Health and Social issues related to Marriage

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 SOGP & AMAN seminar on
Health and Social issues 
related to Marriage

KARACHI: Society of Obstetricians and Gynaecologists of Pakistan (SOGP) in collaboration with AMAN organized a seminar on Health & Social issues related to Marriage at JPMC, Karachi on February 9, 2013. It was very well attended by gynecologists and members of various NGO’s working in the field of women health.
Dr. Laila Shah, form (NCMNH) talking about Pakistan Demographics & the importance of family planning said that Pakistani population is 185 million which will be 335 million by 2015. It is 6th largest growing country and will be 4th position in 1950 if it continues at this speed. Thirty women out of one hundred opt for family planning while 35 million were living below poverty line. Lack of education, difficult areas, lack of services, no counseling, legal and regulatory barriers to introduce new treatment and lack of adequate resources are the major problems being faced in the family planning. Internees and PGs should be included in awareness programmes besides , involvement of religious leaders, media and increase in budget.
Prof. Shireen Bhutta, Vice President of SOGP speaking about fertility & family planning said that too much emphasis is given on the wedding and too little on the marriage. We must focus our attention on marriages because it involves new roles by the couple, addition of expectation and responsibilities, new relationship, and pressure. Before marriage we should know the Blood Group, Rubella Immunity, Hepatitis status, relevant family history, chromosomal anomalies, Thalassemia and other hereditary disorders. Talking about family planning she said that one third of two hundred five million pregnancies each year are unplanned all over the World. Family planning prevents unwanted pregnancies, brings wanted births and regulates interval between births. A contraceptive choice for newly married couples is condom and its failure rate 2 to 15%. EOC are not a substitute for regular contraception. Injectable and implants are also available. Benefits of emergency pill are there but it should not be used regularly, she added.
Dr. Tabinada Sarosh from Shirkat Gah discussed the social issues and Nikah Nama. Marriage she stated is a social reunion, a legal contract, which is a journey towards mutual happiness. There are forty two percent underage marriages in Pakistan which is strange thing. Child Marriage Restrict Act (CMRA) is available but need advocacy, awareness and strong implementation of the law. There is need for standardization of marriage age. Underage marriages and anti women practices are very common in rural areas like, exchange marriages, Vanni, Swara and Chatti etc. Domestic violence is the under reported and internalized taboo. Access to health and pre martial counseling is lacking and there is also need to focus on adolescent reproductive health. It is very important to read Nikah Nama because it is a very important document, she added.
Dr. Sadiah Pal speaking at the occasion highlighted the importance of vaccination against Cervical Cancer, Rubella and other health concerns before marriage. Special issues which has to be considered includes like finance, dowry, job, education, sex education, children and parenting, previous marriage and polygamy etc. Health issue like problem with sexual intercourse, gynecological problem, irregular menstrual period, and delay in conception and PCOPD fibrosis.HPV is the major cause of cervical cancer. It is increasing in Pakistan. Its incidence was less than nine per thousand in 2002 while it was reported 19.5 per thousand in 2008. This can be prevented by vaccination. CERVARIX and GARDASIL are the two vaccines available but they are very expensive. Routine vaccination of girls from eleven to twelve years of age must be done she added. Vitamin-D deficiency is very common especially in women in Hijab. Folic Acid should be started before planning a pregnancy, she further added.
Taking part in discussion Prof. Tasnim Ahsan, Director JPMC, Karachi said that Thalassemia is major problem than Hepatitis B. Its carrier rate is 10% and management is very expensive. Intermarriages are the major cause of its spread, she added. We need to use each and every forum to educate the people in this regard and include orientation training in family planning in core training for our graduating doctors. Dr. Shireen Bhutta said that we have laws but no one is bothered because until we have strict punishment, no one is going to take care of it. She also urged that doctors and specialist from other specialties should also educate the Patients regarding gynecological problem when they visit them for other diseases. Dr. Samrina Hashmi, President SOGP said that sensational issues are picked up by media while health related issues of women are not highlighted since religious issues are involved in it. We should educate family physicians who can play an important role to improve women health status, she added. Dr. Shahida Zaidi, President AMAN, in her remarks said that Obstetricians and Gynecologists should have a special place in the society. We have to give corrective measures where the problem has been encountered. We should guide the organizations working on these lines to improve their working, she added.
Mrs. Hilda Saeed from Shirkat Gah informed the participant that Shirkat Gah works through awareness and capacity building on women’s rights, legal issues, reproductive health and environmental issues. Shirkat Gah has established six contact places where one can contact, discuss women related issues. TBA training program are also being conducted, she added. Dr. Ayesha from Aahung and Dr. Alia from Greenstar also briefly discussed services being provided for the women health issues by their organizations.

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