Poor Women Most Affected by Unsafe Procedures


Induced abortion is legal under very limited circumstances in Pakistan, yet it is commonly performed, according to a new literature review, Abortion in Pakistan, released today in Karachi by the National Committee for Maternal and Neonatal Health (NCMNH) and the Guttmacher Institute. Researchers estimate that 890,000 abortions were performed in Pakistan in 2002, a rate of 29 abortions per 1,000 women of reproductive age (15–49) annually. Because access to abortion is highly restricted, the majority of these procedures take place under clandestine—and often unsafe—conditions. As a result, many Pakistani women suffer from serious health complications that sometimes result in long-term disabilities and death.

A major factor contributing to Pakistan's level of unsafe abortion is the country's low level of contraceptive use, which results in high levels of unintended pregnancy. Only 30% of married women of reproductive age use any contraceptive method and more than a quarter of these women use traditional methods, which are less effective than modern contraceptives.

Despite limited contraceptive use, the country's fertility rate is declining, and, on average, Pakistani women have four children. This disconnect between low contraceptive use and a relatively small average family size suggests that women are relying on abortion as a method of controlling their fertility. Patterns of contraceptive use and abortion in Pakistan support this conclusion: Contraceptive prevalence is lowest in Balochistan and North West Frontier Province, the provinces with the highest abortion rates.

Most women who have induced abortions in Pakistan are married, have four children and are about 30 years old. These characteristics echo patterns found in many other Asian countries and contrast with patterns found in other regions of the world (such as Sub-Saharan Africa), where young, unmarried women constitute the majority of those having abortions. Researchers also found that education is not a factor in determining who seeks induced abortion—the educational profile of women having abortions is similar to that of Pakistani women as a whole.

When asked what motivated them to seek an abortion, women most often cite having had all the children they want and being unable to afford another child as their main reasons. Poor women seeking abortions are at particular risk, as they are more likely than better-off women to resort to untrained providers, and are thus more likely to experience complications.

"As is so often the case, poor women are forced to rely on the least trained providers, who charge less for an abortion and offer less safe procedures," said Susheela Singh, vice president for research at the Guttmacher Institute and one of the review's authors. "Access to safe procedures offered by trained personnel in hygienic settings is limited to better-off women who can afford them."

"Many Pakistani women are paying with their health—and even their lives—to avoid births they cannot afford or do not want," said Sadiqua N. Jafarey, president of NCMNH. "Helping women avoid unintended pregnancy and supporting them in achieving their fertility goals would significantly reduce maternal morbidity and mortality in Pakistan and the associated costs to families, communities and the health system."

A fact sheet, Facts on Induced Abortion in Pakistan, summarizing the findings of the Abortion in Pakistan literature review and an Urdu version of this review are also available.