A dystopian reality: what happens when contraception is replaced with abortion

^^ In the photo above is Mehnaz who, after having had one son and six daughters, had to have 3 abortions in fear that she would give birth to more girls. Her husband had threatened to throw her out of the house if she gave birth to yet another girl, which led to her self-administering herself with toxins including tablets and brews of boiled dates, as well as purposefully lifting heavy things in order to have an induced abortion. This is just one story, but there is most likely so many other stories that are similar to Mehnaz's, not just in Pakistan but in other parts of the world too.

In the western world, we are fortunate that contraception has become more normalised over the years, with the stigma surrounding using condoms or birth control in order to avoid unwanted pregnancies being lessened. However, in countries where the very mention of anything sex-related is condemned and shunned, many people are left unequipped with the appropriate tools to have a healthy sex life. In this article, I will be using the example of Pakistan to illustrate the detrimental effects of using contraception as a replacement for abortion, although I do acknowledge that this problem is present in other countries in the South Asian continent and the Middle East.

In 1990, the Pakistani government revised the abortion law which legalised abortion in mitigating circumstances, where it is illegal except if needed to preserve the women’s life or health in line with Islamic teachings. This piece of legislation is problematic mainly due to the sex-negative culture: Pakistan is a country governed by Islamic law which means that there is a lot of taboo surrounding sex and relationships. Pre-martial sex is forbidden as sex is considered to be exclusive to marriage, with the only acceptable opposite sex relationship being with your husband. The notion of having a boyfriend or girlfriend is condemned, with social repercussions of exclusion and even murder (honour killings are common within the community), which means that sex education is deemed unnecessary and possibly dangerous.

The patriarchal, sex-negative culture means that contraceptive knowledge is very scarce, with only 30% of Pakistani women using a contraceptive method, and more than one quarter rely on traditional, low efficacy methods such as withdrawal and periodic abstinence. This method is undeniably ineffective which leaves women largely unprotected against unwanted pregnancies, and combined with poverty, means that women are forced to do unsafe backstreet abortions. Furthermore, many married women have difficulties obtaining contraception due to its unavailability or because they are unaware of how to use it effectively, and thus abortion is used as a back-up when unintended pregnancies occur. In 2002, 890,000 induced abortions took place (thus making it one of the world's highest), with 200,000 of these women being hospitalised for abortion complications such as incomplete abortion, haemorrhage and excessive bleeding. This suggests that induced abortions contributes to avoidable illness or even death.

In order to solve this problem, attitudes towards contraception need to change: many Pakistani men and women refuse to use contraception and instead rely on the excuse of fatalism – “it’s up to God” – to justify why they have more than the average number of children (which is 5), despite the fact that they cannot financially afford to support such a big family. Other factors that explain the relatively low contraceptive use includes a fear amongst women that contraceptives will damage their health and that their husband will object to family planning, lack of knowledge about contraception, as well as their belief that religious and social norms do not endorse their use. In 2010, there was violent backlash against the set-up of an abortion helpline, with Islamic groups and political parties condemning it as "anti-Islamic" and "colonial". It's aim was to save the lives of thousands of women who die in backstreet abortion clinics, by teaching women how to use a drug to induce a miscarriage safely. Abortion, and supporting women who choose to do it, is not evidence that the west is superior or anything along those lines; instead, it is about saving women from preventable deaths and illnesses. This is important as Pakistan has one of the highest maternal mortality in the world, with 320 women dying for every 100,000 live births.

The use of more effective contraceptive methods needs to be normalised and made available to the population so that unwanted pregnancies do not take place, and in turn the likelihood of induced abortions happening will be decreased, because Pakistani women use abortion as part of their strategy to avoid unwanted or mistimed births. They do this notwithstanding the illegality of the procedure and the considerable health risks it entails as proven by the large number of women hospitalised for treatment of complications each year.

P.S. I hope you liked this article, and that you learnt the importance of contraceptive knowledge in non-western countries, as it's easy to accept the west's position on issues as the norm when in fact it is the exception. I am not endorsing any personal beliefs on whether or not contraception and abortion is right or wrong; however, I do believe that it is more safer for women to use contraception so that they can avoid unwanted pregnancies, and thus require an abortion of any kind (illegal or legal).