In 1998, 391 infant girls were found dead, about 68 in 1999, 59 in 2000, 51 in 2001, and 39 in 2002. The Family Planning Association of Pakistan (FPAP), now called "Rahnuma", was founded in Lahore by Saeeda Waheed in 1953. According to this change in the abortion law, preservation of "the physical and mental health" of a woman, early on in the pregnancy, also became legal grounds for a permissible abortion. In spite of being a deeply conservative Muslim country, Pakistan is estimated to have one of the highest rates of abortion in the world, based on a 2012 study by the Population Council. According to the UN Inter-agency Group for Child Mortality Estimation, Pakistan's rates of child mortality (neonatal mortality rate: 44.2; infant mortality rate: 61.2; child under 5 mortality rate: 74.9)[10] nearly double the worldwide average (neonatal mortality rate: 18; infant mortality rate: 29.4; child under 5 mortality rate: 39.1)[11] set by UNICEF Global. 338. Family Planning in Pakistan: Applying What We Have Learned. [1] One-fourth of married women are estimated to have an unmet need. [1], The Family Planning Association of Pakistan (FPAP), now called "Rahnuma", was founded in Lahore by Saeeda Waheed in 1953. … [1], According to Dr. Ansar Ali Khan, an advisor of reproductive health to the United Nations Population Fund in Pakistan, "A combination of factors like non-availability of services, baseless traditional beliefs and misconception play a big role. • An est… [17] Honor killings in Pakistan are known locally as karo-kari. Oxford, 1996. Laws may permit, prohibit, restrict, or otherwise regulate the availability of abortion.A few countries ban abortions entirely. Induced abortions are known to occur in Pakistan, The infanticide was mainly almost all … In 2007, Pakistan had increased in world population ranking to 6th, with over 164 million people and the United Nations (UN) has projected that in 2050 it will move into 5th place with around 292 million people. [1] Though Pakistan was one of the first Asian countries to begin a family planning program with some help from international donors, fertility has declined slower than in neighboring countries. [1], The first abortion penal code (Article 312) of this region dates back to 1860, during British colonial rule which stipulated that unless an abortion was to "save a woman's life," it was expressly illegal and punishable by law, and the same applied for (self)induced miscarriages. In 2013 some of the provinces - notably Punjab - reported that they were developing their own population policies. Many women experiencing an unintended pregnancy resort to induced abortion: A nationwide study estimated that close to 900,000 unintended pregnancies were terminated by induced abortion in 2002. In fact, many NGOs have implemented interventions where they have worked with local or national clergy. "[7] However, due to extreme and unrealistic goals,[vague] the USAID program was highly ineffective. A new hotline has been launched in Pakistan that gives information about how women can use the medication misoprostol to have a safe abortion, or to prevent dangerous hemorrhaging after giving birth. [6] Waheed, a member of the All-Pakistan Women's Association, began advocating for birth control when her maid died from an attempt to abort her own pregnancy. The accompanying concerns of this crisis have resulted in extremely high neonatal, infant and child mortality rates. The Ministry of Health (Pakistan) started a similar program in 1994 called "lady health workers." An honor killing is the homicide of a member of a family or social group by other members, due to the belief the victim has brought dishonour upon the family or community. It has the world's second-largest Muslim population.It is the 33rd-largest country by area, spanning 881,913 square kilometres (340,509 square miles). [24][25] Since the PDHS 2006-7, operations of NGOs have increased but it appears that according to the supply data there has been no increase in supply of FP commodities[26] and that entry of the NGO Marie Stopes Society into FP services has displaced clients from other private sector, perhaps those that previously self procured commodities. [15][16] Unfortunately, however the interpretation of necessary treatment required by a woman for an abortion to be performed is vague, and despite the legality, health professionals in Pakistan felt abortion was "immoral, contrary to religion and illegal," especially according to female paramedics when compared to doctors and gynaecologists. 06 Apr 2011. However, the large discovery in Karachi shows that many of the female infants were killed because of the local Islamic clerics, who ordered out of wedlock babies should be disregarded. [29] In 2006 there were 96,000 lady health workers. However, under the 18th Amendment to the Constitution, the Ministry was devolved and its responsibilities were shifted to Provincial Population Welfare Departments. Hence, a likely reason why so many Pakistani women are self-inducing miscarriages. [27], In the 1990s, two agencies in Pakistan started village-based community health worker programs in Pakistan. The total change in users of FP services between 2006 and 2012 was around 700,000 women. Of the 2.4 million unwanted pregnancies, 900,000 are end in induced abortions. There were 118 males per 100 females. Both groups of women provide door to door health and family planning services, supplied with oral and injectable contraceptives and condoms to distribute to their communities. 7 In one study, 70% of women were aged 25­–39; 7 in another study, 78% were aged 25–34. An abortion that occurs without intervention is known as a miscarriage or "spontaneous abortion" and occurs in approximately 30% to 40% of pregnancies. [1] It was estimated in 2005 that Pakistan's population totaled 151 million; a number which grows 1.9 percent annually, equaling a 2.9 million population growth per year. Given a lack of clarity in interpreting the law, legal abortion services are difficult to obtain, and most women who have an abortion resort to clandestine and unsafe procedures. Women bearing at least one son have higher say in household decision-making. "[7], Near the end of Zia's era of power, family planning and population control became tied to the Ministry of Health (Pakistan). 9­–11 Moreover, almost all the women were married. [4], Similarly to other countries in South Asia, Pakistani households have a strong preference for sons. [14][15], Pakistan has a strong 'culture of honor', where a female can easily tarnish the 'honor' and 'reputation' of her family through certain behaviors (often related to chastity), whether these behaviors are real or suspected by the community. However, at the time of writing, Khyber Pakhtunkhwa, Sindh and Punjab are working on individual Health and Population strategies. [5] In Pakistan, many local religious figures are supportive of family planning and have begun discussions in their communities in order to promote the health of women and children.[5]. “We have been dealing with such cases for years and there are a few such incidents which shook our souls as much. This program emphasized maternal and child health, and also delivered family planning services. However, murdering of the fetus – abortion, is one of the most sinister taboos of our society… In a country like Pakistan, where abortion is considered to be the one of the most perplexing of all difficulties a couple or an individual faces, almost 900,000 cases of premature-murders are reported annually. [1][5] The rate of unwanted pregnancies is higher for women living in poor or rural environments; this is especially important since two-thirds of women live in rural areas. Pakistan Penal Code (Act XLV of 1860), Chapter XVI, Section 338 (A)- (C). The tragic adventure of Mirza and Sahiban is said to have been the cause of desperate quarrels. He had used the religious lobbies and conservative middle-classes as support for his take-over. In Pakistan, high levels of unmet need (25%) and low levels of contraceptive use (30%) put women at risk for unintended pregnancies. [12] In Pakistan, extremely conservative Islamic beliefs predominate in many parts of the country, in which purdah restricts women to their homes unless chaperoned by a male relative. [1][5] The most commonly reported reasons for married women electing not to use family planning methods include the belief that fertility should be determined by God (28 percent); opposition to use by the woman, her husband, others or a perceived religious prohibition (23 percent); infertility (15 percent); and concerns about health, side effects or the cost of family planning (12 percent). (1) If the person committing the act of abortion is a medical doctor, surgeon, pharmaceutist, or a nurse, the offender shall be sentenced to the maximum anticipated punishment for the crime. 23 percent of these women are hospitalized for treatment of complications. Abortion has been a controversial subject in many societies on religious, moral, ethical, practical, and political grounds. Surgical procedures that are available are Manual Vacuum Aspiration (MVA) and Dilation and Evacuation (D&E). "[1], Dating from 2002, Pakistan's current family planning policy reflects the government's concern with rising population trends and poverty. A more accurate picture will emerge with the release of the data from the Pakistan Demographic and Health Survey 2012. Despite legal restrictions that limit women’s access to abortion, the incidence of the procedure in Pakistan is high, and the abortion rate has increased during the past decade. A report from 1884 states: The Kharrals are the most northerly of the great Ravi tribes, occupying a great portion of the land between Gugera and the Lahore district on both sides of the river, and extending some distance into the Gujranwala district. Health and Policy Planning. Pakistan provides both medical as well as surgical abortion services. They know of 890 newborns killed in 2008, 999 in 2009 and about 1,210 in 2010, and this counts only the large cities. [7] Soon after the seminar, the National Board of Family Planning was established as a policy-advising body for the federal government. [1] In the 1990s, women increasingly reported to wanting fewer children, and 24 percent of recent births were reported to be unwanted or mistimed. Historically, political strife and cultural restrictions on women constraining their empowerment have hampered implementation of family planning strategies throughout the country. [19] [20], Sex selective abortion - the practice of terminating a pregnancy based upon the female sex of the fetus - is happening in Pakistan, although it is illegal. The Official Abortion Law. Instead, govt must encourage use of contraceptives through advertisement campaigns. Female infanticide in Pakistan had been a common practice in the Indo-Pak Subcontinent. Wajihuddin Ahmed, the Family Planning Commissioner during Yahya Khan's rule, focused on reducing pregnancies in women "rather than meeting contraceptive targets alone" and introducing the pill to Pakistani women. This custom of female infanticide was common among the Kharrals till Colonel Hamilton, Commissioner of Multan, persuaded them to discontinue it. Girls who are unwanted are often forced into early marriage. Additionally, it appears that the if the amount of commodities that are being reported by the Pakistan Bureau of Statistics in its "Annual Contraceptive Prevalence Reports" is accurate, the overall increase in population may mean that the CPR for modern methods may have actually declined. The Ministry of Population Welfare started planning a program in 1992 based on a similar program in Bangladesh. When deliberate steps are taken to end a pregnancy, it is called an induced abortion, or less frequently "induced miscarriage". A study released in 2005, by the Population Council of Pakistan and the Guttmacher Institute, found that 890,000 abortions occur in Pakistan every year and, given that this data was collected mostly through women hospitalized for post abortion complications, one can expect this figure to be grossly understated. [7] Its leader, Zulfiqar Ali Bhutto, needed to gain legitimacy and popularity by taking an anti-American, anti-capitalist, and anti-Ayub Khan-stance. [7] At the onset of the program, condoms were the most available method of contraception, but by 1966 the Intrauterine Device (IUD) had replaced it has the "corner-stone" of the Scheme. In essence it showed that the overall increase in CPR since the previous DHS had been around 1% per annum overall and around 0.5% in modern methods. "Islam and Family Planning." The unmodified word abortion generally refers to an induced abortion. Pakistan's high abortion and low contraception rates reflect a family planning policy in shambles, says Abdul Ghaffar Khan, director general of Pakistan's population program wing. [16][17] The family is viewed as the main source of honor and the community highly values the relationship between honor and the family. Our antiquated Penal Code does however criminalise abortion seekers and providers. Even though there is considerable demand for family planning in Pakistan, the adoption of family planning has been hampered by government neglect, lack of services and misconceptions. • The proportion of women thought to have complications from abortion procedures performed by traditional birth attendants ranges from 55% among nonpoor urban women to 68% among poor rural women. Approximately 25% had an unmet for Family Planning, of this around 2/3rd was for limiting and the rest for spacing. Isqat-i-Hamal. Although it rarely makes headlines in this country, Pakistan has a massive illegal abortion problem. But it is no longer a common practice both in Pakistan and India via steps taken by local polices and Governments and Ordinances made in both neighbours. * 1 In 2006–2007, 24% of all births in Pakistan were unintended. [7] Son preference prevails in rural areas, due to male inheritance of agricultural land, and males being seen as better suited to work the land. [1] Challenges to Pakistani's well-being, opportunities for education and employment, and access to health care are escalated due to the country's continuously-growing population. Pakistan, officially the Islamic Republic of Pakistan, is a country in South Asia.It is the world's fifth-most populous country with a population exceeding 212.2 million. [2] Though Pakistan's fertility rates still exceed those of neighboring South Asian countries with a total fertility rate at 4.1 (3.3 children in urban settings and 4.5 children in rural areas) and contraception use is lower than 35 percent, approximately one-fourth of Pakistani women wish to either delay the birth of their next child or end childbearing altogether. The policy's goals include reducing population growth (from 2.1 percent in 2002 to 1.3 by 2020), reducing fertility through voluntary family planning (from 4 births per woman in 2004 to 2.1 births per woman by 2020), and as a signatory to the Programme of Action developed at the International Conference on Population and Development in Cairo in 1994, Pakistan pledged to provide universal access to family planning by 2010. [7], Pakistani journalist/researcher Ayesha Khan has suggested various reasons for Ayub Khan's position on population control. [18][19], When a comparison of the private sector and public sector was made with regards to abortion and post-abortion care provided, it was noted that the private sector performed more abortions and took on double the case-load of post-abortion care, as opposed to the public sector. Prenatal sex-selection is more common among the upper classes who have access to medical care and technology, while abuse after birth (infanticide and abandonment) is more common among the lower classes. The infanticide was mainly almost all were female infants. Demographics play a large role in Pakistan's development and security since the recent change from military rule to civilian leadership. were notably absent from this policy.[22]. It is also important to note that other elements of population development such as education, capacity building, economic development, climate etc. [a][5] While 96 percent of married women were reported to know about at least one method of contraception, only half of them had ever used it. Over the 15-year span of 1964-1979, USAID "spent over $30 million on Pakistan's population programme; during 1965–75 US AID provided 40% of total programme inputs. Since 1997 abortions carried out before the unborn child’s organs have been formed are prohibited except when performed in good faith for the purpose of saving the life of the woman or providing necessary … According to the World Health Organization and Population Action International, as of 2007, "only 16 percent of women receive at least four antenatal care visits during pregnancy, fewer than one-third of births are attended by skilled health personnel, and the maternal mortality ratio, at 320 maternal deaths per 100,000 live births, remains high. [14] In 1990, the penal code was provisionally adapted in order to better reflect Islamic Law, and finally was made permanent in 1997. ); while the overall quantum services by the Government and those that self procure commodities from stores remained the same. The rate in 2012 was 50 abortions for every 1,000 women aged 15 to 44. [28] The number of infanticides, particularly of girls, is on the increase, according to the Edhi Foundation. Population Reference Bureau. • According to knowledgeable health professionals, women who are seeking clandestine abortions often obtain them from dais(traditional birth attendants) or midlevel providers such as Lady Health Visitors, nurses and midwives—and as a result often experience complications. This represents an increase of 700,000 users since the last DHS; around 2/3 of this difference may be attributed to increased population and nearly all these were supplied by NGOs. Pakistan's Lady Health Worker programme. [5] Additionally, levels of schooling are very low in Pakistan, allowing men to have more power in decision-making. Although many public health specialists feel that religion plays a major role in resistance to the use of FP in Pakistan, the Pakistan Demographic and Health Survey of 2006-7 showed that religious reasons accounted for only 9% of FP non-use. [27], The preliminary DHS report does not report sources of FP services but analysis of government's contraceptive prevalence report suggests that 44% avail public sector services and that the role of NGOs has increased from 11% in 2006-7 to around 40%. These murders were cause of such bloody feuds between the clans that it at the length was thought inauspicious to have daughters, and as soon as they were born, they were strangled as Sahiban had been. [23] The DHS also dispelled the popular notion that religious reasons keep families from using family planning. [citation needed], In 1977 Bhutto's Chief of Army Staff, General Zia ul-Haq, deposed the leader and declared martial law. Pakistan's high abortion and low contraception rates reflect a family planning policy in shambles, says Abdul Ghaffar Khan, director general of Pakistan's population program wing. As many as 72 dead girls have been buried in the first four months of this year by Edhi Foundation alone in the metropolitan city. For medical abortion (MA), a combination of two drugs, Mifepristone and Misoprostol is used. The feuds of the Lakheras and upper Ravi Kharrals have been noticed. At least 77 people have been killed and 94 injured in northeast Pakistan after a series of avalanches destroyed and buried houses. A brief version of the Pakistan Demographic and Health Survey 2012 was released in October 2013. Volume 11, Number 1, 30-51. Islamic scholars permit an abortion within 120 days of pregnancy in Pakistan. [5] Though Pakistani couples commonly cite religious reasons for avoiding birth control, there is not one definitive agreement about family planning and contraception in Islam. The revisions sought to conform better to Islamic teachings regarding offenses against the human body. It left us wondering whether our society is heading back to primitive age,” Anwar Kazmi, a senior manager in Edhi Foundation Karachi, told The News. IRIN. Among Kharal people, female infanticide was common. [24], In 2017, two Pakistani organisations discovered large cases of infanticide in Pakistani cities. Roudi-Fahimi, Farzeaneh. 1 According to a recent national study, women in Pakistan had an estimated 2.25 million abortions in 2012, equivalent to an abortion rate of 50 abortions per 1,000 women of reproductive age—nearly double the rate estimated … While Pakistan is not among those countries which lets women make this decision on her body, the abortion laws … As of 2016, the abortion rate in the U.S. was highest among women aged 20 to 24 years with around 19 legal abortions reported per 1,000 women in this age group. World Health Organization and Global Health Workforce Alliance. USAID funding was suspended, and Pakistan became alienated "from the Western powers that Ayub Khan had so carefully cultivated. Thirdly, it had political utility for a military leader with no popular mandate to his leadership and in need of a development strategy. In 2017, two Pakistani organisations discovered large cases of infanticide in Pakistani cities. The Indian Penal Code, enacted in 1860 and written in accordance with contemporaneous British law, declared induced abortion illegal.Induced abortion was defined as purposely "causing miscarriage". The Kharrals were Rajputs... and never got on with each other. An analysis of this policy showed that while the Government of Pakistan spent US$652 million funds under this policy between 2000 and 2009 (UNFPA), there was hardly any change in CPR which was 30% in 2000 and remained unchanged in 2006. Misoprostol hotline Pakistan, June 2010. A research studies conducted in 2002 and 2003 (by Population Council-Pakistan) reveals that a n estimated 890, 000 induced abortions occur annually in Pakistan. "[2] Unlike family planning in Iran, a neighboring Islamic republic, Pakistan's family planning program has failed in recent years due to neglect and constant policy changes as a result of political upheaval. Since a large number of modern method users are sterilized and received the service in a previous year, the actual number women availing any FP service were just under 3 million or less than half of those with an unmet need. And Karachi has topped in this notorious ranking with 180 cases in 2017. Pakistan's laws on abortion. The given data is just tip of the iceberg as Edhi foundation maintains the data of those cities where it provides services.[25]. Extrapolating these results to estimated populations suggest that there are 8.8 million users of any FP, 5.5 million users of modern methods and 3.65 million women who avail FP services in any given year. Islamabad based think tank Research and Development Solutions reports that there is no quantitative evidence that any of these interventions have resulted in an increase in CPR in these communities. [30], Rural and Urban Healthcare Disparities That Contribute to Pakistan’s High Child Mortality Rate. In August last year, a representative from the United … The reason given by the local authorities were poverty and local customs, where boys are preferred to girls. Due to a lack of access (especially in the rural areas), no clarity (dearth of awareness, understanding and education), fear of legal persecution (especially in the public sector), an inability of health care professionals to interpret the law, as well as a form of FP, women are often forced to seek abortion by untrained providers. There is no abortion-specific legislation in Pakistan. [7], Pakistan's first Family Planning Scheme was a part of the country's Third Five Year Plan (1965–1970). In 2006–07, the Pakistan Demographic Health Survey of Pakistan (PDHS 2006-7) showed that approximately 30% of married women of reproductive age (MWRA) were using some form of Family Planning. Changes in CPR between Pakistan DHS 2006 and 2012, "Assessment of a New Approach to Family Planning Services in Rural Pakistan". However, Bhutto found that he could not fund many of his socialist promises, and so allowed economic assistance from USAID. In 1990, the Pakistan government revised the colonial-era Penal Code of 1860 with respect to abortion. In order to avoid such problems related to the honor culture, families reject altogether the idea of having daughters. Unfortunately, the program has remained fairly unchanged over the past 35 years due to implementation problems involving over-centralization, lack of coordination, and structural flaws.[7]. [10][11] Son preference has effect on the status of Pakistani women. This was lead by the Edhi Foundation and Chhipa Welfare Foundation. [21][22][23] It was said to be "safe, cheap, reversible," and it required "little user action. In Pakistan, as in many Islamic and South Asian countries, induced abortion is against the law except to save a woman’s life. [7], In 1971, while the country was split apart and international assistance halted due to army atrocities in Bangladesh, the Pakistan Peoples Party took power of the Pakistani government. This was lead by the Edhi Foundation and Chhipa Welfare Foundation. That should be avoided at any cost. As, babies born out of wedlock in Islam is considered a sin.[25]. • In Pakistan, abortion is legally allowed only to save the life of a woman or to provide “necessary treatment” early in pregnancy. The scheme's goal was to have a vast impact in the shortest time possible, with a reduction of the birth rate from 50 to 40 per 1000 by 1970. It has been banned frequently and otherwise limited by law. [8] Although the nation has recently been making active efforts to adhere to the United Nations Millennium Development Goals[9] that aims to reduce global infant mortality by two-thirds, their efforts have fallen short as a large population of the Islamic Republic of Pakistan resides in rural areas where the nation's efforts have rarely been seen. 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