Nida Fatima Daterdiwala ( Fourth Year MBBS Student, Ziauddin University, Karachi, Pakistan. )
Shama Akberally ( Fourth Year MBBS Student, Ziauddin University, Karachi,Pakistan. )
Dear Madam, Pakistan's law permits abortion only to save the woman’s life or, early in pregnancy. A large fraction of women who require the procedure are forced to subject themselves to unsafe methods and/or untrained practitioners and almost all of these are done illegally and confidentially.1 This communication discourses on the causes of induced abortions, their complications and some recommendations to alleviate the matter.
A countrywide study in 2002 revealed that a total of 890,000 induced abortions took place in Pakistan. The rates were significantly higher in two rural provinces, KPK and Balochistan, mainly due to decreased use of contraceptives in these regions. Despite the illegality and huge stigma attached to it, women in Pakistan choose to have abortions1 primarily because of unwanted pregnancies and poverty. Furthermore, some of the main reasons are little knowledge about the use of contraceptives, fear of its side effects andor husband's refusal.2 Other causes include maternal comorbidities, and foetal malformations.3 Many doctors refuse to execute abortive procedures either due to religious beliefs or the danger of being called an abortionist. These patients are maltreated by Health care professionals.4 Women are at a higher risk of suffering from complications as safe abortion services are usually unavailable. Some of these include excessive bleeding, and trauma to the reproductive tract or adjacent anatomical areas, which may require further surgeries. Sepsis can also occur which can ultimately cause peritonitis or septic shock, leading to death. According to studies, septicaemia was the most frequent cause of death in women admitted to the hospital for post abortion care between 1997–1998.1
In light of the current worrisome state of health care workers’ attitudes towards induced abortions and patients’ lack of awareness on it, it is essential to make some changes. Health care workers should be sensitized about needs of abortions, emphasizing on not withholding safe abortion procedures from patients. Female-centric awareness campaigns should be held for the local population, about contraception and the importance of routine pregnancy check-ups to minimize chances of foetal abnormalities and complications. Couples must attend these campaigns before marriage. Contraceptive and emergency pills should be made available at subsidized costs, if not free, at female-owned-and-run, secured pharmacies so that any repudiation from husbands is bypassed.
Conflict of Interest: None.
Funding Disclosure: None.
Submission completion date: 10-04-2022 Acceptance date: 25-05-2022
1. Vlassoff M, Singh S, Suarez G, Jafarey SN. Abortion in Pakistan. Issues Brief (Alan Guttmacher Inst) 2009;2:1-6.
2. Naveed Z, Shaikh BT, Nawaz MA. Induced abortions in pakistan: expositions, destinations and repercussions. A qualitative descriptive study in rawalpindi district. J Biosoc Sci 2016;48:631-46. doi: 10.1017/S0021932015000255.
3. Amjad MA, Zia Z, Manzoor I, Javed A, Anjum A, Khawaja A, et al. Pattern And Determinants For Termination Of Pregnancy In Lahore, Pakistan. Biomedica 2016;32:177-82.
4. Rehan N. Attitudes of health care providers to induced abortion in Pakistan. J Pak Med Assoc 2003;53:293-6