Providing safe, clandestine abortion services in Pakistan.(SPOTLIGHT)

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Editor's Note: Names of organisations operating clinics and locations have been withheld upon their request.

Harsh realities. In countries like Pakistan where the procedure is restricted and accessing safe services is problematic, the decision to have an abortion is often a difficult and stressful one for women. Despite this, some 890,000 unwanted pregnancies (or one in six pregnancies) end in induced abortion per year in Pakistan. (1)

In the absence of accessible, safe and officially authorised abortion services, most rural poor women opt for traditional methods or go to dais (traditional birth attendants), (1) who use a range of methods including insertion of knitting needles or pouches containing arsenic into the uterus. (2) Urban women, on the other hand, often approach safias or backstreet clinics where environments are unsterile. (2) It is no surprise that many women's health and lives are put at risk--some 197,000 women are treated annually for post-abortion complications in public sector facilities and private teaching hospitals. (1) Complications from unsafe abortions factor for a large portion of the maternal mortality rate of Pakistan, although the exact number cannot be determined due to the secrecy that shrouds the issue. (2)

Research reveals that 65% of women who had induced abortions were aged 30 or above, while 80% had three or more living children (i.e., abortion is being widely used as a family planning method). (1) It also indicates a fairly high level of acceptance of induced abortion, with 80% of women having discussed with their husband the possibility of terminating the pregnancy, 89% indicating that the husband was aware of the induced abortion, and in 66a% of cases, husband and wife had taken the decision jointly.

But what about younger women? While the Population Council research revealed that "almost certainly a small minority of aborted pregnancies occurred outside of marriage," (1) it must also be noted that 21% of young women aged 15-19 are already married. (3) Moreover, while the number of Pakistani young women having abortions is unknown due to the unavailability of age-disaggregated data, it is certain that they seek abortions. Shirkat Gah cites that NGO field workers say that young unmarried girls are the more frequent abortion seekers in rural areas. (2) On the other hand, smaller urban hospital and clinic-based studies found that young women comprise 3.3% to 20% of those who sought abortions or were treated for complications. (4) It must be noted that young women may be overrepresented in such urban studies because they face an increased risk of complications, possibly caused by delays in seeking medical care. Conversely, the dearth of rural-based health services and the difficulty of accessing urban-based ones mean that an undetermined number of women do not access medical treatment for post-abortion complications. This difficulty is even greater for young women, especially the unmarried, due to their limited decision-making power and severely restricted physical mobility in the Pakistan context. (4)

Some relief. Set apart from backstreet clinics and dais are a few non-governmental organisations that provide safe abortion services because they believe in a woman's right to decide for herself about her body and reproduction. These "no-loss, no-profit" organisations provide a range of sexual and reproductive health (SRH) services, including information, referrals and safe abortion services up to 12 weeks of gestation. These organisations are well-established in the communities they serve and have earned credibility through an unwavering client-centred and needs-based approach, which considers communities' needs in the location and timings of facilities as well as in their service fees. In addition, their strict adherence to quality, protocols and professionalism instil comfort and trust in clients.