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Population Council Launches New Report
on Postabortion Care in Pakistan

Latest Research Evaluates Status of Postabortion Care in Pakistan; Highlights Need for Expanded Access to High-Quality Family Planning Services

ISLAMABAD, PAKISTAN (23 August 2013) — Today, the Population Council released a report, "Post-abortion care in Pakistan: A national study" that outlines ongoing gaps in the quality of postabortion care following unsafe abortion procedures, societal stigmas, inequities in the healthcare system, the burden of postabortion complications, and the significant role of the private and public sectors in ensuring access to care. As an update to a study completed in 2002, this report provides recommendations for promoting safer postabortion care, expanding access to high-quality and affordable family planning services and contraception, and building capacity among healthcare providers to help achieve these goals.

The report was launched during a meeting that took place at the Marriott Hotel, Islamabad, featuring Mrs. Saira Afzal Tarar, Minister of State, National Health Services, Regulations and Coordination, as chief guest and keynote speaker. Speakers from the Population Council and the Guttmacher Institute were joined by a panel of experts from leading national institutions and professional organizations.

Attended by representatives from the Government of Pakistan, donor organizations, health professionals, academics, NGOs, and civil societies, the report launch was an opportunity for experts to share their views on timely topics shaping the reproductive health and socioeconomic climate in Pakistan and determine the best way forward for helping women and communities achieve optimal health outcomes.

In her keynote address on the occasion, Mrs. Saira Afzal Tarar spoke to the urgent need for policies and planning at the highest levels to tackle the issues raised in the report. She also stressed the need to focus on actual implementation of plans and policies.  

"It gives us great cause for concern that nearly 700,000 women in Pakistan needed treatment annually for complications of induced abortion or spontaneous abortion," said Mrs. Tarar. "Many facilities do not have adequate equipment if complications occur. Lack of well-trained staff, stigma, and financial constraints also pose inherent barriers to good service delivery. Coordinated efforts of Health and Population Welfare Departments must augment other actors together as a community to address these issues that threaten the lives of women in Pakistan each and every day." She suggested that a pool of nurses, lady health visitors, and other mid-level providers be trained to specialize in the provision of postabortion care.

Dr. Zeba A. Sathar, Country Director, Population Council, Islamabad, and report co-authors (Dr. Gul Rashida, Dr. Zakir Shah, and Iram Kamran) presented the study findings, along with Dr. Susheela Singh, Vice President, Guttmacher Institute and report co-author, who participated via videoconference. Ms. Sarah Hall, Program Manager, Maternal Health Programme-Research and Advocacy Fund, Islamabad, commented on the report and provided rationale for study funding.  

Following the presentation, the report was discussed by a panel of experts, including: Dr. Rizwana Choudhry, Professor, Gynaecology & Obstetrics, Rawalpindi Medical College; Dr. Yasmeen Sabeeh Qazi, Senior Program Advisor, Packard Foundation; Dr. Lubna Hassan, Gynecologist & Obstetrician, Peshawar; and Dr. Ghazal Mehmood, Gynecologist & Obstetrician. Dr. Sadiqua N. Jafarey, President, National Committee for Maternal & Neonatal Health, and Dr. Tasneem Ashraf, President, Society of Obstetricians and Gynaecologists of Pakistan, articulated their perspectives with concluding remarks.

The study found that in 2012, nearly 700,000 women in Pakistan went to health facilities for treatment of complications resulting from induced abortions or spontaneous abortions using unsafe methods or with the assistance of an unskilled provider. While safe procedures for postabortion care were found to be more widely used in 2012 than they were in 2002, health facilities still rely on unnecessarily invasive procedures such as dilation and curettage (D&C). Additionally, many facilities do not have adequate equipment and supplies to provide quality care for complications, and a majority are not equipped to provide around-the-clock services to manage severe complications. Lastly, the private sector plays an important role in the provision of care, as more than 60 percent of all cases were treated by private-sector providers.

In Pakistan, 25 percent of women would like to avoid or delay pregnancy but are not using contraception, and therefore are at risk for unintended pregnancy. As a result, many women resort to induced abortion to end unintended pregnancies. The current law in Pakistan permits abortion to save a woman's life and to provide "necessary treatment." Due to these legal restrictions and the lack of clarity among women and healthcare providers in interpreting the law, women may be forced to seek abortion by untrained providers. The resulting morbidity and mortality places a heavy burden on women, their families, communities, and the national health system.

The study was funded by the Research and Advocacy Fund, the UK Department for International Development, and the Australian Agency for International Development and was conducted by the Population Council in collaboration with the Guttmacher Institute and the National Committee for Maternal & Neonatal Health. The Population Council and the Guttmacher Institute collected data through two quantitative surveys and several qualitative methods, including surveys of 266 health facilities and 102 healthcare professionals; in-depth interviews of 44 women who had an induced abortion in the past six months; and ten focus groups involving women with at least three children to gain an understanding of community norms regarding abortion and postabortion care.

The report authors unanimously reached a consensus on five key recommendations:

1. Improve the quality of postabortion care and expand the use of safer, World Health Organization–recommended treatment methods, such as manual vacuum aspiration (MVA) and medication abortion.
2. Ensure that health facilities in the public and private sectors are equipped with the technologies they need to provide the full range of postabortion care.
3. Establish a national consensus on provider training and capacity building and promote continued advocacy.
4. Ensure facilities that provide postabortion care are prepared to offer a full range of contraceptive services onsite, or in their immediate vicinity, 24 hours a day, seven days a week.
5. Develop postabortion care protocols that are in accordance with the latest scientific developments and are distributed widely to service providers.
   
   

For more information:

Guttmacher Institute. 2013. "Postabortion care in Pakistan," In Brief, 2013 series, no. 4. New York: Guttmacher Institute.

Zathar, Z.A., S. Singh, Z.H. Shah et al. 2013. "Post-abortion care in Pakistan: A national study." Islamabad: Population Council.

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About the Population Council
The Population Council confronts critical health and development issues—from stopping the spread of HIV to improving reproductive health and ensuring that young people lead full and productive lives. Through biomedical, social science, and public health research in 50 countries, we work with our partners to deliver solutions that lead to more effective policies, programs, and technologies that improve lives around the world. Established in 1952 and headquartered in New York, the Council is a nongovernmental, nonprofit organization governed by an international board of trustees.

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Media contact
Sasha Gruber: sgruber@popcouncil.org; +1 212 339 0668