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Half of Sindh’s women desire no excess births, says report

KARACHI: More than half of the women in Sindh desire no excess births despite certain social pressures on them to give 26 per cent more births than the desired level, a report authored by the population welfare and health ministries showed on Saturday.

It said women in Sindh had 26pc more births than the desired level three years ago while this figure had increased further in the last three years.

Recent surveys conducted by government agencies show the emergence of three key characteristics clearly identifying the concentration of unintended pregnancies, which were 35pc in the rural areas. The lack of education and poverty cause 33pc of such pregnancies.

The report, part of Sindh’s family planning plan for 2020, said fertility in rural Sindh was 35pc higher than the desired level. Social pressures and poor accessibility of services lead women in rural Sindh to face the brunt of demand for large families and to experience single or multiple factors of high-risk pregnancies, threatening their health and life.

“Evidence reveals that the proportion of women desiring no more births has risen from 36pc in 1993 to 51pc to date; indicating a growing desire among women to curtail their pregnancies. The inconsistency between women’s fertility goals and not availing contraceptive services at the same time, results in unwanted pregnancies or women who seek recourse to induced abortion.

In addition to investing in the availability of services, it said, it was equally important that services were confidential, located at an easily accessible location, offer respectful care to women and are delivered as per their choice at an affordable cost.

In Pakistan, abortion is legally allowed only to save the life of a woman, but due to difficulty in interpreting the law, it has been complicated to obtain legal abortion services. An earlier official report in 2007 revealed that around 10pc of women reported experiencing a miscarriage or an abortion during the five years before the survey. As per more recent estimates, the proportion of unintended pregnancies rose from 38pc in 2002 to 46pc in 2012. The rate of unintended pregnancies increased from 71 to 93 per 1,000 women aged 15 to 49 years. In 2012, there were around nine million pregnancies in Pakistan, of which 4.2 million were unintended. Of those unintended pregnancies, 54pc resulted in induced abortions and 34pc in unplanned abortions.

As per provincial estimates, Sindh and Balochistan have the highest rates of induced abortions (62pc and 63pc, respectively). There were about 2.25m abortions in Pakistan in 2012. Thus, the national abortion rate was 50 per 1,000 women aged 15 to 49. This is much higher than the rate estimated for 2002 which was 26.5 per 1,000. The abortion rate for Sindh is 57 per 1,000 women aged 15 to 49 which is higher than the national estimate. In 2012, an estimated 623,000 women in Pakistan were treated for complications of induced abortion. About 63pc of treated women obtained post-abortion care in private facilities. In Sindh, 58pc sought care from private facilities, a slightly lower than the national average. When observed in relation to high unmet need, this phenomenon of seeking care from private facilities, demonstrates a need for immediate policy and implementation initiatives, particularly in the provision for easily accessible services to avert recourse to abortion and post-abortion care.

The report said more poor women reported experiencing side effects of family planning [FP] methods than wealthier women. Twice as many poor women experience side effects of modern methods (28.3pc) relative to wealthier women (14pc). The findings reflect poor quality of services (weak counselling about side effects and choice of method) at facilities serving poor women. Moreover, unmet need is highest among the poorest of the poor (24.5pc); and lowest among the wealthy (15.3pc). It shows poor women get low-quality commodities or obtain services from poorly-skilled providers due to lack of affordability and proper care. The service delivery mechanisms are less inclusive and less supportive in rural or underserved areas.

The report said the total demand for FP in Sindh was high (met need 29.5pc; unmet need 20.8pc). The FP services by public and private sectors have not kept pace with the rising demand. A large proportion of health sector facilities provide FP services but at a slower pace.

The report quoted a recent survey that women in Sindh, on average, had one birth in excess of their desired fertility, with a total fertility rate of 3.9 compared to a desired total fertility rate of 3.0. The alarming proportion of women not desiring additional pregnancies (51pc) and experiencing unwanted pregnancies are a reflection of this critical situation.

In Sindh, early marriages among girls is a persistent practice, even though the average age at marriage has reached 20, and the legal age for marriage increased to 18.

Many districts that have low female literacy also have high proportion of women giving birth between the ages of 13 and 18. This high-risk pregnancy behaviour (around 8pc from 2001 to 2013) puts the health status of women at a serious risk.

Courtesy : Dawn News

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