PLANNING BEFORE A PREGNANCY

Pregnancy is a natural process but entering it without complete readiness saves mother and the babies from several complications. Such pregnancies can be termed as “planned”. Experts believe that children should be born “by choice” not “by chance.” Along with willingness to have a baby before getting pregnant, it is also important for a woman to have sound physical and mental health for a healthy pregnancy.what is the condition of an average women regarding prgnancy in pakistan.Read this story,which mostly u get in pakistani poor families and illiterate women, Rasheeda's first pregnancy ended up in a stillbirth. The trauma of losing a baby cost the already weak Rasheeda further health. After a year she gave birth to a girl, who was not only underweight but also had various complications. She died after three months. These incidents were enough for her in-laws to decide that they wanted their son's second marriage. They tried to convince her that in future she would either not be able to conceive or the baby would not be normal. Her refusal to accept this brought her a divorce.
Before deciding about remarrying Rasheeda, her parents wanted to inquire about the complications of her previous births so that she could be treated. Two reasons were brought to knowledge after doctor's consultation and tests. First, Rasheeda was anemic and this not only affects the mother but also the baby. Second, because of the positive/negative difference in blood groups of the spouses. If the mother's blood group is negative and the baby's positive then the mother produces certain antibodies that can affect the next pregnancy. Anemia can be countered with improving diet and folic acid supplements. Whereas, the harmful effects of difference in spouse blood group can be corrected with simply an injection.
If Rasheeda had overcome her nutritional deficiencies and had some knowledge about “pregnancy”, she would have not only given birth to normal babies but also wouldn't have had a broken marriage. Many girls like Rasheeda blame their ill-fate for such incidents but lack of knowledge and education are the actual reasons. There are very few people who are concerned about failure of a smooth pregnancy. Most of the time it is taken as “Allah ki marzi”. Such attitudes need to be changed.
Pregnancy is a natural process but entering it without complete readiness saves mother and the babies from several complications. Such pregnancies can be termed as “planned”. Experts believe that children should be born “by choice” not “by chance.”
Along with willingness to have a baby before getting pregnant, it is also important for a woman to have sound physical and mental health for a healthy pregnancy. Dr. Nabia Tariq, a gynecologist explains a few benefits of planned pregnancies. “Firstly, the woman psychologically accepts and prepares for it. Secondly, pre-pregnancy care can be provided effectively.”
Dr. Nabia and Dr. Ghazala Mehmood, another gynecologist, provide guidelines as to what things should a woman take care of before deciding to have a baby.
The woman should have an initial visit to the doctor to know about her general health. She should take a balanced and nutritious diet. Lack of proteins and nutrients during pregnancy can cause the baby to be born with neural tube defects which lead to incomplete brain formation. Anemia is common in Pakistani women there along with proper diet, use of folic acid is recommended a few months prior to becoming pregnant.
Moreover, those suffering from blood pressure, diabetes, arthritis, kidney or heart problems should first control these diseases before thinking of getting pregnant.
Uncontrolled sugar can cause numerous problems like, abortion, severe abnormality in the baby, miscarriage, overweight baby, premature baby, excess water in the womb, increased chances of cesarean section and slow healing.
Age is a major factor as there are many issues that develop usually in later age. Like diabetics or if you have deficiency of blood, there are chances that you can develop severe anemia. Additionally, due to late age pregnancy, there are increased chances of chromosomal anomalies, and downs syndrome in babies.
Females have the ability to reproduce approximately from the age of 15 to 45 years. Many pregnancies regardless of age are healthy. However, females less than 18-19 years of age or over 35 tend to have slightly higher risk of pregnancy complications (like miscarriage, placenta previa, low birth weight baby, high blood pressure, cesarean section, etc.). Sometimes due to family history or tendency of medical disorders, there is chance of getting diseases during pregnancy due to its stress.
Moreover, egg and sperm quality declines with age, which increases risk of congenital defects, like Down's syndrome. On the other hand, the bodies of young girls are not mature enough and their bones tend to be weaker. The ideal age to plan a family is between 20-35 years.
In our society, we have more unplanned pregnancies as compared to western countries. The major reason is lack of family planning. Although family planning facilities are available, a large number of people do not avail them. “It is acceptable to have first two unplanned pregnancies. After that the health of the mother is compromised and burdened,” explains Dr. Nabia.
“Without practicing proper family planning measures, the mother is not physically and mentally prepared to go through that pregnancy.”
According to Pakistan demographic and health survey 2006-07, overall, 24 percent of births were not wanted at the time of conception, with 13 percent wanted at a later time and 11 percent not wanted at all. The rate of unwanted or ill-timed pregnancies was higher among women aged 45-49.
According to Dr. Nabia, the major complication of unplanned pregnancy is illegal termination of the fetus, i.e. abortion. And in Pakistan the main reason for abortion is unplanned pregnancy. Sometimes pregnancy can end in a miscarriage or when women see that their health does not allow them to have a new pregnancy; they intentionally opt for an abortion.
Abortion is illegal in our country and is only allowed if pregnancy can kill the mother. Therefore it is common for women to have an unplanned pregnancy and get it aborted from places where sterilization and skills are unavailable. Due to this, there is high morbidity and morality rate in the country. Septic abortions, induced abortions and deaths of mothers are a big challenge for the gynecologists.
Dr. Zeba A. Sathar is a country director of population council, according to her research; an estimated 890,000 induced abortions are performed annually in Pakistan. And an annual abortion rate among 15 to 49 aged women is 29 per 1,000 women. Moreover, the unwanted pregnancy rate is 77 per 1,000 women or about 27 percent of all pregnancies. An estimated 197,000 women are treated annually in public and private hospitals for induced abortion complications.
A research on child spacing and abortion done by population council's project FALAH under the supervision of Dr. Gul Rasheeda, revealed the severe complications of unsafe abortions. “The stories of women who had such procedures were shocking. In some cases the abortion methods were so wrong and brutal that the intestines and other internal parts came out of their bodies.”
“The biggest reason for going ahead with such methods was because pregnancy occurred at a time when the mother's didn't want it,” she adds.
To avoid unplanned or unwanted pregnancies, couples should opt for contraceptives so that maintaining a gap between pregnancies for health concerns becomes possible. Interestingly, couples hesitate in using contraceptives but when it comes to financial problems, children care or poor health of the mother then they have no problem in opting for an abortion and naming it as “majbori.”
“Lack of knowledge and cultural attitudes are reasons for reluctance of contraception use rather than religious,” says Dr. Zeba.
Many couples hesitate to use contraceptives due to the risk of side effects. “Rather than getting concerned about the side effects of contraceptives, they should consider the side effects of getting pregnant,” says Dr. Ghazala.
Moreover, Dr. Ghazala says that old ladies think mothers breast-feeding their child will not get pregnant. Though true the chances are less but depending entirely on it will not fulfill the nutritional requirement of the baby. The baby needs to be fed on food other than breast milk after a period of 4 months. Therefore contraception should be used for child spacing.
Dr. Zeba remarks, “Spacing should not be taken in perspective of number of children rather the health of the mother. We need to advocate the importance of child spacing instead of specific number of children.”
The government has also made efforts in changing the slogan from “bachay do hi achay!” to “waqfa bahot zaroori!”

WORKING WOMEN…
The concept of unplanned pregnancy is not the same in our culture as it is in the western society. Planned pregnancy means wanted pregnancy according to western concept. But we may not consider unplanned pregnancy as unwanted pregnancy.
Majority of the women work in the west. Hence, they have to plan and arrange everything before planning to have a baby. The trend of working women is gradually increasing in our part of the world as well. But women of our society do not enjoy the benefits the western women do after having a baby. Usually, a pregnancy means to bid farewell to their job. The maternity leave issue is strange and complicated in our society. In public sector three month maternity leave is allowed but in private, it is only for one month or 25 days unpaid leave.


Batool's story
Population council, an NGO in Islamabad, did a research under its project named FALAH. Following is an interview of Batool Bibi conducted during the survey. Her story reveals how women of our society have to deal with unplanned pregnancies due to the communication gap and understanding of the spouses