美国国家公共电台 NPR Why The Abortion Rate In Pakistan Is One Of The World's Highest

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Why The Abortion² Rate In Pakistan Is One Of The World's Highest

STEVE INSKEEP, HOST:

This next story takes us to Pakistan, a deeply conservative Muslim country where doctors routinely refuse to undertake abortions³. But it is estimated to have one of the highest rates of abortions in the world - 50 abortions for every 1,000 women. That is more than three times higher than the rate in the United States. A warning - this story may be disturbing for some listeners. NPR's Diaa Hadid reports from Abbottabad.

DIAA HADID, BYLINE⁴: When Mehnaz was 19, she fell pregnant for the fifth time. She already had four daughters. Her husband was threatening to throw her out if she had another girl.

MEHNAZ: (Through translator) When I learned about the pregnancy⁵, my heart sank in fear.

HADID: She knew a midwife who undertook abortions, but only to end pregnancies⁶ that were already troubled. So she tried to sabotage⁷ her own.

MEHNAZ: (Through translator) I kept taking tablets, whatever I laid my hands on. I lifted heavy things.

HADID: She points to the heavy furniture in her tiny living room - like that, she says. She drank brews⁸ of boiled dates. Many Pakistanis believe it triggers labor⁹.

MEHNAZ: (Through translator) Then there was a terrible pain in my stomach. My husband took me to the midwife. She told him the baby was dead. She gave me injections, and it came out.

HADID: That was her first abortion. Mehnaz is now 27. She's got six daughters and one son. She's also had three abortions. She tried to have a fourth by taking pills, but the attempt failed. In Pakistan, many women are pressured to abort¹ fetuses¹⁰ they fear are female because they face rejection¹¹ if they have too many daughters. They are seen as an economic burden. But that's not the only reason why they're having so many abortions.

XAHER GUL: For the most part, women don't have access.

HADID: This is Xaher Gul. He's a public health expert and adviser¹² on family planning policy. He says women can't get contraception.

GUL: The system is, I would say, disconnected. There are no service providers. If there are service providers, they're not trained. If they are trained, they don't have access to commodities. If they have commodities, they are not good at counseling women. If they are good at counseling women, there is bad follow-up and bad management of side effects.

HADID: Consider Mehnaz's experience. She's illiterate¹³ and didn't know about contraception, but she gave birth seven times in a hospital and clearly said she didn't want to have any more children. But nobody there educated her about her options. Worse - after she had her last child, she begged doctors to sterilize¹⁴ her, and they refused.

MEHNAZ: (Through translator) The doctors said I had to get a permission letter signed by my husband, but he won't sign. He says it's a sin.

HADID: Gul, the public health expert, says this is why Pakistan has a thriving underground abortion industry. But the thing is abortion is acceptable in Islam, and it's legal in Pakistan if a woman's health is in danger or if there's a need for it. That need isn't defined, so there's lots of wiggle room. But culturally, it's not OK, so most hospitals will only do them in urgent cases.

GUL: Because they refuse to perform the service, medical doctors themselves for the most part have pushed women in need of therapeutic¹⁵ abortions into back alleys¹⁷.

HADID: Literally¹⁸.

(SOUNDBITE OF BABIES CRYING)

HADID: We went to a back alley¹⁶ in a slum to meet an abortion provider, Mumtaz Begum. She's about 60. She charges between $25 and $70 for an abortion.

MUMTAZ BEGUM: (Through translator) I'm not educated, but I have a lot of experience.

HADID: Begum's clinic is dank, and the pink paint peels off the walls. There's a dusty table piled with medicines, a bag of onions and a stack of Qurans, the Muslim holy book. Begum also leads pilgrimages to holy sites. And she says, because she's devout¹⁹, she'll only do abortions for women whose pregnancies are already in trouble. Otherwise, she believes it's murder.

BEGUM: (Through translator) I don't help with murder, but if there is a necessity - for instance, if the woman is bleeding - then I clean out her womb.

HADID: What's clear in the interview with Begum and other abortion providers is that most of them expect women to look desperate. And like Mehnaz, women will hurt themselves to get help. That, combined with the lack of hygiene²⁰ and training, makes abortions in Pakistan dangerous and sometimes deadly. This is Gul.

GUL: Nearly about a fifth of the women who die because of pregnancy-related complications die because of unsafe or less-safe abortions.

HADID: That's thousands of women every year.

(SOUNDBITE OF CALL TO PRAYER OVER LOUDSPEAKERS)

HADID: Gul directs us to a clinic run by an organization that offers contraception and safe, legal abortions. We aren't naming them out of concerns they'll be harassed²¹. The Muslim call to prayer echoes outside.

(SOUNDBITE OF CALL TO PRAYER OVER LOUDSPEAKERS)

HADID: Inside, we meet Asma. She only gives us her first name. She's 32, a conservative Muslim. And she wears a long black robe and covers her hair and face with a black veil. She's got four kids, and she's waiting for an ultrasound to see if she's pregnant again.

ASMA: (Through translator) When I'm pregnant, I can't walk. I can't stand. I vomit²² all the time. My body swells²³ up.

HADID: If she finds out she's pregnant, she'll get an abortion here. She feels there's no conflict between her faith and her need to terminate her pregnancy.

ASMA: (Through translator) I have to look after my life as well. I have other children to take care of.

HADID: Mehnaz, who we meet at the start of the story who's already had three abortions, can only dream of that kind of service. She lives in fear of falling pregnant again. Her husband won't use contraception and refuses to stop having sex with her. He also constantly threatens to throw her out if she has another daughter.

MEHNAZ: (Foreign language spoken).

HADID: "I'm stuck," she says. "This society doesn't let women live."

Diaa Hadid, NPR News, Abbottabad.

(SOUNDBITE OF OLDTWIG'S "DUNES")-