BY Madiha Latif
Decision making and agency over reproductive choices is a fundamental right for all reproducing beings. In practice, however, socio-political and economic structures create space for this right to be undermined and diminished.
A type of intimate partner violence, reproductive coercion and abuse come in the form of behaviors that take away the right to reproductive choices and autonomy. This could be physical, psychological, economic or sexual, resulting in promotion/prevention of pregnancy (Tarzia & Hegarty, 2021). In Pakistan, national surveys show how limited women’s decision making when it comes to reproductive choices (approximately 37% of women have stated that decisions around contraception were made by their husbands). The survey indicated while women did not want to have more children, they were unable to exercise reproductive agency, and it was the men that wanted to continue having children and did not allow their partners to use contraception.
One of the contributing factors are state-imposed anti abortion laws – criminalizing safe access to abortion and forcing reproduction on people could be argued to be state-backed violence and a measure that perpetuates gender inequities.
State-imposed criminalisation of abortion has a higher degree of impact on the young, poor, and uneducated compared to their counterparts who have access to resources and opportunities, which further exacerbates the cycles of poverty and violence. It forces young people to look for alternatives, pushing them towards unsafe and unskilled healthcare, which can result in long term morbidity or mortality. There is no evidence to suggest that abortion laws reduce the incidences of abortion; rather, they create an additional economic and health burden on countries, the price of which young people bear the most with their health and lives.
To create an environment that allows for people to prosper and live healthy and free lives, it is important to question policies and processes that further inequities and violence. Allowing people to exercise their reproductive autonomy and enabling an environment that supports the access to and availability of a full range of non-discriminatory reproductive health services would contribute significantly to better reproductive health choices and health-seeking behaviors. In situations of violence, where reproductive coercion effectively forces a young person to become pregnant, the state further criminalizes the survivor through denial of abortion services – with the perpetrator not being held accountable in any way. Is this, in any form, justice?
Drawing from the experiences of child, early and forced marriage, we know that in Pakistan, this is a continuously occurring violence, and with the growing economic and climate crisis in the country, it is only anticipated to increase. Human rights advocates have continued to raise concerns over the implementation and implication of the Child Marriage Restraint Act – with the young child bride bearing the burden as both the victim of reproductive coercion and the consequences of the law. Legal restitution is to criminalize the “husband” and those that have allowed for the marriage to take place, however, does not necessarily annul the marriage. While the courts may declare a marriage contract void, if intercourse has taken place already, the young girl is, from a religious perspective, considered to be married, and she can thus be socially ostracized and tormented for “criminalizing her husband”. Young children are the most vulnerable to reproductive coercion, and it’s important to remember that young people getting married at an earlier age are less likely to continue education, do not have any decision making agency and financial independence and are, at the end of the day, unable to access or use contraception without the interference of their spouses and families – therefore this cycle of violence continues, irrespective of what the law states.
A difficult violence to measure, reproductive coercion is often not identified or even recognized by the survivor, leading us to question whether the state is even able to intervene in such cases. Therefore, states must assess the reproductive policies they formulate and the implications they potentially have on the continuity of violence or violent circumstances. Incorporating social behavior change models in mainstream education facilities, from a younger age, using Life Skills Based Education [LSBE] for example, could be a means of supporting young people in understanding their rights and strengthening their negotiation skills. States could also take on transformative approaches that target out-of-school children through community centers, employing peer mentors who can work with young people in communities to counter gender stereotypes that perpetuate violence. Prioritizing education and employment for young people is also a means of supporting economic independence, and states should invest resources in enhancing educational institutions across the board, integrating LSBE into the curriculum.
Further, primary healthcare workers need to be trained to respond to unique circumstances and dynamics that are often the realities of young people, especially those from marginalized backgrounds, integrating a higher degree of care and support to encourage health seeking behaviors. Healthcare workers could be trained to identify signs of violence and be mandated to provide emergency services where necessary and continued psychosocial support as needed.