Champion of Choice: The Life and Legacy of Women's Advocate Nafis Sadik

8 Family Planning

138 8 FAMILY PLANNING Always in motion, the Sadiks would soon be separated again. When Azhar completed his coursework at the academy in Kingston in 1958, he returned from Canada alone, reporting to his new post in military intelligence at army headquarters in Rawalpindi. Meanwhile Nafis stayed behind to help her father cope with her now motherless baby brother, Tariq. She also utilized her considerable packing skills, dismantling the Georgetown home to move the family back to Pakistan, where Mohammed Shoaib would become the new finance minister for President Ayub Khan. The young wife, now five years married, reached an agreement with her husband that when they returned to their homeland, they would once again live apart: Nafis would move into her father’s place in Karachi, assuming the role of lady of the house, and Azhar would stay on the base in Pindi, commuting to visit his wife and little girls seven hundred miles away. Once she had settled back into her parents’ home, Nafis resumed her career as a civilian medical officer at the Naval Hospital, treating officers’ wives in obstetrics and gynecology. During this era the clinician became increasingly frustrated at dealing with the same problems over and over again, exasperated at encountering illness and death fueled by ignorance, and a culture that reduced the feminine gender to chattel. Outside her elite group, the mothers she cared for FAMILY PLANNING 139 held no more control over their own destiny than the children they bore. For the next four years she counseled each patient individually, repeating the same advice until the words echoed in her head like a prayer for the damned. Finally, fed up with her Sisyphean task, in 1963 she told her husband the unthinkable: she was going to retire from medicine and become a housewife. Before she came to this decision, Dr. Sadik had worked in obstetrics, yet the cases that distressed her the most were from another ward. She had inherited a handful of patients with chronic tb, and Nafis was reminded of her trials with the army wives in Abbottabad and their struggle against anemia, as she fought a similar battle here in Karachi . “During a pregnancy the tuberculosis gets suppressed; however, immediately after the birth it becomes rampant. Really you should not be pregnant with this disease, but there again, I had great difficulty with the treatment because I couldn’t just address the illness—I had to deal with the patients’ whole social situation.” In 1959 streptomycin had just come into vogue as the preferred remedy, “so at least we were no longer relying on fresh air and good living to cure the patients. We did have some drugs. But still they needed to be properly nourished, protected from infections, they couldn’t be anemic, or pregnant—anything like that. Unfortunately, the women would often get well enough to leave the tb ward to go home; then they’d have a baby. At that point whatever treatment I’d given was undone. To help them, I got contraceptives from the hospital superintendent.” Nafis decided to repeat her method from the Abbottabad days, and she was lucky that even though family planning was still not routinely discussed in this era, the head of the Karachi hospital was much more open-minded than her previous boss. “He understood that it was absolutely essential for these women to avoid childbirth.” When Nafis released a tb patient to go home, she gave her condoms and in return required the woman’s husband to sign a contract agreeing he would use them. “And I’d take a lot of interest in these 140 CHAPTER 8 cases: ‘When did you feed her? How much food did she eat?’ You know, all these silly questions to make the point that her nutrition was more important than his. And I would say, “Who’s looking after your children—is it your wife? Then she has to be well nourished.’ I made all kinds of arguments with these husbands, short of saying, ‘Your male attitude has to change’—you know, this macho attitude. He had to make a decision, a decision that his wife was as important as his children. I knew if he started to think his wife was important, everyone else would too.” As the good doctor carried on her valiant—and increasingly wearisome— effort to rescue the have-nots, her friends all advised that she...