Family planning: ‘Women forced to seek abortions from amateur doctors’

Report on post-abortion care in Pakistan reveals dismal situation.

ISLAMABAD:

Lack of post-abortion care facilities, untrained medical staff, stigma of contraceptives and financial constraints pose inherent barriers for efficient service delivery which ultimately put women’s lives at stake.

This was the crux of a report on  ‘Post-Abortion Care in Pakistan’ launched by the Population Council in collaboration with the Guttmacher Institute and the National Committee for Maternal and Neonatal Health on Friday at a local hotel. The report reveals startling facts about post-abortion complications faced by women due to Pakistan’s poor health-delivery system.

The report, an updated version of another study completed in 2002, provides recommendations for promoting safer post-abortion care, expanding access to high-quality and affordable family planning services and contraception, and building capacity of healthcare providers to help achieve these goals.

According to the Pakistan Demographic and Health Survey 2006-07, which is quoted in the report, the country’s maternal mortality rate was 276 per 100,000 live births and 6 per cent of all maternal deaths result from complications in unsafe abortions.

“The current law in Pakistan only permits abortions to save a woman’s life…Due to these restrictions and the lack of clarity in interpreting the law among women and healthcare providers, women may be forced to seek abortion by untrained providers,” the report states.

The study found that 25 per cent of Pakistani women want to avoid or delay pregnancy, but are not using contraception, and are therefore at risk of unintended pregnancy. The approximate level of contraceptive use among married women aged 15-49 is as low as 30 per cent and the unmet need for contraception is as high as 25 per cent.

An estimated 15 per 1,000 women of reproductive age are treated for complications in induced or spontaneous abortions every year, according to the report.

In 2012, nearly 700,000 women in Pakistan went to health facilities for treatment of complications resulting from spontaneous or induced abortions using unsafe methods or with the assistance of an unskilled provider. From that total, 62 per cent received post-abortion care in the private sector, while 38 per cent went to public-sector facilities for treatment.

According to the report, 75 per cent of the country’s health facilities do not have access to Manual Vacuum Aspiration (MVA) kits, recommended by the World Health Organisation (WHO) for treatment of post-abortion complications, or are not equipped to provide around-the-clock services. It was also revealed that health facilities still rely on unnecessarily invasive procedures such as dilation and curettage (D & C).

“An estimated 41-49 per cent of abortions performed by the Lady Health Workers, nurses and midwives result in complications, compared with just one in 10 abortions performed by a professional gynaecologist,” the report states.

Recommendations

The report calls for the immediate use of WHO-recommended methods for post-abortion care, improving the provision of family planning services, developing protocols for provision of post-abortion care and proficient training health workers and medical staff.

Speaking at the launch, Minister of State for National Health Services, Regulations and Coordination Saira Afzal Tarar said that safer methods for treating post-abortion complications, which have already been approved, should be made available at all health facilities in the country.

Published in The Express Tribune, August 24^th, 2013.