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PAKISTAN: Clandestine abortions threaten the health of millions

LAHORE, 12 November 2009 (IRIN) - People living along the busy Temple Road in Lahore, the capital of the eastern Punjab Province, are accustomed to some unusual sights.

“Every now and then we see blood or parts of an aborted foetus floating in the drain that runs past the houses and shops,” said Rubina Bibi, a housewife.

The street in Lahore is home to a dozen or more illegal “abortion clinics”, known as ‘Safia clinics’. Run in most cases by midwives, the clinics are visited by a large number of women seeking an abortion but having difficulty getting one in a society where the practice is highly stigmatized - and legal only under extremely limited circumstances.

“The [abortion] rate is rising because in these times of high inflation fewer families can afford many children,” Uzma Parveen (not her real name), who runs one of the clinics, told IRIN. She said that until two or three years ago around 10 women visited her clinic each month seeking an abortion, whereas “there are now 15 or 20.”

According to a May 2009 report by the government’s National Committee for Maternal and Neonatal Health (NCMNH) and the New York-based Guttmacher Institute, which works worldwide to advance sexual and reproductive health, “a nationwide study estimated that 890,000 abortions took place in 2002. This amounts to 29 abortions per 1,000 women.”

''Every now and then we see blood or parts of an aborted foetus floating in the drain that runs past the houses and shops''
About 30 percent of married women use contraception, although a quarter of them, an estimated 6.6 million women in 2007, have an unmet need for contraception, the NCMNH-Guttmacher study found. Opposition from husbands, a belief that God alone should decide if a child is to be conceived or not, and a lack of awareness are all factors in the low levels of contraception use.

The report noted that abortion rates were substantially higher in the North West Frontier Province (NWFP) and Balochistan, the most rural of Pakistan’s four provinces. In NWFP an estimated 37 abortions take place per 1,000 women aged 15-49 and in Balochistan the rate was 38 per 1,000. The lower rates of 25 per 1,000 women in the Punjab and 31 in Sindh were linked to higher contraception use in urban areas.

Research by the US-based Population Council in rural Punjab found women resorted to abortion when contraception was unavailable. It stated: “Women attempt to abort pregnancies that are unwanted by all means even if their husbands are not supportive.”

Most women seek abortions to avoid surpassing a desired family size, on average around three children: poverty is another factor.

Poverty link

“I am coming here for the second time, to have an abortion. I know it’s a bad thing, but what can I do? I already have four children and we simply cannot manage to care for more,” said Amna Bibi (not her real name), outside a clandestine abortion clinic. The clinic is based in a dingy room; the equipment used by the `dai’ (traditional midwife) looks primitive; there are no facilities for sterilization and the sheet on the bed is badly stained.


Photo: Kamila Hyat/IRIN
Feeding children is not easy for impoverished families
“What choice do I have but to come here? No one else will help me though I am terrified about going through this, and all the pain it will cause,” said Amna, who estimated that she was about three months pregnant. She said she expected to pay around Rs 2,500 (about US$30) for the abortion. Prices for abortions run from around Rs 1,700 (US$21) to Rs 4,150 (US$50)

Amna’s sister Naseem Bibi (not her real name), who accompanied her, said: “I use birth control pills given to me by a nurse secretly, because my husband would be angry if he knew. Men think pills could encourage us to have intercourse with other men, as there would be no fear of pregnancy.” Naseem has two young sons, and does not want more children for now.

“Many practitioners know abortions are illegal, and refuse to perform them. Therefore women turn to quacks who perform abortions in unsafe conditions. This can lead to complications and many women end up in hospitals. Some of them even die due to these complications,” Marium Waqas of NCMNH told IRIN. “Abortions in unsafe circumstances do affect the health of women.”

Post-abortion care

According to the NCMNH-Guttmacher report, the 2002 national study estimated that 197,000 Pakistani women were hospitalized for complications after unsafe abortions. Only about 50 percent of poor women who need treatment for severe abortion complications receive hospital-based care. A study in a large Karachi hospital over a 21-month period reported that 10 percent of women admitted for post-abortion care died of serious complications.

“We see women regularly who have suffered acute post-abortion complications. Many are brought in very late because their families are scared. Few admit they have had an abortion. Infection and heavy bleeding are the most common problems,” Rubina Ahmed, a gynaecologist at a community clinic, told IRIN.

kh/ed/cb/oa

Theme (s): Gender Issues, Health & Nutrition,

[This report does not necessarily reflect the views of the United Nations]

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