Unplanned pregnancy: Time to speak up

There is hope but only if women speak out about their feelings regardless of societal or family pressures.

How many of us, Pakistani or South Asian women, have the courage to narrate our feelings on the issue of unplanned pregnancies?

Why does society not understand that an unplanned pregnancy is a risk factor for depression both, during and after pregnancy?

Why do health care providers tend to miss opportunities to learn more about the pregnant woman’s feelings about her pregnancy?

I understand that these are difficult questions to answer, considering the norms of our society and medical practice which traditionally view pregnant women as a machine whose purpose is to produce a healthy infant and then be a happy mother-to-be throughout her pregnancy and happy mother after childbirth.

What if she does not want the baby?

This reflects the biases of medical practitioners, who fail to identify the intentions behind the pregnancies and pregnant ladies under stress.

Society’s attitude towards pregnant women

Even if the pregnant woman dares to discuss her ‘unplanned pregnancy,’ she is told to be thankful to God for making her a 'complete woman' and bestowing her with the most precious gift of motherhood. She is lectured on how to stay happy and calm throughout her pregnancy because stress will affect the growing fetus. It seems that once a woman is pregnant, she loses her voice and her reproductive rights; she is  viewed herself from the perspective of the growing fetus inside her womb.

To top it all, most people cringe at the word “abortion,” which automatically denies a pregnant woman to even think about options.

This biased attitude begins within a pregnant woman’s immediate family: her husband, parents, siblings - following in the line are the in-laws and the extended family. They all become pro-baby advocates. They bless her and make her feel proud of her pregnancy, only for the good health of the baby in the making.

After the baby is born, she is constantly reminded of her task of being a good mother and loving her baby so it grows up to become a better person.

The prenatal and postpartum life mostly revolves around the well-being of the newborn. In this process the person who suffers the most is the mother of an unplanned baby. Fathers also go through postpartum depression if they were not fully ready have a baby. But, who cares about the parents feelings - it is taboo to show depression in a place where a newborn is cradled.

Importance of awareness

Adding to the misery is the fact that many women living in the middle or lower middle-classes of Pakistan are not even aware of their “reproductive rights” or “reproductive justice.”

So, it is important to explain to our fellow Pakistani women that reproductive justice - to choose when to have an abortion or plan a family - is a basic human right. In this case, women’s reproductive right is significant to highlight because only a pregnant woman knows whether she is ready to have a child.

The journey of getting to know your pregnancy begins with self-examination, which in turn provides every woman an opportunity to analyse several issues before deciding whether to go for an abortion or carry on with the pregnancy.

According to Dr Earle, senior lecturer in Health Studies (2004), the first step is to determine the woman’s experience of pregnancy, whether it was mistimed or unwanted. A mistimed pregnancy is a situation where pregnancy occurs earlier than the desired time. Whereas an unwanted pregnancy means that a baby was not wanted or desired by the woman in the first place.

Patient health-care provider relationship

After self-examination, the role of patient-healthcare provider communication about psychosocial issues related to unplanned pregnancy comes into play (Meiksin, Chang, Bhargava, Arnold, Dado, Frankel, Rodriguez, Ling, and Zickmund, 2010).

Patient-healthcare provider communication is mostly required during the first prenatal visit. In this visit, the health care providers should provide the opportunity to the pregnant woman to express her intentions and concerns about the pregnancy and discuss issues such as:

1. The woman’s feelings about the timing of the pregnancy - whether it was planned or not.

2. Whether the child will have a single parent or will be brought up by both parents.

3. The cost of raising a child.

4. The barriers to healthcare access.

5. The family support.

Based on the information provided by the patient, if the pregnancy is determined to be unplanned, the healthcare provider should analyse:

1. Whether it was due to contraceptive failure.

2. Whether the patient is willing to be responsible for life unintentionally conceived.

3. Whether the patient will consider an adoption plan after the birth of the baby.

4. Whether the patient will opt for an abortion, or would choose parenthood regardless of the problems.

After determining the above mentioned points, the healthcare provider should examine, through one-on-one communication, if the patient is under stress or suffering from prenatal depression. If there are any signals of depression then the communication between the patient and the healthcare provider should be geared towards providing psychosocial support to the pregnant woman. Psychosocial support includes providing the patient with abortion counselling referrals, family planning services and postpartum support groups.

Therefore, it is incumbent upon women to identify if their pregnancy is mistimed or unplanned. Similarly, South Asian women also need to understand few important aspects before deciding to continue their pregnancy to full-term. Those aspects are:

Have you been recently pregnant?

Do you feel sad or hopeless like you cannot handle things?

Have you had a miscarriage or have wanted to have stability in your career before the arrival of the baby?

If the answer to any one of the questions is ‘yes,’ it is most likely that the pregnant woman will face prenatal or postpartum (baby blues) depression at some point in her life. To avoid the severity of depression it is better to speak up rather than pretend to be a happy-pregnant-woman!!

The purpose of this is to make South Asian women aware of the fact that no matter how bad they feel about their pregnancy, there is hope for a brighter tomorrow and ways to handle their problematic situation. But it is possible only if they speak up about their feelings regardless of societal or family pressures.