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Early Pregnancy, A serious threat to woman’s health

By : Karishma Lalani

During my academic clinical in a government tertiary reproductive care hospital, I was assigned to work in labor room. While I was orienting myself to the setting of the hospital, I heard screaming of a woman coming from one of the delivery room. I went there and found that a patient Mrs. A with diagnosis of abortion had come for Manual Vacuum Aspiration (MVA). The patient was not aware about the procedure and was screaming in pain and anxiety. After the procedure she was shifted outside. While interviewing she told me that she was of 23 years and got married at the age of 14 years. In 9 years of marriage she got pregnant for 5 times. Out of which 3 children were alive and 2 had died. From the record file I found that she had been advised by the doctor to have some gap between her pregnancies and to use family planning methods. Her uterus was badly affected by repeated pregnancies and was not in a condition to bear child so frequently. On further exploring, the patient told me that she and her husband had been told about this fact. But her husband refuses to use any family planning method, because according to him it is against their religion. While she was speaking her eyes were full of tears, which was revealing the physical and emotional trauma she might have gone through.

I was taken aback by this situation, this scenario made me realize about the real and practical condition of our people. It made me think that still woman in developing countries has to go through series of physical and emotional trauma from birth till death. She has no power on her decisions, whether it is of education, marriage or timing of pregnancy. Irrespective of the potential damage to her health she has to take every risk for the happiness of her partner and family. Secondly, it made me think that even though many family planning programs have been organized in Pakistan, still there is lack of awareness. According to a study done in northern areas of Pakistan in 2006, the family planning program of Pakistan couldn’t achieve the same results as in other developing countries. There is universal level of awareness i.e. 97% about different contraceptive methods but the use rate (contraceptive prevalence rate) varies from 18% to 36% in different areas of the country, hence there is a wide gap between knowledge and practice regarding family planning. Although, I was astonished by the case of my patient, I found no difference in the attitude and behavior of the staff working there. One of the reasons for this may be that in government hospitals there is an influx of women with such cases everyday. In a study carried out by the National Institute of Population Studies (NIPS), early marriage of girls is very common in Pakistan and in this study, 36% respondents approved early marriage below 18 years of age. Pakistan is a male dominated society in which women have to live under worst conditions. Factors like poverty, low status of women, lack of education and lack of awareness forces girls for early marriages, which eventually lead to early pregnancy. According to Nasir, S., (2002), “the concept of marriage in the region of South Asia is synonymous with children.” As the fertility life span of a woman is from 15 to 30 years, women who marry early and begin child bearing in adolescence are expected to have more children. Early pregnancy has fatal consequences on health of the mother. In the early age a girl is not physically prepared to bear a child, which leads to natal and maternal complications like abortions, miscarriages, fetal death, low birth infants, anemia, hemorrhage and if this is not managed appropriately it may lead to maternal death. According to Khawar, H., (2007) women’s health indicators in Pakistan present a grim picture with high maternal mortality ratios of 340 to 400 maternal deaths per 100,000 live births. That is some 25,000 to 30,000 women die each year due to preventable maternal causes and many more suffer from serious and disabling problems. Apart from the health consequences early pregnancy also affects the psychology of a woman. Ali, S.F., (2006) states, “I have nothing against marriages but people need to understand the fact that marriage is not only confined to fun and romance, it’s a huge social responsibility which if not treated delicately gets too complicated to handle.” I agree with her comment. Think what will happen with a teenage girl who is not mentally prepared for the responsibility of child bearing and rearing. A girl of 14 15 years, herself is a child and has not even seen and explore the world. Without sufficient support she will find it very difficult to adjust in the role of a mother. If she fails to adopt this role she may suffer from stress and may have a sense of inadequacy. As discussed earlier, abortion, fetal losses and neonatal deaths are common in early pregnancy, it imposes additional stress on psychological health of a woman. To be a mother is one of the delightful moments in a woman’s life and losing a child can leave the mother devastated. At that time the woman needs support from the family, but the cultural norms makes it a difficult experience for her to cope with. In our society more attention is given on the necessity to have children even if it negatively affects the mother. Thus early pregnancy affects the physical and psychological dimensions of a woman health.

Many of the times, health professionals are not able to address all the issues of these women because of lack of understanding, shortage of time and resources. However, it is important to perform a thorough assessment and identify the cause behind early pregnancy. Moreover, fear and anxiety related to the pregnancy loss, its treatment, or the outcome may affect a woman’s level of tolerability and acceptability. Thus it makes education important to decreasing the emotional distress. (Nansel, T.R., Doyle, F., Frederick, M.M., & Zhang, J., 2005). On hospital level health care professionals should do researches to identify areas where such issues are very common and measures should be taken to prevent such situations. For e.g., workshops and seminars could be organized to make people aware about the consequences of early pregnancy. According to Dr. Mobashir Malik, (as cited by Khawar, H., 2007), “We have to look at the larger picture of maternal mortality in Pakistan. Preventing early marriages, delaying the age of first pregnancy, timely access to good emergency obstetric care, girl’s education, poverty and women’s empowerment are important areas of intervention.” Government should also play their role. They should make certain programs to increase the literacy rate of men and women, as education plays an important role in shaping the personality of people. As far as attitude towards family planning is concerned, concrete efforts are required by the family welfare programs. Religious and political leaders of the area should be involved to motivate the people and to clear the misconception. (Naeem, Z., Bux, H., Shaukat, F., & Memon, M.H., 2006). Continuous efforts are required to bring the change in society and make it worth living for women.