Bodily autonomy and deteriorating women’s health in Pakistan

It would not be an exaggeration to say the state of women’s health and especially, maternal health in Pakistan is in shambles. And what better time to highlight this than the now controversial Women’s Day.

The current debates on ‘Mera Jism Meri Marzi’ (My Body, My Will) criticize the uncultured intentions of demanding bodily autonomy for women. However, a woman’s jism is for more than sex. It also just functions, exists, reproduces and nurtures (often the same men and women who don’t believe in its autonomy!). So when we hear ‘Mera Jism Meri Marzi’ next, our mind should not go towards all women wanting to run naked (I am yet to see this even at a nude beach at UBC!). But rather think about the jism’s basic autonomy that has been taken away by normalization of other’s deciding what happens to it.

Too risky to give birth

Some quick research into women’s reproductive health in Pakistan suggests that we still have a high Maternal Mortality Ratio (MMR) – 140 deaths per 100,000 women in 2017.

Data Source: UNICEF Data
Data Source: UNICEF Data

While MMR is declining, the fall is much slower than our neighbours, as shown below in the two graphs above. We had a headstart from our neighbours due to a smaller population, yet we could not achieve a faster decline than them.

A recent Our World in Data report state that the five countries with the highest number of maternal deaths in 2015 were: Nigeria (58,000); India (45,000); Democratic Republic of Congo (22,000); Ethiopia (11,000); and Pakistan (9,700).

Death in childbirth is avoidable, and these numbers may not seem too high but are shocking when we consider this is 2020 and a natural procedure becomes deadly due to poor access to appropriate healthcare.

But that’s the government’s fault right? What’s it got to do with women’s rights?

However, the “widely endorsed strategies for promoting safe childbirth—skilled birth attendance, with timely referral for emergency care in a well-functioning health care system—are reflected in Pakistan’s formal maternal health policy”. This study concludes that social norms like caste systems affect the success of healthcare policies as they don’t function in isolation, therefore the “causes of the causes” should be targeted.

Essentially, changing societal norms and normalizing bodily autonomy of women resolves the demand-side hurdles in reducing maternal mortality. You can have all the healthcare facilities but if it is not normalized for women to access it, it’s not useful!

Now you might think this is a rural phenomena. But a study of social factors affecting maternal mortality by Sohail Agha concludes that

At a major teaching hospital in Karachi, most mothers who died during childbirth were not from distant areas; rather, most maternal deaths were of women who lived 6–8 km from the hospital, in a city where transportation is readily available. Study findings indicated that approximately one-third of those maternal deaths were due to financial constraints; another third were the result of socio-cultural barriers (e.g. family reluctance to take woman to the hospital); and one-fifth were caused by inadequate maternal health services (e.g. delay at the maternity home in referring a mother or time lost in transferring the mother to a secondary care facility).

Sohail Agha, A profile of women at the highest risk of maternal death in Pakistan, Health Policy and Planning, Volume 30, Issue 7, September 2015, Pages 830–836, https://doi.org/10.1093/heapol/czu066

Whether you’re based in a village or city, mindsets don’t change with location. The key to achieving some of the goals the government spends tax rupees on is by changing ourselves first. Tabdeeli hukoomat mein tou agayi, hamare andar kab ayegi? (Change has come in the government but when will we, the people change)

Even before birth

The perils of a patriarchal society are further revealed when we get to know that Pakistan also has one of the highest rates of abortion in the world, as it has become a form of contraception

In a society where abortion is a taboo, even in situations where it is permitted, it is truly shocking to read that 54% of unintended pregnancies are terminated. Because a lot of these wouldn’t legally qualify for an abortion, women resort to back-alley procedures that are a health risk.

Couple unintended pregnancies with conceiving a female fetus and the rate would go even higher as social pressure to reproduce men forces women to opt for dangerous methods of induced pregnancies.

One lady Mehnaz’s case reflects the entire dilemma where a woman feels trapped in choosing between her body and the relations in her life:

Three years ago she had her seventh child, a girl. She then tried taking the pill, offered by the visiting health workers.

She says it made her dizzy and she stopped taking it.

She again became pregnant but miscarried — and pleaded with doctors to sterilize her.

She says they told her she had to wait until she was 40 — or get a permission slip from her husband. He refused: “He says he can’t sign this, it’s a sin.”

She says he also refuses to use condoms or to stop having sex with her.

If she has another girl, her husband may well abandon her. If she tries to induce another abortion, her health could deteriorate.

“I am stuck,” she says.

Dia Hadid, Why The Abortion Rate In Pakistan Is One Of The World’s Highest, (2018), NPR

There are countless stories of such cases where women’s right to choose what happens in and through their bodies.

On the surface it may look like women’s empowerment is a struggle to achieve absolute, wild freedom that will wreck all cultural norms. But if cultural norms cost so many lives every year, what’s the harm in wrecking them?

My brief study of Islam in South Asia has also revealed that so much of religion ‘sold’ to us is culture. And such that we cannot untangle culture from religion at times. So using religion to defend barbarous practices is also against the very spirit of Islam – a religion, who’s first convert was a woman Khadija.

I’ll end with a small byte that medieval Islamic medicine made farther strides in women’s health than their Greek. predecessors. So what is stopping us in 21st century?

Limitations in our own mindset and society.

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