Post-Abortion Care in Pakistan: A National Study

Abstract

The most recent study on unwanted pregnancy and post-abortion complications was carried out by the Population Council in 2002, and provided national-level estimates of the prevalence of induced abortion, as well as information on abortion providers, abortion methods and the conditions under which induced abortions were being performed. The present study was conducted to assess whether and how these conditions have changed over the past 10 years, including changes in abortion practices, abortion-related complications and the provision of post-abortion care (PAC), or any changes in regional patterns. In addition, the study aimed to provide a more in-depth understanding of gaps and needs in PAC services. Chapter 1 provides the global and local context for the present study and highlights the need for data to identify priority actions to be taken at the national level to reduce the incidence of unsafe abortion. It gives an overview of the issue of abortion in Pakistan, and compares it with the situation in developing countries and the developed world. Chapter 2 describes the study design and overall methodology. It describes the sampling procedures used in the surveys of health facilities and of health professionals, and the data collection tools and methodology. The training of medical researchers prior to the start of field work, some major issues faced during data collection, and procedures for data management and analysis are also discussed. Chapter 3 describes, as reported by health professionals, the various methods used by women themselves to induce their own abortions and the pregnancy termination services used by providers. It also discusses the typical profile of clients seeking pregnancy termination and describes typical abortion providers among urban and rural, poor and non-poor women, comparing these findings with those of the earlier 2002 study. Chapter 4 discusses health professionals' reports about the characteristics of women experiencing post-abortion complications, the proportion of abortions likely to result in complications and the type and level of health facilities that women needing treatment go to. This chapter also describes the preparedness of services to provide post-abortion care, the type of staff available and the various medical procedures used to treat women suffering the health complications of unsafe abortions. Chapter 4 also examines the status of staff trained in procedures to manage abortion-related complications. Chapter 5 analyses the burden on the health delivery system, both public and private, from treating patients with post-abortion complications. It presents the average annual number of cases treated as out-patients and as inpatients, by province and type and level of facility. The findings are compared with those of the 2002 study to show changes in caseloads across the four major provinces of Pakistan. Chapter 6 analyses the proportion of facilities providing various types of family planning methods and describes the attitudes of health professionals and service providers toward the role of contraception and post-abortion family planning counselling services. Chapter 7 explores the demand side of the issue of post-abortion care by assessing barriers and challenges women face in seeking care in a variety of settings mainly in rural Pakistan where there is a greater lack of services. Chapter 8 concludes the report by discussing the overall lessons learnt from the study and makes recommendations for future actions at the program and policy level