Islamabad - An estimated 2.25 million induced abortions occurred in Pakistan in 2012 and almost all of these abortions were clandestine and placed women’s health and lives at risk. There were an estimated 622,600 women treated for complications resulting from induced abortion in Pakistan in 2012, in both public and private sector facilities. Most of these complications were treated in Punjab, with fewer cases in Sindh, Khyber Pakhtunkhawa and Balochistan. In Punjab alone 1.29 million induced abortions were estimated, while in Baluchistan they were about 136,000.

The national study on post-abortion care and abortion incidence “Induced Abortions and Unintended Pregnancies in Pakistan”, carried out by the Population Council in collaboration with the Guttmacher Institute, USA, launched Wednesday.

The research estimated the national abortion rate 50 per 1,000 women aged 15–49. But there is substantial variation among the provinces, with the highest induced abortion rates in Baluchistan (60) and Sindh (57), followed by Punjab (51), and the lowest rate in KP province (35).

This rate is much higher than the rate estimated for 2002, 26.5 per 1,000. Even acknowledging an underestimation of the 2002 rate, which did not count private-sector procedures, the study found that a significant increase occurred over the 10-year period.  In Pakistan, abortion is legally allowed only to save the life of a woman or to provide “necessary treatment” early in pregnancy, said Dr Zakir Hussain Shah, a public health consultant and one of the authors of the study. “So given a lack of clarity in interpreting the law, and social stigma attached to it, legal abortion services are difficult to obtain, and most women who have an abortion resort to clandestine and unsafe procedures.”

The study reveals that about 62 percent of all women treated for any abortion complications in 2012 obtained care in private facilities, evincing the large role the private sector plays in post-abortion care (PAC) provision. The proportion of women treated in private facilities is highest in Punjab (about 70%), Sindh (58%) and KP (57%), while much lower in Balochistan (39%), says the research.

It reports that the unintended pregnancy rate increased between 2002 and 2012, rising from 71 to 93 per 1,000 women aged 15–49. In 2012, there were approximately nine million pregnancies in Pakistan, of which 4.2 million were unintended. Of these unintended pregnancies, 54 percent resulted in induced abortions and 34 percent in unplanned births.

As the consequences of unintended pregnancy and induced abortion result in substantial costs to the country’s health care system as well as to women and their families, policymakers and service providers must make improved access to quality contraceptive services an urgent priority, especially in rural areas, so that Pakistani women are better able to time and space their pregnancies and have the number of children they desire, suggest the study.

The provision of family planning counselling and methods should be made a routine part of post-abortion care in both public and private sector facilities. Essential supplies, such as manual vacuum aspiration kits and disinfectant equipment, must be made consistently available.

The study concludes that the need to accelerate and strengthen the family planning programme is greater than ever, as is the need to implement strategies to improve the quality and coverage of post-abortion services.