Haroon Mustafa Janjua
An unsafe abortion is defined as “a procedure for terminating an unintended pregnancy carried out either by persons lacking the necessary skills or in an environment that does not conform to minimal medical standards, or both.” Whether they live in countries where abortion is legal or not, the fact is that women across the world have always found ways to terminate undesirable pregnancies. And where the law of a country remains a hurdle making it difficult or illegal to have an abortion, women have often resorted to unsafe methods that include undergoing the process at the hands of a rookie abortion specialist and or even self-induced terminations. In all cases, post-abortion knottiness presents a dangerous challenge for public health, and determining the accessibility of care in a country’s public and private health facilities continues to be significant for the design of reproductive health policies and programmes. As a result, women resort to clandestine and unsafe abortion procedures, which often lead to complications. Such practices are found excessively in both rural and urban areas, a danger to women’s reproductive health.
Recently some groundbreaking research around the issue was conducted by the Population Council and published in August last year. The study was entitled ‘Post-Abortion Care in Pakistan: A National Study’. It targeted 266 hospitals in the country and also interviewed 102 health professionals and 44 women who had undergone abortions. It found that in 2012, 700,000 women had abortions using unsafe methods or with the assistance of unskilled service providers. According to health professionals intimate with some cases, women who sought clandestine abortions often obtained them from dais (traditional birth attendants) or mid-level providers such as lady health visitors, nurses and midwives, and as a result often experienced complications. The practice is still common, leading to permanent damage or deaths.
The condition is exacerbated by the large number of unintentional pregnancies in Pakistan. It is estimated that 25 percent of the births in Pakistan are not planned. Generally, ignorance and misinformation about contraceptives have created a relatively low level of contraceptive use of about 30 percent amongst married women aged 15-49 years in Pakistan. A study conducted in 2002 found that for that year the number of terminated pregnancies was close to 900,000. That is, some 29 abortions for every 1,000 women of reproductive age.
To avoid this situation the use of contraceptives should be encouraged, because research shows that 25 percent of women usually want to delay pregnancy but do not use contraceptives and are at a risk of unwanted pregnancies as a result. The abortion rates in the more urban provinces of Punjab and Sindh are substantially lower than those in Khyber Pakhtunkhwa and Balochistan. In urban areas, the contraception rates are higher because of awareness campaigns by government on media and action by urban-based NGOs and other health organisations. Awareness campaigns remained a beneficial tool for understanding and tackling the issue in big cities.
The state of reproductive health is still very troubling. Several hospitals lacked adequate equipment and supplies to provide quality care while the majority is unable to provide round-the-clock services to manage severe complications. Emergency services are often absent, compelling patients to shift into large and expensive private hospitals. The findings of the report revealed that the private sector played an important role in this regard as more than 60 percent of all abortion cases were treated by practitioners in the private sector. It added that the current law in Pakistan permits abortion to save a woman’s life and to provide necessary treatment. However, due to legal restrictions and lack of clarity among women, people are forced to seek abortion from untrained health experts. The state of public sector health centres is alarming because low budgets, outdated equipment, and untrained staff are further debilitating the state of maternal healthcare for women. The report said that better health facilities equipped with the latest technology should be ensured in both the public and private sector hospitals. Services like medication abortion (pills), in-clinic abortion, sedation options (medication to make the abortion more comfortable), pre and post-abortion patient education, post-abortion follow-up examinations and referrals for other abortion services are needed. Furthermore, a national policy on training and capacity building was recommended by the Population Council members and researchers. Similarly, facilities that provide post-abortion care should also offer a range of contraceptive services as well.
To reduce the number of women in Pakistan in need of post-abortion care, access to quality family planning services that will help women avoid unwanted pregnancies must be made more widely available, especially in rural areas. An expansion of planning services will require the training of health providers and the uninterrupted availability of contraceptive supplies. There is a strong need to ensure that quality counselling and contraceptive services are provided to both spontaneous and induced abortion clients within health facilities at all levels of the public and private sectors. There should be closer coordination between the Health Department and the Population Welfare Department to develop an inter-departmental referral system and more efficient referrals between facilities in the public and private sectors, and for ensuring the regular supply of contraceptives.