and Baluchistan had the highest proportions of induced abortions (62% and 63% respectively), while the lowest was found in Khyber-Pakhtunkhwa (40%), while Punjab had 54 per cent which is equal to the national level.
In Pakistan, abortion is legally allowed only to save the life of a woman or to provide “necessary treatment” early in pregnancy. Given a lack of clarity in interpreting the law, legal abortion services are difficult to obtain, and most women who have an abortion resort to clandestine and unsafe procedures.
According to the study, the national abortion rate in 2012 was 50 abortions per 1,000 women aged 15-49. This rate is much higher than the rate estimated for 2002 (26.5 per 1,000). Acknowledging an underestimation of the 2002 rate, which did not count private-sector procedures, the study points to a significant increase over the 10-year period. In 2012, an estimated 623,000 Pakistani women were treated for complications resulting from induced abortions, the vast majority of which were performed by unqualified providers.
In making recommendations, the report calls upon policymakers and service providers to make improved access to quality contraceptive services an urgent priority, especially in rural areas, so that Pakistani women are better able to time and space their pregnancies and have the number of children they desire. It also emphasises that the provision of family planning counselling and methods should be made a routine part of post-abortion care in both public- and private-sector facilities.
“Expanding public-sector services will require the training of additional health care providers, including doctors and midlevel providers in safer methods of treating post-abortion complications. Essential supplies-such as manual vacuum aspiration kits and disinfectant equipment-must be made consistently available. The effective expansion of family planning services will also require recognition within the health sector that family planning is an essential part of improving maternal, neonatal and child health. The provision of all of these services must be better integrated,” the report recommends.
The study on contraceptive use highlights major obstacles in family planning adoption and its continuation; these range from domestic hindrances to issues of access of family planning service provision at facilities. It focused on probing beyond traditional explanations with a holistic view to identify gaps in the demand for family planning care as well as supply issues.
The report calls for sensitisation of local religious leaders on family planning to support the need for policymakers to prioritize birth spacing from the religious perspective. It also suggests that provision of family planning counselling and services during antenatal, natal and postnatal checkups, as well as during general health visits, be made mandatory by healthcare providers. “The availability of supplies should be ensured in all health and population welfare service outlets. The departments must focus on addressing discontinuation of family planning methods by clients on priority,” it recommends.
Speaking on the occasion, Saira called for better coordination at the national level and formulation of well thought out policies that take new evidence from the two studies into account. “Until policies are implemented with accountability mechanisms in place, our indicators will not improve. Although people want to better plan their families, they are unable to do so due to issues of access to services and quality of care,” she said.
The minister maintained that while Pakistan can raise its CPR and bring it at the same levels as Bangladesh, Iran and Saudi Arabia, the ‘business-as-usual’ approach will get the country nowhere. “We have to shake up the health system to deliver birth spacing services as part of its other maternal care services; men should also be at the centre of these services; accountability for delivering what is an essential human right to millions of Pakistanis must lie with the highest levels of political leadership,” she conceded.
Saira complemented the Population Council and the Research and Advocacy Fund for visiting districts across the country to disseminate ground realities from Pishin to Umerkot. The Population Council provides crucial evidence for improved decision-making.
The event was a welcome opportunity for subject experts to share their views on topics shaping the reproductive health and socioeconomic agenda in Pakistan, and to determine the best way forward to help women and communities achieve optimal health outcomes.