Sadia’s Story

Why should we care about women we will never meet, in countries most of us will never visit? As a foreign aid worker promoting women’s reproductive health and rights internationally, I have faced this question throughout my career. The answer is a mix of compassion and enlightened self-interest. 

Consider Sadia, a farmer’s wife in Pakistan. I heard her story from Imtiaz Kamal, a midwife I worked with, as we waited for an appointment with the director of a family planning organization in Lahore. Railing against the stubbornly high number of pregnancy-related deaths in her country, Imtiaz told me about Sadia, one of her clients.

Sadia had just a few years of schooling. Her parents arranged her marriage when she was 14. She had five daughters before she was 30. Small and undernourished, she looked like a girl herself. Because she suffered complications during her last two home deliveries, Imtiaz warned her against getting pregnant again. But Sadia’s husband wanted a son. He decided that they would not use contraception until Sadia gave him a boy. Like so many uneducated women in traditional societies, Sadia gave in to his wishes. It was her wifely duty. 

And so, Sadia got pregnant again. She didn’t have checkups with Imtiaz this time, afraid of being chided for ignoring her advice. When she went into labor, things went very wrong. The baby did not come. Sadia lay for hours writhing and wailing on a bed of dirty blankets. Then she grew quiet, her swollen body wracked with convulsions. Her eyes no longer focused. 

At some point her husband panicked. He rushed down the unpaved, dung-strewn path that cut through their village and led to the midwife’s clinic. He found Imtiaz and urged her to come quickly. 

“My wife is very sick,” he said.  

Imtiaz grabbed her medical kit and followed the farmer back to his modest home. Inside, it took a moment for her eyes to adjust to the dark in the airless room where Sadia’s body quaked, her sightless eyes sunk back in her head, foamy spittle dripping down her chin. Imtiaz could see immediately that the lives of both the woman and her baby were in danger. 

“Your wife needs to get to the hospital as soon as possible,” she told him. She knew the hospital was several kilometers away. Instead of snapping into action, the man went quiet. “Didn’t you hear me?” Imtiaz cried, her voice shrill with alarm. “Without emergency treatment, your wife and baby will both die.” 

The man, lean and toil-hardened, stood gazing at the dirt floor, applying the cold calculus of the destitute to decide what to do. He knew he would have to pay for transportation to the hospital, and that he would then have to buy the medicines and supplies the government facility wouldn’t provide. He would need to go to a pharmacy for whatever the doctors required to save his wife and baby. As a subsistence farmer he had no cash; he bartered what he grew for things he could not cultivate. But medical costs were likely to be high. He asked himself how he could get money. His two water buffalos, with which he plowed the field, were his only asset. 

For a moment he thought of selling one of the animals to pay for his wife’s treatment. But he had children to feed and could not farm with only one buffalo. It would be better, he reasoned, to let his wife die and replace her with another while keeping his assets. He would actually come out ahead. Another marriage would bring him a dowry plus the renewed chance for a son. So he figured that, unlike his buffalo, Sadia was expendable.   

An eternity passed before he raised his black eyes. “No hospital,” he said. “Do what you can for her. If she dies, it is God’s will.” 

The midwife’s skilled hands were tied. With neither medication nor the ability to perform a Cesarean section, she was powerless. She pleaded with the husband. He explained his decision and could not be moved. 

Imtiaz was tormented by the prospect of yet another preventable death. She watched and fretted, mopped the young woman’s soaked brow, and uttered soothing sounds until the convulsions stopped. Both Sadia and her infant were dead. And her five young daughters were now motherless.

The relived pain of remembering that day was visible in Imtiaz’s face as she told the story. She knew too many Sadias, she said. And she knew what was needed to save them. Her skills were not enough. She couldn’t make up for a society that placed such a low value on women and gave men control over their bodies and their lives. If only girls were kept in school instead of being married off while still children. If only her government was held accountable for fulfilling women’s human rights to decide for themselves whether and when to get pregnant, and to have access to contraception.     

I felt despondent, knowing as health care workers we couldn’t solve the challenges we faced. Even if we managed to improve and expand contraceptive ser­vices, that wouldn’t change the fundamentals of gender inequality and poverty.

“Well,” I said. “Contraception may not be sufficient, but it’s a necessary part of the solution.” Imtiaz agreed. 

At that moment, the office door opened. I followed Imtiaz’s lead as she squared her shoulders and marched in to our meeting. 

What does this have to do with us? The simple fact is that improving the welfare of women like Sadia is in our enlightened self-interest. Their well-being affects ours. 

Keeping girls in school and giving adolescent girls and women access to contraception are known to be the best things governments can do to reduce poverty, promote social and economic development, and mitigate climate change. This potent combination delays marriage and the start of childbearing, and naturally leads to smaller families. Educated women make better choices about health care, nutrition, and education for their children. Smaller, healthier families can prosper. 

Multiply this at scale, and you get thriving villages and towns and a reduced burden on fragile social services and the environment. Women with knowledge and skills can take part in community organizations, businesses, and local government. They can become teachers and doctors. Unleashing women’s full potential promotes national prosperity and stability.   

The Trump administration rejects this reasoning. It is working to reverse hard-won advances in reproductive health and rights at home and abroad, limiting access to contraception and abortion even where legal. It has deleted references to human rights from the government’s Global Health website and wants to slash funding for development assistance. It misses the role that women’s health and welfare play in the poverty and instability fueling the migration crisis at our southern border. 

This Mother’s Day, consider the hardship countless women suffer from having children too early, too close, and too often, with neither the freedom to make their own contraceptive decisions nor access to lifesaving services.   

This election season, consider how gender, human rights, women’s reproductive health, and foreign aid figure in proposed policies and platforms. Think of Sadia, for the good of us all.  

Jan Kumar, a participant in the Ashawagh Hall Writers Workshop, is writing a memoir about navigating different cultures both personally and in her work at the intersection of women’s health, human rights, and foreign aid. She lives part time in Southampton.