Illegal back-alley abortions and reproductive rights in Pakistan

At a rate of 50 abortions for every 1,000 pregnancies, Pakistan has one of the highest abortion rates in the world. The number comes from a survey done in 2012 and is a steep increase from a previous study done in 2002 which estimated 27 abortions for every 1,000 pregnancies.

The growth in this rate, despite abortion being perhaps one of the most taboo topics in Pakistani society – is proof that the standard Pakistani ideal of keeping things under the rug to prevent them is false. Of course, that comes as no surprise.

What this glaring lack of awareness and proper healthcare resources has done instead is create a system that forces women into back-alley abortions which researchers say cause almost a third of them to suffer from severe complications.

"According to Pakistan's revised 1990 law on abortion, prior to the formation of foetus organs, abortions are permitted to save the woman’s life or in order to provide 'necessary treatment'

While a renewed conversation on abortion in Pakistan began on social media following recent abortion bans in the US, what’s interesting to note is just how different the situation is here, despite US aid funding much of abortion and reproductive care in Pakistan.

Many of the abortions that occur in Pakistan have to happen under wraps, and while many people continue to believe that abortions are a way for unmarried women to abort pregnancies out of wedlock – a fact severely frowned upon in the country – the reality is very different.

“The majority of abortion-seeking women are married women above the age of 25. In fact, it is used as a family planning method,” says Kulsoom Masood, who worked in the Public Health sector in Pakistan and trained over 50 Community health Workers on Gender Transformative Approach in Family Planning in Punjab and Sindh and is now pursuing a postgraduate degree in Public Health.

Despite the complications and health risks that come with undergoing multiple – often self-triggered abortions – many women turn to abortion as a solution due to the lack of any other alternative.

Contraception drives are rare, and oftentimes healthcare workers are uneducated regarding reproductive health themselves due to cultural taboos colouring their own understanding. When they do happen, women are either given expired contraceptives or little follow-up on how to use them.

Much of this lack of growth within reproductive health comes from the fact that local and national authorities all but ignore that this issue even exists. Even though Pakistan is a very conservative Islamic nation, many place Pakistani laws around the issue to be far more progressive than its similar counterparts.

Instead, the situation around women’s reproductive healthcare has been made so dire due to many other contributing factors. In fact, Masood points out, “according to Pakistan's revised 1990 law on abortion, prior to the formation of foetus organs, abortions are permitted to save the woman’s life or in order to provide 'necessary treatment'. After organs are formed, abortions are permitted only to save the woman’s life. The law itself uses the word “goodwill” of pregnant women.” 

Dr Rabia Nisa, an expert in family planning and reproductive health points out that while a few decades ago family planning adverts encouraging the use of contraception were more common, they’ve all but disappeared.

The lack of conversation around this altogether means that very few people even understand the extent to which the law legally allows abortions. “Pakistan’s abortion laws were shaped up 20-22 years ago to add that abortion is legal to save the mother’s life and for any ‘necessary’ treatment but nothing has changed after that,” Dr Nisa says while adding “No one really explains what necessary treatment is.”

When Fatima* who works as a domestic cleaner in Karachi came to her employer last year with news of her sixth pregnancy she was less than happy. In fact, she’d already tried home remedies and over-the-counter pills to abort the pregnancy but they’d only made her sick.

She considered herself lucky that her employer helped her get access to a safe clinic and took care of the procedure, but most women aren’t as lucky as Fatima, and even for the ones who have physical and financial access, finding safe reproductive healthcare, both for the procedure and the aftercare isn’t always easy.

Fatima had been using family planning methods for almost eight years now and told her employer that with four surgeries and a big family, she couldn’t afford to keep this baby both because of financial and health reasons. “Things have become expensive enough as they are. And if I die, who will take care of the rest of my family,” she had told her employer at the time. 

But while Fatima managed to find solace in an understanding employer, most women in Pakistan find themselves trapped in a patriarchal system where their husbands, mothers in-laws and family members often dictate the decisions they make about their bodies.

Stories of women unable to get their tubes tied or take contraception because their husbands don’t allow it are far too common and the refusal of doctors to carry out safe abortions makes it worse.

“I think it is not just the doctors, a pregnant woman’s mother, mother-in-law, especially the husband and their personal beliefs have a lot to do with making this access difficult to women.

"Many cross-sectional studies have explored the impact of a husband’s attitude toward antenatal or post-abortion care on a woman’s access to the sexual and reproductive health facilities. Of course, women whose husbands had positive attitudes were more likely to access such facilities,” Masood shares.

Talking about the impact of doctors allowing their personal views to come forward, Dr Nisa says, “If I get a patient who wants an abortion I should try and understand her.  We have this horrible concept that if a woman is getting an abortion she’s a ‘bad woman’, and even our doctors perpetuate these beliefs but slowly things are getting better,” she says.

Advocates of abortion rights are firm supporters of a shifting mindset that allows women more autonomy over their own bodies, whether that be in the form of family planning, childbearing or abortion.

Speaking about how to eliminate the dangers of back-alley abortions Masood says, “We can take on-board these secret clinics, locate them, provide them with appropriate materials and training in carrying out safe abortion practices,” while adding that “recruitment of trained female public health officials with a comprehensive understanding of the abortion laws can make a huge difference.” 

Anmol Irfan is a freelance journalist with bylines in VICE, HUCK, and The Guardian among others. She has experience writing on minority politics, activism, and gender issues. She is also the founder of the Pakistani community platform, Perspectives Magazine.

Follow her on Twitter @anmolirfan22