused by complications resulting from unsafe abortion.
However, reliable data on induced abortion is almost
impossible to obtain. For something that is done so commonly, it is
surprising how well it is hidden. While the evidence is limited, it is clear
that post-abortion complications account for a substantial proportion of
maternal deaths in Pakistan.
In 1990, the Pakistan government revised the colonial-era
Penal Code of 1860 with respect to abortion. Under the 1990 revision, the
conditions for legal abortion depend on the developmental stage of the foetus
— that is, whether the foetus’s organs are formed or not.
Islamic scholars have usually considered the foetus’s
organs to be formed by the fourth month of gestation. Before formation of the
organs, abortions are permitted to save the woman’s life or in order to
provide “necessary treatment.” After organs are formed, abortions are
permitted only to save the woman’s life. (Ref: United Nations Population
Division, Abortion Policies: A Global Review, New York: United Nations,
2002). However, generally, this is a debatable issue.
Since 1997, under certain circumstances, abortion is
legal in Pakistan, not only to save the woman’s life but also to provide
Most women who have induced abortions in Pakistan are
married and already have more children than the average Pakistani woman
wants. Thus, abortion is used as a form of family planning.
The average age of the women seeking abortions, reported
in several studies, was just under 30. Research provided by NCMNH shows that
96.1 per cent of the women who seek abortions in Pakistan are married.
“This shows that it is a misconception that abortions are common in
unmarried girls who want to abort an illegitimate child,” says Dr Azra
Ahsan of NCMNH.
“Also, female infanticide is not a problem in Pakistan,
apart from isolated incidences. In 15 years of medical practice in Pakistan,
I have not received a single request for termination of pregnancy on the
basis of gender,” says Dr Sadia Ahsan Pal, also of the NCMNH.
Pakistan Demographic and Health Survey 2007 (PDHS)
reveals that 41 per cent of urban married women of Pakistan use
contraception, compared with 24 per cent in rural areas, while 25 per cent of
Pakistan’s married women have an unmet need for family planning, both for
spacing and limiting the number of children. This has a direct bearing on the
probability of abortions, which is used as a form of family planning.
Unsafe abortions are a public health issue that needs
immediate attention. Timely family planning and awareness about use of
contraceptives can be the actual solution to this silent epidemic that claims
many lives of women each year in Pakistan.
Older than her years
“I belong to district Lodhran in the Punjab. My father
got me married off to my paternal cousin when I was 14 years old. My husband
is older to me by some 13 years,” says 23-year old-Sughra, who looks much
older than her years. She is a mother of two children.
Dark circles, breathless upon walking, dragging her feet,
Sughra is displays the classic signs of anemia.
“A couple of years ago my husband beat me up so
severely that I could not even swallow or lift my hand for days. I came to my
mother’s house. At that time I was pregnant. I stayed on in my parents’
home and thought about ending the marriage. Having another child in such a
marriage seemed like a bad idea. I was hurt, and took my revenge by deciding
to abort the baby,” shares Sughra, wiping her eyes with a worn out dupatta.
“My mother took me to this daai who charged us Rs 1000.
Her instruments were not clean. I still remember the rusty looking, stained
metal probes she used. But what option did I have? I was about four months
pregnant when I got it done. The daai had promised I would be on my feet the
next day. But I was on bed for two weeks, bleeding profusely,” she
Sughra was finally taken to the nearest hospital where
she ended up getting blood transfusions. “My health has never been the same
ever since. The doctors said I could have died because of the bleeding and
infection related to my abortion,” she says.
Sughra is now back in her husband’s home. He refuses to
use any contraceptives, but Sughra now has started using injectable
contraceptives. Her face, though, saddens every time she remembers that
Two years ago, waking up in my hotel room in Milan, I
observed there was no loadshedding during the last three days I was in Italy,
no news of explosions or suicide attacks. I wondered what kind of a country
is this till I realised we too were once a normal country.
These days, one notices the news of such attacks and
blasts have considerably reduced as is the cut in electricity. This return to
normalcy is not extraordinary and citizens do deserve the basic
rights of peaceful existence and comfortable living. However, in our peculiar
circumstances it was somehow not possible for a number of years. Now, when
life returns to routine, no one appreciates it or admits that the decrease in
terrorists’ activities may have something to do with the response of the
government and its allies, meaning largely the US. Pakistan Army and American
forces, sometimes jointly but often independently, have been destroying the
strongholds of extremists, either with the help of field troops or through
air strikes. People usually lament the killings through drone attacks but
forget that the country is in conflict with those who challenge the
constitution of Pakistan and strive to impose their version of faith that
does not have room for followers of other beliefs, or even for different
sects within the same religion. The example of that worldview — to which
several of our leaders, journalists and media persons seek to revert — was
practiced in Afghanistan during the Taliban rule.
The extremist elements in Pakistan united under the
banner of Tehreeke Taliban Pakistan have carried out a series of terrorists
attacks; including the killing of Shiite community, exploding shrines of
saints across the country, destroying schools for girls and threatening
everybody who dares to differ from their opinions or supports freedom of
expression. Some amongst us claim this is not our war, forgetting the fact
that thousands of Pakistani citizens lost their lives by these extremists,
ranging from the assassination of Benazir Bhutto to the beheading of hostages
in tribal areas.
Everyone can recall how the news of an
explosion by a suicide bomber became a frequent item in our print and
electronic media and soon lost its sense of shock or uniqueness.
Arguably one major reason for minimising the
terrorist activities, apart from the military operations, is of course the
drone strikes. Most of us feel their collective duty to condemn drone
attacks, calling them a violation of our national sovereignty, completely
neglecting the fact that in today’s world the concept of conventional
sovereignty is not possible or applicable. Like the terrorists from different
countries (Libya, Saudi Arabia, Yemen, Indonesia, Philippine, Sudan, Egypt
and Central Asian’s States) who came to Pakistan uninvited and are living
here without the government’s permission, consent or knowledge, the drone
planes too are entering our space.
Not only Pakistani but many foreigners have
also joined the discourse; writers, intellectuals, analysts and activists
from Europe and North America are pronouncing their disgust against the drone
strikes. A recent exhibition, Zero Hour, arranged by Reprieve (international
organization that uses the law to enforce the human rights of prisoners) at
Drawing Room Gallery Lahore, was an illustration of how we are caught in
situations without our consent. A glimpse of it was sited in the show, which
included works by Adeela Suleman, Ayesha Jatoi, Farida Batool, Faiza Butt,
Haider Ali Jan, Hasnat Mehmood, Imran Mudassar, Jamil Baloch, Saba Khan,
Sheraz Faisal and Waseem Ahmed.
Zero Hour (the joint venture of Rohtas 2 and Drawing Room
Gallery held from Oct 26-29, 2011) depicted how our artists are being used in
a narrative designed by others. For instance, some artists have created works
— like the installation of dead birds by Adeela Suleman, Lenticular print
of a child behind yellow flowers by Farida Batool and miniature of Waseem
Ahmed — which did not have a direct link with the theme of the exhibition.
A number of other works did not embody the artist’s strong or conscious
response against drone attacks, even though these addressed war on terror and
fundamentalist in multiple manners. Yet all that visual diversity, freedom
and openness was twisted in the exhibition, since it was presumed that the
viewer will believe that each artist made a critique of the drone attacks; an
understanding that was not based on facts.
Even if some works from the exhibition had a link with
the war on terror, the makers’ approach as an artist was not for or against
a doctrine or political entity. The situation was presented more in the form
of a question without providing an answer. It was understandable because the
task of an artist is not of a political worker or a reformer but of an
individual who investigates the essence of things, without being caught in
the frenzy of popular propaganda. In addition to that, the mediums, methods
and means of producing art turn their works into exclusive endeavours.
Regardless of the fact that they, in their naivety, assume they are creating
a political/public art and thus making a difference — by putting red
clothes on a defunct war plane in a busy square of Lahore. This and other
such works, whether in their documented versions or actual form, are just
drawing room exercises.
Though rural theatre has been part of our cultural
landscape for as long as one can remember, its plays, actors, musicians and
impresarios have been taken for granted. Not much has ever been written as
they have not really been signalled out exclusively for detailed profiling.
Theatre has been taken as part of the performance constituting the entire
matrix of cultural life in the subcontinent.
Now the taken for granted approach has been abandoned by
Fouzia Saeed who has focussed on the lives of the personnel who took part in
theatre and performing arts on the less glamourised end of the cultural
scale. Cinema has been much galmourised with the Indian cinema now the
biggest industry in the world, and television only on a slightly lesser
scale. Women associated with cinema are like goddesses, all pervasive,
seizing the fantasies of people but women associated with rural theatre and
performing arts hardly ever get mentioned. Actually the entire activity is
dismissed as something lowly and not worthy of being mentioned as such among
the urban circles.
When women step out of their protected space and enter
the world of television and cinema they are zeroed down in terms of glamour
and gossip. But the purpose of Forgotten Faces by Fouzia Saeed is not to come
to terms with the image of the person but the person herself, in flesh and
blood as she negotiates the perils of her profession. It should be mentioned
that the lives of women in showbusiness of whatever grade is not easy for it
has rested somewhere between stigmatisation and worship. Between these two
subhuman and superhuman extremes it is not easy to find a steady balance and
the chances of tripping over are ever present. We have seen most of the times
that the tripping over takes place which again exposes these women to
But, in this book, women who appeared to live normal
lives, juggling career and domestic duties were not ordinary women, protected
and circumscribed. While they also carried out the common chores, they also
embedded the other dimension of women being independent in terms of their fan
following and finances. Like men, these women also joined the profession
either because their families were associated with it or it was the
consequence of an accident or mishap. Many of the famous actresses have been
mentioned and some profiled like Khurshid Kukko, Rukuyya Jabeen, Surraiya,
Naznin Mano, and above all Bali Jatti. The latter was the main draw of rural
theatre in the 1960s when she held her own against the likes of Alam Lohar
and Inayat Hussain Bhatti. The protagonists of all other theatre companies
were male except for Bali Jatti. She sang and danced while successfully
running her company and competing on equal terms with the other figures on
the rural theatre scene. They now lived in retirement with the glitz and
turmoil of their acting days and nights only a memory.
The book is a documentation of the rural theatre,
especially in the Punjab. It does not only focus on the plays and the roles
but the way these were managed and run, their economics, sociology and
morality all form part of the study. Very few people were aware of Watan
Theatre, Phajji Shah Theatre, Shahjehan Theatre, Kissan Theatre, Wali Shah
Theatre, Tufail Theatre, Shama Theatre, and Lucky Theatre and Bashir Lohar
Theatre and less so the women who played the roles in mainly dramas based on
folk tales of the area. Gaman Theatre, one of the most important theatres,
was the only one which did not have women in their team. Like in traditional
theatre, it was the men who played female roles. But in other companies,
women played an active part on and off the stage.
Only when some of the actors and vocalists
appeared on screen, either big or small, it became their introduction to the
urban mass and it became aware of their existence.
Fouzia Saeed has been exploring the
conditions of women who work in showbusiness and what actually constitutes
their lives. As part of the same quest, she wrote Taboo and had written
earlier on the women working in the folk theatre. Now, building on that, she
has come up with added insights.
She aptly points out that rural theatre was on the verge
of extinction. Even a few years ago, it was vibrant but now its incidence is
much less and its contribution to the festivities has been marginalised. The
reasons could be many; the introduction of other means of entertainment, in
particular television which has tremendous outreach across the length and
breadth of the country and for which one does not have to venture out of the
house and the charges are minimal. In Pakistan, the rise of orthodoxy that
shuns such cultural activity has been successful in scaling it down with the
threat of violence. The replacements have been Indian films and music which
is not local but has been distributed by the bigger companies in the
subcontinent. It appears that if the present trend continues there will be no
rural theatre in its existing form. In this research, she has also talked to
the progeny of the personages of the theatre. It has been an accepted
tradition that the children inherit the profession of their parents but, in
this case after talking to the children, it was clear that they are moving
away and opting for other professions. This book, therefore, can also serve
as a documentation of a cultural activity that was popular and widespread in
the near past.
It seems that were we are also entering the era of
virtual or ghost entertainment. In view of the oppression, condemnation and
threats, the activity will be conducted or held in areas that cannot be
easily targeted. The only casualty will be live performances because through
television, satellite and net, the performances can be received by people in
their private protected spaces.
My teenage offspring often accuse me of not listening to
most of what they are saying. They are always chiding me “We told about
that, but you never listen”. It is true that sometimes they are speaking to
me and I do hear sounds coming out of their mouth but I must not be paying
attention because it is all a bit of a blank. I am sure it works both ways
though: for example they also seem unable to hear me when I tell them —
eight or ten times — to tidy up after themselves or clean up their rooms.
It happened to me again recently when First
Born told me happily that she had “signed up for Nanowrimo”. Of course I
looked blank. It did sound vaguely familiar but I couldn’t think why. She
was exasperated “I’ve told you about it! So many times!” True, it did
sound familiar — perhaps something to do with the ipod nano? Or something
to do with Harry Potter? She patiently went through it again and after a
couple of sessions I finally understood what she was referring to: Nanowrimo
is an international writing initiative in which you finish a novel in one
month, i.e. it is National Novel Writing Month. You sign up and thus have a
fixed deadline and become part of a writing community and have a support
group and a clear focus. You have access to advice and tips and you can chat
with other writers on various forums.
This brilliant initiative was set up in 1999 by
“Freelance writer Chris Baty and 20 other overcaffeinated yahoos” and it
is now run by a non-profit organisation in the US. In the first year, 21
people participated and there were six ‘winners’ (winning means you
declare you have met your targets and finished your novel), but by 2010 there
were 200,500 participants and 37,500 winners (!). Many Nanowrimo writers have
gone on to be published and been fairly successful — for example, Sara
Gruen (Water for Elephants, The Ape House), Amelia Atwater Rhodes (The
Persistence of Memory) and T. Greenwood (The Hungry Season)
to name but a few.
The Nanowrimo initiative has sponsors but it also asks
individuals to donate and, amazingly, 48 per cent of all donations are from
private individuals. This is followed by merchandise (32 per cent), corporate
sponsorships (7 per cent) and then various others like events, grants etc.
The money is mostly spent on running creative writing programmes (especially
for young writers) in school, communities and libraries and creating more
places and resources for writers and group leaders.
Inspired by First Born, I too have signed up for
Nanowrimo and according to the logic of scheme I should have finished my
novel by the end of the month. Ahem.... we shall see how that unfolds...
Nanowrimo has been criticised by some publications for
being unrealistic and encouraging rushed and, hence, poor quality work.
Others see it as exactly what aspiring writers need to kickstart their
writing careers and get going. Not all participants are ‘winners’ as not
everyone can finish their novel, but this probably does help them to get
quite a lot of it written, which is terrific. What I particularly like is the
sense of purpose and worth that is attached to the craft and practice of
writing here; the recognition and encouragement of language, wordcraft and
expression and the sense of purpose that is imparted.
First Born is taking it all quite seriously. I sincerely
hope she can finish her book, find a publisher and then become rich and
famous quite soon. I’ll definitely listen to her more attentively then...