Abortion in Pakistan: struggling to support a woman"s right to choose

Sonia woke up in dingy room with searing pain in her stomach. All she remembered was being accompanied by her husband to a clinic for an ultrasound. She’d recently found out she was pregnant; her husband had often been abusive and didn’t react well to the news. Today was supposed to be different: he insisted on going to the clinic so he could see the scan and Sonia hoped that reflected a change of heart.

However, slowly Sonia realised she had been drugged and given an abortion without her consent at a private clinic. It took years for her to come to terms with the violence she suffered.

Islamic scholars permit an abortion within 120 days of pregnancy in Pakistan. But despite this framework for permitting abortions, health professionals are reluctant to carry out the procedure. Many women resort to ingesting drugs, using sharp objects, or physically abusing their body resulting in long-term health complications. In 2012, an estimated 623,000 Pakistani women were treated for complications resulting from induced abortions. In Sonia’s case, her ex-husband was able to pay an unqualified provider to conduct a procedure she hadn’t not consented to. Her story highlights the danger to women’s health when the only option for is an unhygienic facility clinic with untrained staff.

In such dangerous circumstances, who is filling the gap? Saba Ismail, co-founder of the Pakistani women’s group Aware Girls, launched an abortion hotline in June 2010.

Aware Girls has received US Aid funding in the past but now will have to depend on grants from European foundations after President Trump reinstated the global gag rule which prohibits US funding to NGOs which provide information about abortions.

“We have not heard any donor withdrawing our funding on this basis yet, but we will become automatically ineligible for US Aid and other state department grants on this basis, and that’s the challenge,” says Ismail. “We fear that Trump’s decision will affect Pakistan because any organisation, hospital or clinic working on abortion will not be able to get any US funding.”

A woman told us to stop talking about abortions or contraceptives and instead educate women on how to be better wives

Saba Ismail, co-founder of Aware Girls

US Aid spent $ 54.1m dollars funding family planning and reproductive health in Pakistan in 2015 and Marie Stopes International, the family planning NGO which receives funding from US Aid says that its work in Pakistan over the past decade has “averted 4.6 million unintended pregnancies, 1.9 million unsafe abortions and 6,000 maternal deaths”.

Aware Girls provides an anonymous toll-free service called “Saheli” (Urdu for “friend”) to educate on abortions and contraceptives: “When we first launched the helpline we were told that we were promoting murder; that abortion wasn’t about choice but about murder. This stigma and taboo is what bothered us the most.”

Over the course of six years Ismail and her colleagues have faced harsh criticism and threats. “In the beginning we started with 30 calls a month and now we average about 180 calls,” she says. “This is because we went into the communities and spoke to women about their health informing them about the helpline. At one of the events a woman approached me, identified herself as a representative of the Taliban, and told us to stop talking about abortions or contraceptives and instead educate women on how to be better wives to their husbands.” This didn’t stop her, although threats forced them to temporarily close down for six months in 2014.

Ismail’s helpline follows the World Health Organisation’s guidelines on safe methods of abortions that can be performed at home for women under nine weeks pregnant. Misoprostol, a drug used to induce abortions, is available over the counter in many countries including Pakistan because it is also used to prevent stomach ulcers. Ismail’s staff asks women to provide details about their health and verify the length of the pregnancy, and takes them through the process of abortion.

“People think that most women that call us are sex workers or unmarried women. While we do not judge and only ask reasons for abortion for our research purposes, I can tell you that the we get a large diversity of calls. From women aged 17 to 50, women that are married, who have recently given birth, who already have a lot of children and even women who have been raped by their own family members,” Ismail recalls the story of 21-year-old Sameena who was raped by her own cousin and was refused help at a hospital.

An extensive women’s health report conducted in 2012 found that of the 9 million pregnancies in 2012, 4.2 million were unintended; 54% of these unintended pregnancies resulted in induced abortions and 34% in unplanned births.

I attend to calls even when I am in a family gathering, in a funeral or anywhere, I never miss a single call

Tahira Khan, helpline counsellor

The vast majority of the helpline’s calls are about abortions, only 4% of the callers ask about contraceptives. Nonetheless, each caller receives information on the use of contraception. The contraceptive prevalence rate is low in Pakistan – out of a population of more than 190 million, only 35% of women aged 15–49 use it. The reasons for this range from lack of sex education and awareness, and the fact that contraception is still considered a taboo and, in some places, seen as a western concept. Last year, Pakistan banned advertising for contraceptives.

The counsellors on the helplines are young women with no medical background who are trained with the WHO’s clinical handbook [pdf] on safe abortions. Tahira Khan says the helpline has now become more than just a job: “This hotline is a part of my life now, I attend to calls even when I am in a family gathering, in a funeral or anywhere, I never miss a single call, I always call back. When I help women, I feel satisfaction and happiness. Before starting counselling, I thought I could never do it, but with the passage of time, I am now an expert.”

The hotline has received over 25,000 calls so far and this is increasing by the day. Ismail’s organisation can only help women who are under nine weeks pregnant, but in some cases they have to provide referrals for surgical abortions at selective clinics that conduct these procedures under hygienic and medically approved conditions.

Ismail is determined to continue her work but she knows she is treating a symptom rather than a root cause. “My fight is against the taboos that tell women that their bodies aren’t theirs,” she says. “Unless women are seen as human beings who have a choice and right to their own body nothing will change.”

Some names have been changed.

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Abortion in Pakistan: struggling to support a woman"s right to choose

Nigerian gold mining: farmers choose death by lead poisoning above poverty | Monica Mark

Flanked by fields of millet and groundnut, the northern Nigerian outpost of Bagega is so far out on the periphery of the global economic system that when the financial crisis struck in 2008 couple of residents had any idea it was happening. And no one particular in a village with no automobiles, electrical power or tarred roads imagined it would end up indirectly poisoning hundreds of their children.

“We knew there was gold around here, but most folks didn’t care. We have often been farmers right here,” mentioned Alhaji Jibril, the white-haired village chief, sitting in the gnarled roots of a tree in front of his residence, which he calls his workplace.

But when western fiscal markets went into meltdown, gold offered traders with a haven from the turmoil, sending its price tag rocketing. For the very first time, it grew to become lucrative to mine the ore on which the village sits. “We considered [the gold boom] was a very good factor at initial,” said Jibril. So did 1000′s of itinerant fortune seekers, who beat down the dust trail leading to the village, swelling its population.

Shortly afterwards, officials from Médecins Sans Frontières (MSF) received a cellphone call from neighborhood wellness employees. “They advised us their kids have been dying, and they didn’t know why,” said Michelle Chouinard, the health care charity’s nation director. It was, in truth, the beginning of what Human Rights Observe named the worst incident of lead poisoning in present day history. Gold is extracted from lead, which accumulates in the blood and can severely harm the nervous technique.

By the time the rush subsided, Bagega, and seven other villages dotting the Zamfara countryside, had been ravaged by the deadliest lead poisoning epidemic in modern background. At least 460 kids died and practically 2,000 have been poisoned. “Lead poisoning can make adults infertile, but its most severe affect is on kids. So we had been seeing children who have been blinded or paralysed. Some have neurological injury, and that is not normally reversible,” Chouinard said.

Right after three many years of official dithering, some of the $ five.4m (£3.25m) pledged in government funds released last year permitted global organisations to begin cleansing the worst of the contaminated regions. Nevertheless, with few options, 1000′s proceed to mine in perilous conditions.

For the 3 extended households that dwell in Soweba’s compound, mining presented a a lot-needed improve when their farms suffered from erratic rainfall, partly linked to climate modify. Three many years in the past, her 14-yr-previous son started bringing rocks property. Soweba and the other women would sift via them, searching for glints of gold dust. A gramme could bring in up to 7,500 naira (£27) in a state where 70% lived on less than $ 2 a day.

Then, one by a single, the young children in the compound have been struck by convulsions and sweats. “There was a herbal concoction which we utilized, but it didn’t function,” stated Soweba, a slight girl with almond-shaped eyes. Her two-yr-outdated toddler died initial. A number of weeks later, another daughter died. Even cattle – drinking from contaminated waterholes – started to die, more diminishing the family’s earnings.

“We thought it was a genie, an evil spirit,” she stated, cradling a surviving daughter throughout a weekly go to to a clinic run by MSF. Nevertheless, her husband continued to permit their son to go mining towards her wishes. “He says it is the only way to feed the surviving children. They just leave their [contaminated] garments outdoors the property when they come back.”

Overall health staff also worry about a potential crime boom. Lead poisoning is linked not only with finding out troubles, but also with violent crime.

Glints of mercury, which is used to separate gold from its ore, is also highly toxic. The employees use their bare hands as they deal with hazardous heavy metals

Environmental scientist Simba Tirima, whose organization shipped in about ten,000 cubic metres of soil in an work to clean hundreds of compounds in Bagega, identified astonishing charges of contamination: up to 35,000 components per million of lead, virtually a hundred times the sum regarded safe for residential soil. In the vast tracts of land the place processing took area, the costs soared to a hundred,000 components per million.

“It is my sincere hope that the communities will not be recontaminated. The crucial to avoiding this from taking place once again lies in very carefully created safer mining programmes that are pragmatic and relevant,” Tirima said.

As soon as a significant component of the economic system, mining was abandoned by the government once oil was identified in the 1960s, leaving the operate to tiny-time diggers outfitted with practically nothing but shovels and hand-powered stone crushers. The unregulated market continues unabated. Villagers who make ten times as much money mining as they do from farming have advised Tirima they would rather die of lead poisoning than poverty.

“They are not going to cease. I noticed a female who had misplaced eight youngsters, but she is nonetheless mining,” mentioned mines minister Musa Sada, who aims to enhance the sector’s contribution to the economic climate to 5% from its current 1% by following year. “The only way around it is to invest in obtaining greater approaches for mining, give modern day tools and get a more structured industry for these individuals to function in.”

For now, that has not took place. A brief trip away from Soweba’s home, a fine mist of dust rises from the ground, clinging to garments and machines and cloying the eyes, nose and mouth. Payment increases in accordance to how hazardous the operate is. At the leading of the chain are employees who operate hand-powered grinders. Sitting amid fumes for hours a day, they earn up to 2,000 naira (£7.twenty) per jute bag of powdered stone. Up coming come those who mix poisonous mercury, employed to separate the lead from its ore, with their bare hands.

“The early days had been great days,” explained Adamu Tsiko, chairman of the Bagega Gold Miners Association, surveying employees raising plumes of dust at a vast open-pit web site. “Everybody wished to join – some people walked from [neighbouring countries such as] Burkina Faso, Chad, Niger, even Ivory Coast.”

Tsiko was element of a delegation that met government representatives in the Nigerian capital of Abuja final year to lobby for modern day products. He worries the government’s efforts to woo huge gamers – utilizing tax holidays and duty waivers – indicates artisanal miners are being forgotten.

“Appropriate now we even now need to have the correct tools, we require [pipe-borne] water to do items properly. Like now, there is nowhere to wash my hands just before I commence eating this sugar cane,” he said, breaking off a piece for a blank-eyed toddler wandering by means of the clouds of fumes.

Nigerian gold mining: farmers choose death by lead poisoning above poverty | Monica Mark

Abortion: A pregnant woman"s correct to choose - free of any pressure

Worryingly, investigations by this newspaper have shown that the info they share about the bodily and mental effects of an abortion is usually not supported by healthcare evidence or in line with official guidance from the Royal University of Obstetricians.

What an unforgivable mess. Exactly where are the voices from women’s groups condemning this whole set-up? Where had been the feminists after this newspaper also uncovered physicians who had been inclined to terminate pregnancies for ladies who did not want to have a baby girl? A couple of muted whimpers – but practically nothing much more.

Last month, yet another investigation advised that the practice has grow to be so widespread inside some communities that it is stated to have led to the “disappearance” of amongst 1,400 and four,700 females. Why are not males and ladies who think about themselves supporters of women’s rights up in arms about this?

What was exposed is pure misogyny, and but, since it relates to abortion, ideological confusion creeps in. Why can’t you criticise the way abortion companies are run even though still supporting a woman’s appropriate to select?

For me, this is a clear instance of how farming out companies from the NHS to independent companies can go cataclysmically incorrect. The entirety of pregnancy suggestions should be brought back into the NHS, in which rigid recommendations on impartiality can be enforced and there is no financial incentive for folks to advise a single decision above one more.

I’m professional-choice – and I want things to change to ensure that that selection actually is the woman’s.

Cosmetic cowboys escape once again

_{Actress Lesley Ash necessary remedial operate after her lip injections went wrong}

In the ongoing pursuit of a youthful complexion, numerous flip to anti-ageing procedures this kind of as dermal fillers – merchandise injected under the skin to plump it up and smooth away wrinkles. Yet dermal fillers are no much more regulated than floor cleaners.

Last 12 months, I manufactured a short programme for Channel 4 and was horrified to find out that anybody can inject fillers with no instruction whatsoever, regardless of potentially critical side effects. Without a doubt, I met a surgeon who specialises in removing botched filler and dealing with infections he aided the actress Lesley Ash (right) right after filler injected into her lip went terribly wrong.

Ministers final week lastly announced programs to tighten up the cosmetic surgical treatment sector. This followed a evaluation led by the NHS health care director, Sir Bruce Keogh, which named for these “anti-ageing injections” to be accessible on prescription only.

The programs, however, fall way brief of this and have been branded a “wasted possibility to make certain patient safety”.

The Government says it was unable to make fillers prescription-only owing to EU legislation that states fillers are not a medicine. Instead, anyone administering fillers will simply have to have undergone education – but they do not have to be registered, nor do they have to be governed by the Care Top quality Commission.

This was an excellent opportunity to deal with a Wild West business. Alas, the cosmetic cowboys have not been reined in.

Your tributes pour in for Dr Gancz’s stand against NHS data-sharing

I’ve been amazed by the response to my column final week on the situation of Dr Gordon Gancz, the Oxfordshire GP who has stood up to the Government in excess of its information-sharing scheme, due to be launched in April. He refused to indicator up his sufferers immediately, as an alternative asking that they “opt-in” to the programme, which will gather information from health care records, which includes a patient’s postcode, NHS amount, date of birth, household history, referrals and so on.

A lot of readers have written in applauding Dr Gancz for his principled stance. While there could nicely be a case for collecting data, men and women are rightly angered that it has not been produced clear that the data will be offered to commercial businesses, or that the information will be so in depth that anonymity are not able to be guaranteed.

Final week, the Royal School of General Practitioners explained the strategies ought to be put on hold right up until suitable consultation has taken area. The heads of 5 disability charities have also written to the Well being Secretary, expressing concern that tiny has been carried out to ensure that people with a sensory impairment finding out disability are aware that their data is to be harvested.

It is rather telling that in a latest poll, forty per cent of medical doctors themselves say they intend to opt out. I’ve already written to my GP saying I want no element of it.

Max Pemberton’s most current guide is ‘The Physician Will See You Now’ (Hodder). To buy, call Telegraph Books on 0844 871 1515

Abortion: A pregnant woman"s correct to choose - free of any pressure