Law related to Abortion :
A research studies conducted in 2002 and 2003 (by Population Council-Pakistan) in all four provinces in both urban and rural communities to analyses post abortion care situation in Pakistan and conduct interviews with follows:
- Health professionals
- Health facilities
- Survey of women who suffered from post-abortion complications
- In-depth qualitative interviews with women (and their husbands) who had experienced an induced abortion
The finding of this survey as follows:
- An estimated 890, 000 induced abortions occur annually in Pakistan
- One abortion for every five live births
- Relatively older women with several children
- 89% discussed with husband the possibility of termination of pregnancy* (interview with 189 women who had abortion)
- Decision made jointly by husband and wife in 66%.
- Abortions resorted to in order to limit family size or space births, and for financial reasons
- D & C is the most common method used *(health professional survey)
- An estimated 196,671 women are hospitalized for complications of induced abortions
- The rural poor and the urban poor are more likely to seek abortions under unsafe conditions*
- When complications occur, poor women are more likely to seek care from government facilities
Law Situation in Pakistan :
“A Woman’s right to obtain an abortion by her own choice within the first 120 days of pregnancy should be unambiguously declared an absolute legal right”
(Source: Recommendation of the Commission of Inquiry for Women, Pakistan, Aug.1997). This still remains as a recommendation.
In 1990 the Pakistan Penal Code of 1860 and the Criminal Procedure Code of 1898 was amended. The purpose of the amendment was to bring the law into conformity with the injunctions of Islam, as laid down in the Holy Quran and Sunnah. Since 1997, as a result of amendment of the Penal Code, abortion is allowed in the early stages of pregnancy not only to save the life of the woman, but also for providing necessary treatment. This has widened legal permission for carrying out the abortion in the early stages of pregnancy. 6
Short summary of conditions within the law :
To save the life of the woman : Yes
To preserve physical health : Yes
To preserve mental health : Yes
Rape or incest : Not specified
Foetal impairment : Not specified
Economic or social reasons : No
Available on request : No
Analysis of it being restrictive if at all :
Public and Private Organizations have different interpretations. Generally, it is considered restrictive but since 1997, as a result of amendment of the Penal Code, abortion is allowed in the early stages of pregnancy not only to save the life of the woman, but also for providing necessary treatment. This gives privilege to medical practitioners to work on it. No qualified medical practitioner has ever been prosecuted for an uncomplicated termination of pregnancy.
Government policy enabling for the law, enabling beyond the law in practice etc such as population control policy, pro- natalist policy, anti sex selection policy, two child family norm)
Govt. has no policy on Abortion. Neither the National Health Policy nor the National Population Policy has any mention of Abortion.
(Providers trained, willing, enabling)
The providers of abortion services are both private & public GP clinics, maternity homes and gynaecologists in private & public hospitals. This is very low key, often considered as clandestine, with little records kept. Charges are variable and often exploitative. It is completely unregulated and no stats are available.
Reproductive Health Perspective :
Signatory to ICPD, CEDAW: Yes / No, any conditions.
Yes, but has reservations about abortion services as per Islamic law and decision of Penal Code as mentioned above.
Abortion Statistics :
No authentic statistics are available.
Public sector :
Missed abortion, inventible Abortion or incomplete abortion services available in
Private sector :
Missed abortion, inventible Abortion or incomplete abortion services available in private sector also.
1st Trimester – yes.
2nd Trimester – yes, up to 120 days.
Cost- varies from US$ 70 to US$300 depending on gestation size, ambulatory or in patient.
Methods used :
D&C, EVA, MVA, MMA with Mife, Miso, MMA with Miso alone, MMA with Methotrexate Miso.
Almost all methods are available included MVA not widely used. But Mifepristone is not licensed but Misoprostol and Methotrexate are available in the country.
2nd Trimester with Ethacridine lactate , Misoprostol, D&E, Hyterotomy.
Mostly D&E and hysterotomy.
Provider level allowed for surgical and medical abortion :
(Ob Gyn, MBBS, Nurses, Other)
Only Ob Gyn and MBBS are permitted by law.
Abortion related morbidity mortality statistics :
No authentic data available expect survey conducted by Population Council-Pakistan (2002-2003).
Manufacture and/or availability through import of abortion equipment (MVA syringes, EVA equipment) :
Almost all available; no restrictions on imports of equipment.
Manufacture/ import of Mifepristone, Misoprostol :
All imported; mifepristone is not licensed in the country.
Facility and provider certification norms in brief :
Pakistan Medical and Dental Council certify doctors and dentists. The registration is a license to practice. The Nursing Council of Pakistan certifies nurses, lady health visitors, lady health workers and midwives. The registration is a license to practice.
Information available in national service delivery standards :
No authentic data are available, however, Govt. is the largest provider of healthcare in the country. Its facilities are according to standards set by Ministry of Health. (I’m not sure about private facilities).
No national service delivery standards are available on Abortion. However, National Service Standards are formulated for RH/FP services.
Informal / illegal providers – if present who are they :
Traditional Birth Attendants (TBAs), Quakes, Lady Health Visitors (LHVs), Lady Health Workers (LHWs) Nurses available in rural & urban areas.
Population urban/ rural – Demography of the country, with an analysis of availability of abortion services ratio to population :
163.82 million Source: Population Census Organization
Urban 34% of total population and Rural 66% of total population.
No available statistics for abortion services to the population as there are no formal abortion services in the public or private sector. However, Marie-Stopes Society is providing abortion services through over 50 centres nationwide.
Role of government :
Supportive, enabling, curtailing barriers, provides adequate funding to run training and service delivery programmes in the country especially on FP& RH.
Role of religion/ religious leaders :
Enabling, supportive, neutral, restrictive.
In Pakistan Muslims are in majority and the ‘ulamas’ are generally restrictive about abortion; but ‘Fatwas’ differ from state to state within the country.
Local Ob Gyn societies :
Supportive, conscientious objectors.
Encourage safe abortion but mostly take traditional approach and no official position taken.
Current status and potential of research :
The International Federation of Gynecologists and Obstetricians with support from IPPF, UNFPA, IPAS, WHO, launched a FIGO initiative on unsafe abortion, calling from member associates in countries with high incidence of related morbidity and mortality to undertake a situation analysis on the subject. The results in case of Pakistan have been shared with stakeholders, including FPAP. Since it was a desk review of available research, no new facts have emerged. The Population Council study is still considered the most authentic research on Abortion in Pakistan. However, there is great potential for research in this field given the restrictive environment and high incidence of unsafe abortions and their complications in the country.
Awareness amongst community members :
No significant awareness on complication on unsafe abortion and legal status of Abortion Law.
Role of member organization/ individual :
I am working as Regional Director in Family Planning Association of Pakistan and looking after multiple RH/FP related projects included “Safe Motherhood and Elimination of Unsafe Abortion”. Through this project as head of the Region I ensured RH services i.e. Management of unsafe abortion through MVA techniques, PAC services included counseling etc at our Family Health Hospitals and Clinics as well.
We are working towards creating greater awareness of women’s rights to sexual and reproductive health among Govt. official, elected representatives, media and hold focus group discussion with mentioned stakeholders.