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Protecting reproductive choice in an unthinkable crisis
Team members from Marie Stopes Society in Pakistan share reflections and stories from the frontlines of the floods.
For those not living through it, the situation in Pakistan is difficult to imagine. More than a third of Pakistan—an area larger than Britain—is submerged under flood water in a climate disaster of epic proportions. As we write this, over 1400 people have died, thousands have been injured, more than a million have been rendered homeless, and 33 million have been affected. Violent monsoon rains and water from melted glaciers have swept away homes, hospitals, businesses, schools, and roads. And more rain is expected.
MSI is supporting Marie Stopes Society (MSS), a locally registered NGO in Pakistan that is rallying to support people. In normal times, Marie Stopes Society deliver reproductive healthcare to people across the country. Right now, they’re on the frontlines of the disaster as the principal organisation providing sexual and reproductive healthcare services. And while they’re at it, they’re also helping provide essential primary health care (including treatment for skin fungal infections and diarrhoea) and will soon be distributing menstrual health kits.
Two team members from MSS have shared their own reflections on the emergency and what they’re doing to help local communities.
I’ve worked at MSS for nearly 29 years, and I’ve never seen anything like this. Pakistan is my home and most of our country has been badly disturbed by the flooding. It is nothing short of mass destruction. People are suffering and in need of shelter, food, and health services. And we’re not able to start recovering yet — the rain just keeps coming so we’re still going through it.
I’m glad to be part of a team that’s responding and helping people in this urgent crisis. MSS’ usual service delivery channels include 13 of our own static clinics and 335 private social franchise facilities. But our unique offering that’s enabling us to respond to this emergency is our 15 mobile outreach teams. Our mobile clinics, each staffed with teams of healthcare professionals, are driving into the affected areas to visit emergency flood relief camps. We’re the main organisation here delivering sexual and reproductive healthcare to women and girls on a massive scale.
Just two weeks ago, a pregnant nineteen-year-old woman in one of the emergency flood relief camps came up to one of our mobile clinics with her parents-in-law. She was in labour. Her husband wasn’t there—he had gone back to their village to try to rescue some of the remaining people. Our outreach teams usually only provide contraception and I can tell you that delivering babies is not normally part of their day! But as midwives they responded immediately and brought her into their care, delivering her baby safely into the world in the back of the van. The team transported her and her baby to the closest hospital to get appropriate vaccinations and post-natal care, before dropping her back to the tent where her family was now taking shelter. I can’t stop thinking about this woman bringing her baby into the world in the middle of an emergency flood relief camp, having just lost their home, money, everything.
This young woman is not the only one facing this extraordinary situation. There are around 127,000 pregnant women in Pakistan’s flood-affected areas and 14,000 are due to give birth this month. How and where are they going to do that? We’re preparing kits for all our outreach teams to help women give birth safely in urgent cases such as this. But with many hospitals under water and more than 880 government healthcare facilities destroyed, we hold major concern for pregnant women across this country.
In fact, our concern is for all women and girls. In humanitarian situations like this, we know that increased gender-based violence is a brutal reality layered on top of already tragic circumstances. With their lives in upheaval, it’s vital that women and girls have the reproductive healthcare they need to prevent unintended pregnancies, as well as specialist gender-based violence support.
Unfortunately, the damage has made it difficult, verging on impossible, for people to get the reproductive healthcare they need, or any form of healthcare for that matter. People are travelling upwards of 100km to get to healthcare facilities and, even then, they may find them flooded or empty of staff. That’s why out mobile clinics are crucial. They’re reaching people where they are.
Our teams are made up of incredible local healthcare specialists who can best provide these services. But we need more money and resources so we can reach more people. That’s how the global community can help us.
In spare moments between managing the crisis in front of us, my thoughts fly ahead to the future. Once the rain stops and the flood water is gone… what then? Our local communities have lost their homes, businesses, shops, malls, crops. The impacts of this will be felt for a long time.
To tell you the truth, I’m very, very sad. The situation is serious. Floods have washed away whole villages. People have lost everything—their homes, businesses, even their clothes. They’re hungry and many don’t have access to clean water. They’re just sitting out there on roads or in emergency flood relief camps, with nothing.
Amidst all of this, I could not be prouder of our MSS team. Despite some of our own team members’ homes having been damaged, they’re still coming into work to help others. Everyone is rallying together in a voluntary capacity on top of their usual work, giving donations, making food boxes, and distributing safe drinking water. We’re going into the field and working in very difficult conditions, responding in any way we can. Anyone going into these flood-affected areas is risking their life—the rain is still falling and water-borne and vector-borne diseases from stagnant flood water are on the rise.
Normally our outreach vans provide contraception, both long and short-term methods, to rural communities around the country. While continuing these normal services where possible, we’re also pivoting teams and resources to the flood-affected areas so we can deliver reproductive healthcare to those who need it most. Since early August, we’ve visited more than 100 medical camps and helped over 11,000 people.
We’re also collaborating with the government and other NGOs because no one can respond to this alone. The magnitude of the crisis is just too large. It feels impossible to face but we’re trying.
The main challenge we’re trying to overcome is making sure people have access to healthcare workers, facilities, and supplies. Time is of the essence—delays in getting the right medicines and supplies to the right people mean more people will die. We’re currently hiring more teams to meet the need, with plans to turn one 8-hour daily shift into two rotating 8-hour daily shifts, so that we can have double the impact.
We’re also procuring culturally appropriate menstrual health kits that we can distribute, which will include cotton underwear, small washable towels, hand sanitizer, and soap. These will give women and girls the ability to manage their own menstrual health, an essential part of their dignity.
We know that 65% of the people we’re helping in these emergency flood relief camps are women of reproductive age. They are coming up to our outreach vans, asking for family planning help, menstrual care, post-natal care including treatment for post-partum haemorrhage, emergency contraception, condoms. And for those who are pregnant, I am deeply concerned for their health. The maternal mortality rate here is already incredibly high. Pakistan is one of six countries that account for over 50% of all maternal deaths worldwide. We need to be responsive or I fear that maternal deaths will rise dramatically.
Whatever strength and whatever resources we have, we’re using to help these people. And any strength and resources you can give us, we will readily accept and use to save lives.
United Nations Secretary-General Antonio Guterres said he’s “never seen climate carnage” at this scale. Despite being the world’s fifth-most-populous country, Pakistan is responsible for less than 1% of global greenhouse gas emissions. This is the reality of the climate crisis: the communities that have contributed the least are suffering the most.
The future impact of the floods is unimaginable. The damage and economic losses will be felt by the people of Pakistan for years to come, and a food crisis looms.
But what we know right now is there are millions of people in need of urgent help. As Dr Tasneem and Shahrukh have told us, people urgently need health services. And MSS are in Pakistan right now delivering high-quality, comprehensive, and inclusive sexual and reproductive healthcare—often an afterthought in crisis responses, and chronically under-resourced and under-funded by the global community. We must do all that we can to support MSS as their brave team members risk their own safety to provide sexual and reproductive health services to the people in these flood-affected areas. They are driven by their belief that it’s essential that women and girls have access to reproductive choice, no matter what.
You can help us reduce health risks, prevent unintended pregnancy, and restore personal dignity for women and girls by providing them with the reproductive healthcare they need. If you believe that Pakistani women’s health and choices should be protected during this unthinkable time of crisis and loss, please donate today.
