Population Briefs | May 2005, Vol. 11, No. 2 | Reproductive Health: Postabortion Complications Prevalent in Pakistan

May 2005, Vol. 11, No. 2

Reproductive Health
Postabortion Complications Prevalent in Pakistan

Determining the levels of induced abortion and postabortion complications in various regions is essential because of the consequences these experiences have for women’s health. The Population Council has studied abortion and postabortion complications around the world, most recently in Pakistan. This comprehensive research has revealed a high level of unwanted pregnancy, induced abortion, and postabortion complications in that country. Abortion is legal in Pakistan to provide “necessary treatment.” This term is vague, however, and safe abortion services are not easily accessible.

Recent national demographic surveys indicate a high level of unmet need for family planning in Pakistan. This situation arises when women wish to avoid pregnancy but do not use a contraceptive method. Unmet need for family planning results in unwanted pregnancy. To investigate further, Population Council researchers conducted four studies in 2002 and 2003: a survey of health professionals, a survey of health facilities, a survey of women who suffered postabortion complications, and in-depth interviews with women (and their husbands) who had experienced an induced abortion. Data were collected in urban and rural communities in four provinces.

Incidence of induced abortion
Although the total fertility rate in Pakistan is 4.8, the wanted total fertility rate is 3.9, according to the 2000–2001 Pakistan Reproductive Health and Family Planning Survey. Hence, women in Pakistan average one unwanted birth in their lifetimes. The Council’s research suggests that 890,000 induced abortions were performed during 2002 and that the annual abortion rate is about 29 per 1,000 women aged 15–49. These figures indicate that the average Pakistani woman would experience one abortion in her lifetime. Nationally, about one in seven pregnancies is terminated by abortion. “What is strikingly clear from these estimates is that induced abortion is a widely used method of preventing unwanted births in Pakistan,” says Zeba Sathar, Population Council country director in Pakistan. Moreover, based on interviews with knowledgeable health professionals, the Council study estimates that 23 percent of all Pakistani women who obtain an abortion are hospitalized for treatment of complications they experience.

Council research reveals that abortions are performed by doctors, nurses, midwives, dai (traditional health practitioners), and others. The five abortion procedures most often named, though not necessarily performed, by health care professionals were dilation and curettage (D&C), intrauterine sticks (knitting needles, bamboo sticks), insertion of an intrauterine device (IUD), oral hormonal pills, and vaginal drugs. Women also sometimes attempt to produce their own abortions using a variety of techniques including drugs, herbs (taken orally or vaginally), insertion of objects, strenuous exercise, or vigorous abdominal massage.

Postabortion complications
The fraction of induced abortions leading to serious complications, according to the perceptions of Pakistani health professionals and women who had undergone an abortion, ranges from about 10 percent of abortions performed by obstetrician/gynecologists to 66 percent of those performed by dai or traditional birth attendants. The health facilities survey reveals that each year roughly 250,000 women are treated for postabortion complications—which can stem from either induced or spontaneous abortions, also known as miscarriages—in mid-size and large public-sector facilities and in private teaching hospitals alone.

The Council survey of health professionals reveals that most women in Pakistan who have induced abortions are nearing the end of their childbearing years. The women are aged 30 or older and have typically had three or more children. A majority of them know about contraception and have used a method in the past. The most common reasons women give for not wanting another pregnancy are that they have already achieved their desired family size, they cannot afford more children, they currently have very young children, and their health is poor. The Council’s research revealed that a variety of constraints, from financial costs to a fear of health side effects, prevent Pakistani couples from practicing effective contraception.

Policy suggestions
Council researchers met with Pakistani government officials, physicians, and professionals at nongovernmental organizations to share their findings and propose policy changes. Among their suggestions, family planning services need to tackle the various obstacles that prevent Pakistani couples from practicing effective contraception. Services need to be more accessible and less costly. Women’s and men’s fears about health side effects of contraception need to be squarely confronted. Medical care for postabortion complications should be more widely available and of higher quality. Men should be more effectively involved in resolving the various problems surrounding unwanted pregnancy—ineffective contraception, induced abortion, and its repercussions.

“No other piece of research that I have been involved with has had such a strong positive response, from government, civil society organizations, and the medical community,” says Sathar. “Policymakers and program managers seem ready to take action to avoid the morbidities and possible death associated with the large number of unwanted pregnancies and abortions.”

Source
Population Council, Islamabad. 2004. Unwanted Pregnancy and Post-Abortion Complications in Pakistan: Findings from a National Study. Islamabad: Population Council.

Outside funding
David and Lucile Packard Foundation, United Kingdom Department for International Development (DFID), United Nations Population Fund (UNFPA

Technical support
Alan Guttmacher Institute and World Health Organization

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