Academic journal article International Perspectives on Sexual and Reproductive Health

Pakistani Study Finds High Abortion Rate and Low Level of Contraceptive Use

Academic journal article International Perspectives on Sexual and Reproductive Health

Pakistani Study Finds High Abortion Rate and Low Level of Contraceptive Use

Article excerpt

Despite legal restrictions that limit women's access to abortion, the incidence of the procedure in Pakistan is high, and the abortion rate has increased during the past decade. (1) According to a recent national study, women in Pakistan had an estimated 2.25 million abortions in 2012, equivalent to an abortion rate of 50 abortions per 1,000 women of reproductive age--nearly double the rate estimated for 2002 (27 per 1,000). Low levels of contraceptive use have resulted in high levels of unintended pregnancy, and more than half of the estimated 4.2 million unintended pregnancies in 2012 ended in abortion.

The data come from two nationally representative surveys fielded in 2012 as part of the study--the Health Facilities Survey and the Health Professionals Survey--and from existing national data sets, including the 2012-2013 Pakistan Demographic and Health Survey. The Health Facilities Survey assessed Pakistan's capacity to provide quality postabortion care and ascertained the number of women treated for postabortion complications. It included 266 facilities: all large public and private teaching hospitals and a sampling of smaller facilities. Researchers used a questionnaire adapted from a previous national abortion study, conducted in 2002, to maintain comparability between the studies; it was administered in face-to-face interviews with senior medical officials and providers working in obstetrics and gynecology departments. The Health Professionals Study focused on providers', researchers' and administrators' perceptions of abortion provision (e.g., the types of providers women use and the likelihood of complications). Researchers interviewed 102 respondents, who were chosen on the basis of their knowledge of and experience with abortion. Both surveys were conducted in the country's four major provinces (Baluchistan, Khyber Pakhtunkhwa, Punjab and Sindh), where more than 90% of the population of Pakistan resides.

The researchers applied the data to an established method for indirectly estimating abortion incidence in settings where the procedure is not reliably tracked and where induced abortions may be passed off as or mistaken for miscarriages. They first used weighted data from the Health Facilities Survey to estimate the number of women treated in a facility for complications of either miscarriage or induced abortion; in 2012, these women totaled 712,000. Reducing this number by the estimated number of women treated for miscarriage (calculated from data on the biological likelihood of miscarriage and the province-specific likelihood that women who have a miscarriage will obtain care in a facility), the researchers estimated that 623,000 women were treated in facilities for complications from induced abortion alone

This number, however, excludes women who did not obtain facility-based treatment for abortion complications (e.g., because they feared legal ramifications and social stigma) or who did not have complications at all. …

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