Search for the situation of unsafe abortion in Pakistan with special emphasis

on Punjab.
Unsafe abortion is one of the major health problems in developing countries and a serious

concern for women in their reproductive years. It is estimated that globally about 20 million
unsafe abortions take place each year, which is one in ten pregnancies.

Around 13% of maternal deaths globally are due to abortion, 95% of these occur in developing
countries.

Induced abortion is perhaps the oldest method of fertility control. Induced and unsafe abortion
are more common in cultures where women have unmet contraceptive needs and their access to
reliable birth control methods to prevent an unwanted pregnancy is limited. Generally, women
tend to seek unsafe abortions where it is stigmatized and where safe abortion services are
inaccessible or unaffordable (WHO, 2012).

Global estimates reveal that around 25 million unsafe abortions take place each year, and a large
number of them (97%) take place in poor and marginalized settings. The majority of women who
undergo unsafe abortions are those who are unable to exercise their sexual and reproductive
rights (World Health Organization, 2010).

In Pakistan, complications of miscarriages/abortion account for 10-12% of maternal deaths.

These include spontaneous and induced abortion. The number of women seeking abortions for
unwanted pregnancies is also high as evidenced in the survey by Population Council.

An estimated 890,000 induced abortions occur annually, which means that 1 out of 6 pregnancies
are
Submitted by: Mahnoor Awais
16-Jul-21
terminated by induction of abortion mostly in an unsafe manner. Moreover about 197,000
women are treated each year for complications resulting from unsafe induced abortions.

Among currently married Pakistani women aged 15–49, the level of contraceptive use is low
(30%) and unmet need for contraception is high (25%).

Majority of women seeking termination of pregnancy are married and they do it either to limit
the family size or space pregnancies. Some seek termination of pregnancy on medical grounds or
for socio economic reasons also. Pregnancy outside of a marriage constitutes a very small
component of the total numbers seeking termination of pregnancy. Despite restrictive laws
abortionists, trained or untrained, exist in the society.

Doctors constitute only a small proportion of the providers who terminate pregnancies on
request. Majority of unsafe abortion providers are lady Health visitors, nurse/midwives and dais.
This is a point to ponder as almost all Post Abortion Care trainings are given to doctors and not
to the actual providers who currently offer this service.

Therefore termination of pregnancy carried out by untrained providers often end up with
complications as sepsis, hemorrhage, uterine perforation, visceral injuries, or long term squeal
like infertility with its psychological effects. This results in significant increase in Maternal
Morbidity and Mortality.

Methods Used for Abortion

a) Home based methods

b) Drugs/Oral Pills
c) Surgical Methods

Apart from clinics and hospitals, abortion is done covertly at the residence of local health
providers such as the dai or the LHV. In addition, women also rely on different home remedies
when they think professional health providers like doctors and nurses in the clinics and even the
TBA or LHW in the village are trying to take advantage of their situation (majboori) by asking
more money for doing a safai (Dilation and Curettage) as compared to their fee they usually
demand for assisting a normal delivery. The cost of abortion varies, depending on the situation in
which abortion becomes the only resort and also how advanced the pregnancy was.

The figure below illustrates unintended pregnancies that result in abortion.

Conclusion:

Induced abortion affects the lives of many women. In this study, all women expressed their
concern about disclosing the need for abortion, fearing stigmatization, social criticism and the
loss of prestige.

Deviance from social expectations and the fear of bad reputation makes women scared and
reluctant to seek professional reproductive health information and services, which in turn
compels them to opt for unsafe abortion either through home remedies or by untrained service
providers which ultimately makes them more vulnerable to various health complications and
morbidities.

References:

https://www.guttmacher.org/fact-sheet/unsafe-abortion-and-postabortion-care-pakistan

https://jpma.org.pk/article-details/1562
http://pu.edu.pk/images/journal/studies/PDF-FILES/34_v21_1_20.pdf

https://www.guttmacher.org/sites/default/files/graphics/UnintendedPregnancies(Graph).png