A friend of mine was asking me what the situation regarding abortions was in the subcontinent. There was a post a little while back on how pre-marital sex was rampant in cities in the subcontinent. It would be natural to assume that many girls do get pregnant in their teens. Are proper abortions available? or is it the coathanger method? or as in hindi movies, do the girls get married off in a hurry?
In India women in villages have very little choice
they know very little bout contraceptives
and end up having too many children which they cant afford to feed
There is this program thingie happening where they set up this clinic kinda thing in these villages with a little bassinet outside the clinic and women who gave birth to unwanted children are encouraged to leave the babies in the bassinett rather then leaving them in temples or killing and burying them
Yes they do kill babies in india too esp if they are girls
because they fear the future and the fact that girls come with dowry problems
These clinics in cities offer ultrasounds for at cheap rates where they can determine very early if its a boy or a girl
If girl is revealed in the ultrasound the same clinic then offers abortion for a very cheap rate
Still some women, mostly girls will feel awkward going to these clinics and touched and seen by male doctors
so they opt for dais, Midwives if you prefer
they have various ways of doing abortions
one is the coathanger method
there is another one where they make the woman lie down and place a bowl of burning coals on her belly and cover it with something
Its supposed to cause the body to abort the fetus
alrite have i rambled enough or is this all making any sense?
I think extra-marital sex is not unknown either in India or in Pakistan (nor anywhere in the world!) and illegal abortions are also common. Certainly, a good number of children are put up for adoption, and this is usually a small proportion of the total number of unwanted pregnancies.
I am sure that in a certain proportion of cases hasty marriages are performed, but equally thre must be cases where it isn't possible. Where there is sufficient money it may be possible to employ the services of a qualified doctor and use a hospital. As usual it's the poor women who are at risk because they are forced to go to dais who may not be able to ensure hygiene or proper care or methods.
As surprising as it may sound, abortions are fairly routine in Pakistan. At one time, I met a gynaecologist in one of the more famous hospitals in Lahore who very comfortably told us that she routinely 'cleans the uterus' of women whose pregnancy is less than 10 weeks old. She even gave us a fancy medical name for the process. Turns out she had a very high success rate as well and it was not too expensive either. But that is an elite hospital.
A few days later, our jamadaarni (sweepress) in Lahore was absent for 2 days. We got a bit worried so sent someone to her home and she sent back the message that she will be back the next day. Next day she came and told us that the reason she was absent was because she had gotten pregnant, but because her last baby is only 7 months old, therefore she decided not to have another baby. So she went to the general hospital (a govt hospital) and "hamal girra diya".
It seems this procedure is fairly common, because she told us that this is not the first time she has done it. She had probably done it a few times and only had a small infection at one time. The total cost of the procedure was Rs 3, which you need to make a parchi (slip) for admittance into the hospital. Being a govt hospital, all the costs are picked up by the govt. Though whether the govt is aware of what is happening there (vis a vis abortions) is anybody's guess.
When I got to know about these things on such massive scale, I can infer that abortions are no big deal in Pakistan. Probably our religious clergy is not aware of it or else they ignore it, otherwise I am quite sure they would raise a lot of hue and cry on this issue.
To sum it up ... just like pre-marital sex, facility of abortion is quite easily available in Pakistan (atleast in big cities). For those of you who are shocked on reading this, trust me, I felt the same feeling of increduilty when I first learnt about it. :)
What in the world is the
"coathanger method"?
Without causing grimmacing & upset at gour & ghoulish description of sort of a murder of foetus,Sajal ,just think they use the wire of coat hanger ,to cause death of foetus by poking inside the womb ******lly !!
Many unlucky pregnant women,bleed to death ,some die of infection,& its all because of crudeness is sometime painful,dangerous &traumatic.
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I really wish you didnt ask this question ,being in the state of your own Pregnancy,its the last thaught you would want to disturb you ,Rather think of
http://www3.pak.org/gupshup/smilies/smile.gif
http://www3.pak.org/gupshup/smilies/smile.gif
http://www3.pak.org/gupshup/smilies/hehe.gif
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barque(bijli) yoon akadti hai apne karname pe ke
jaise phir naya hum aashiyaan bana nahi sakte
Oh my lord.
I am speechless.
ouch.
you have got to be kidding me right
As surprising as it may sound, abortions are fairly routine in Pakistan. At one time, I met a gynaecologist in one of the more famous hospitals in Lahore who very comfortably told us that she routinely ‘cleans the uterus’ of women whose pregnancy is less than 10 weeks old. She even gave us a fancy medical name for the process. Turns out she had a very high success rate as well and it was not too expensive either. But that is an elite hospital.<<<<
facts:
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abortions in Pak are illegal. punishable by law.
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abortion can be performed, only if mothers life is at risk.
my 0.02:
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getting an abortion in Pak is not a park in the walk like u have made it. Not supposed to happen in Govt run facilities. If you have any idea about how govt hospitals in Pakistan work, u know why. they shy away from doing what they are supposed to do… let alone do something they are not.
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pre-marital sex is one big cause of abortions anywhere… for obvious reasons is NOT a problem in Pakistan. exclude the few spoiled elites in big cities. Majority of the middle and lower class Pakistani Muslims do NOT engage in pre-marital sex. Thanks to Quaid-e-Azam in Pakistan we have separate schools for boys and girls. Kidz esp girls are monitored by parents rigorously after school. I wish boyz were too who are sometimes left to wonder the streets and become wankers. Universities are a different story all together where girls are mature enuff and in most cases already married. I think pre-marital sex is boasted/exaggerated by Pakistani teenagers/men of Pakistan. There is little to no truth behind most.
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sweepers which are mainly christians do not represent mainflow Pakistani population. Pre-marital sex, abortions maybe a walk in the park for them but it is not to the mainstream middle/lower class Pakistani muslims.
Above observations are also supported by the research below. Unfortunately poverty leads to induced abortions and causes problems. The solution to that is to promote family planning among poor and NOT To make abortions a common practice. The former will take time but will be the right thing to do the later will cause a whole bunch of other problems and one of them would be an abundance of pre-marital sex etc.
http://www.jsi.com/intl/mothercare/RHF/pak_abortion.PDF
A Community and Hospital Based Study to
Examine the Magnitude of Induced Abortion and
Associated Gynecological Morbidity
in Karachi, Pakistan
Investigators: Sarah Saleem (Aga Khan University) and Fariyal Fikree (currently
with Population Council)
Funding Period: March 1996 September 1998
I. Background:
Abortions in Pakistan are illegal except to save the life of the mother. As a result, clandestine
abortions occur and add to the nation’s high maternal mortality and morbidity. Community-based
information on rates of induced abortion from Pakistan is limited though a few community and
facility-based studies are available, which report the contribution of induced abortion to maternal
mortality.
Pakistan reports an official estimated maternal mortality ratio of 340 per 100,000 live births.
Various studies from different areas of Pakistan report even higher figures. For example, a
national public and private facility-based study, from 1989-90, estimated a maternal mortality
ratio of 670 per 100,000 live births. Eleven percent of these deaths were due to abortions and
most of these deaths occurred in the age group 31-40 years. Data from a large public hospital in
Karachi, spanning a period of 10 years (1981-90), demonstrated that an estimated 10 percent of
maternal deaths were due to abortions when the maternal mortality ratio was estimated as 710 per
100,000 live births. Community-based data from squatter settlements of Karachi estimated the
maternal mortality ratio as 281 per 100,000 live births with 8.8% of all maternal deaths being
attributed to induced abortions. Another community-based study from squatter settlements of
Karachi reveals that out of a total of 282 pregnancies reported by 34 women, 11% ended in
induced abortion.
Aside from these few studies on the contribution of abortion to maternal mortality, very limited
information was available in 1996 on the type of abortion providers and methods used for
terminating pregnancy–both important determinants of morbidity and mortality related to unsafe
abortion.
II. Study Goal & Objectives:
MotherCare contracted with Aga Khan University in Pakistan to provide new data and
information on women’s health issues that had not been addressed adequately to date. This report
focuses on one study examining induced abortion in Karachi with both a community-based and a
hospital-based arm.
- 1 -
Specifically, the project aimed to assess
ß Perceptions and experiences of women regarding induced abortions;
ß Prevalence and reproductive morbidity consequences of induced abortion;
ß Type of abortion provider and methods used for induction of abortion;
ß Factors leading to a decision to terminate a pregnancy in Pakistan’s restrictive socio-cultural
context, in which abortions are illegal; and
ß The quality of care in tertiary hospitals and post-abortion family planning services.
II. Study Components:
A. Community Study in Three Squatter Settlements in Karachi
The qualitative component of this study consisted of 10 focus group discussions with ever-
married women of reproductive age and 15 in-depth interviews with those who had at least one
induced abortion. Women’s perspectives were obtained regarding abortion methods, providers,
reasons for abortion, and cost of abortion.
The focus group and interview responses helped create the cross-sectional questionnaire of the
quantitative component. This survey was carried out with 1,214 ever-married women with a
history of at least one pregnancy. They were randomly selected from three squatter settlements in
Karachi. Additional questions were asked of 100 women from the same sample who reported
having at least one induced abortion in their entire reproductive life. The study team aimed to
estimate the prevalence of induced abortion in three squatter settlements of Karachi, to identify
the type of abortion provider and methods used for induction of abortion, and to examine the
factors leading to a decision to terminate a pregnancy.
B. Facility Study in Four Tertiary Hospitals in Karachi
The questionnaire from the squatter settlement study was adapted for use with women who
received care at hospitals because of incomplete abortion. The four selected hospitals were a
mix of private, public and semi-private and catered to the poor and middle income population in
Karachi. The hospitals were also selected for their large number of in-patient cases in obstetrics
and gynecology. Two hundred eighteen women answered the questions implemented by trained
physicians over the course of eight weeks.
III. Study Results:
A. Community Study Results
Qualitative Study “I have no feelings of
ß Helplessness (majboori) was the most common reason guilt for terminating
mentioned for having an abortion. Factors contributing to my pregnancy. My
this feeling that there was no other option were poverty, children do not get
were too many children, increased cost of living with an enough food, clothing
additional child, and family and spousal conflicts. or schooling. Had this
child been born he
ß Most women mentioned that they experienced unplanned would have been in a
pregnancies because of a lack of cooperation from the
husband to use family planning methods (e.g. condoms), worse state.” Woman
in Karachi during an IDI
the non-use of family planning methods by women due to
side effects, as well as the women’s minimal decision-
- 2 -
making power in the realm of sexual relations with husbands.
ß It was found that most women consult their husband prior to terminating their pregnancies,
unless there is a conflict with the spouse or family. While friends and neighbors were also
sought for advice, in-laws were not frequently consulted.
ß Women were very aware of various household remedies to induce abortion as well as diverse
methods used by traditional birth attendants, nurses, and doctors.
ß While women were aware of excessive bleeding, septicemia, infertility, prolapse of the uterus
and weakness as harmful effects of induced abortions, few mentioned pain and death.
ß Women reported that post-abortion family planning advice was given only by doctors and not
by other providers.
Quantitative Study
The results from the quantitative study confirmed those of the qualitative efforts. The
quantitative results are presented for the overall population of 1,214 ever-married women and for
the subsample of 100 women who experienced an induced abortion when the information differs.
Overall, 43 percent of all respondents reported current use of family planning while only 30% of
those who had sought abortion were using it prior to pregnancy termination. The most frequently
reported methods were female sterilization (43%) followed by condom (26%), followed by IUD
and oral contraceptives.
I wanted to terminate The most important reason mentioned for conceiving an
this pregnancy due to unwanted pregnancy was couple or spousal unwillingness to use
poverty. I had not family planning methods (27.4% and 22.7% respectively).
“Unprotected sex” (16%) was also mentioned with frequency.
enough money to The most frequently mentioned reasons for termination of a
consult a Dai pregnancy were “too many children” (50.8%) and “poverty”
(traditional birth (49%). Interestingly, of those 100 women that did terminate
attendant or TBA). I their pregnancy, 45% cited “short spacing” and 15% said “too
had to do it on my many children”.
own. Woman in
Karachi during an IDI Of all the respondents, 90% said that spouses were likely to be
the first person to consult before terminating a pregnancy and
few women (1.7%) reported that they would make an independent decision to seek care.
However, of those who did have an induced abortion, a lower proportion, 76%, first contacted
their husband, and 16% made their own decision to terminate their pregnancy.
While many different methods were mentioned for terminating a pregnancy, dilatation and
curretage was most often reported (31.2%) and seen as the most successful (39%) by the group as
a whole. Women knew of several types of providers who performed illegal abortions but doctors
were seen as the most commonly sought and the most successful at terminating pregnancy. Of
the 100 women who sought to terminate a pregnancy, 33 did see a physician first, while 31 first
tried self-inducement (7 were successful), 10 went first to the TBA and 15 went first to a nurse,
midwife or LHV (lady health visitor). Those who preferred self-termination or a TBA to end an
unwanted pregnancy cited confidentiality and less cost as reasons. Those who selected a nurse,
midwife or LHV for care did so for reasons of lower cost and safety. Finally, women who went
to the doctor did so primarily for safety.
- 3 -
When the 1,214 women were asked about the perceived complications of induced abortion, they
mentioned heavy ******l bleeding (50.3%), generalized weakness (19%) and high grade fever
(20.2%) most often. Death was also reported by 34.7% of the respondents though, mortality was
not reported from the qualitative studies. Twelve percent of women did not perceive any
complications. Those that had an induced abortion cited ******l bleeding (55%) and high grade
fever (53%) most often.
Multivariate analysis found current maternal age, gravidity and maternal education were
predictors of induced abortion. Women aged 26-35, those that were literate, and women who
were multigravids (> 4 pregnancies) were more likely to terminate a pregnancy. Paternal age, use
of family planning prior to the abortion, paternal education, socio-economic status were not
significant factors.
B. Facility Study Results
The results from the tertiary facility survey often coincided with the community results, but the
results did reveal additional information on the quality of hospital services. Of the 218 women
who were interviewed after being admitted with an incomplete abortion to the tertiary hospitals,
17 were diagnosed as “induced” abortion. According to hospital admission records, only four
cases were diagnosed as induced abortion, but in-depth probing revealed additional 13 cases of
induced abortion. Induced abortion in this study was defined as when the woman, herself, reports
inducing the abortion or when there was evidence of trauma or of a foreign body in the genital
tract. The others were termed “spontaneous” abortions.
While the numbers of the sample were small, the women who were diagnosed as having induced
abortion had a mean age of 28.6 years, and 4.3 live births. More than half of the women who
had an induced abortion consulted their husbands before making an attempt to terminate the
pregnancy, and their reasons for the abortion included too many children, the women’s ill health,
unemployment of the husband and short spacing.
All 17 women with an induced abortion had made at least one attempt to terminate the pregnancy
prior to coming to the hospital. This prior attempt was done either by a traditional birth attendant,
nurse, homeopathic doctor and nine went to an allopathic doctor. The complications with which
they presented to the study hospital were ******l bleeding, pain in the abdomen and generalized
weakness. Most (94%) received a surgical procedure, nearly always dilatation and curretage.
One patient had suction curretage and five percent were managed without any surgical
intervention.
Out of the women with induced abortion, 52.9 percent reported using family planning methods
before conceiving the pregnancy that was later aborted. Eighty-eight percent (15/17) of these
women reported wanting to use family planning after the abortion, but only approximately 53
percent were actually given post-abortion family planning counseling by the doctors and nurses.
IV. Conclusions:
A. Community Study
ß It is estimated that ever-married women on average experience 0.86 abortions1 during their
reproductive lives. The abortion rate for the past year in Karachi was estimated as 25.5 per
1 Total abortion rate refers to the average number of abortions experienced by a woman during her child bearing years,
calculated by multiplying the number of abortions reported during one year per woman aged 15-49 by 34 (the number of
years between 15 and 49).
- 4 -
1000 ever married women of reproductive age. This rate is likely to be higher if non-married
women were included. Such a high rate is suggestive of an unmet need for contraceptives
among married women, but none of the women in the qualitative research mentioned
accessibility to a family planning source as the principal reason for conceiving an
unwanted/unplanned pregnancy. In these field sites, family planning is provided door to
door. The focus group discussions in the community did reveal that there were highly
prevalent misconceptions about contraceptive use that should be explored further.
ß Women are using termination of pregnancy as a method for birth spacing and limiting family
size. Despite some knowledge of severity of post-abortion complications, including
mortality, women are not deterred from seeking induced abortion once pregnant.
ß Nearly all types of health care providers are consulted for abortion services, and methods
used by providers are well known to women. The choice of provider is based on access,
availability, safety and cost.
ß Although abortion is illegal, providers are not deterred from performing abortions, probably
because of need in the market and the economic gains attached to it. These findings suggest
a large need for family physicians to be trained for appropriate family planning counseling,
post-abortion family planning counseling and emergency contraceptive use.
ß Literate women are more likely to have an induced abortion, possibly indicating that
education leaves them more aware of the benefits of small family size.
B. Facility study
ß Underreporting is substantial. Abortions in the hospitals are classified as spontaneous unless
a woman presents extreme conditions such as perforated uterus or a foreign body is retrieved
or she admitted inducing the abortion. Only four women admitted to having induced their
abortion to their doctor. Only after in-depth questioning by the study team did the remaining
13 confide that they induced their abortion.
ß Counseling for post-abortion family planning is inadequate as about half the women (8/17)
who had an induced abortion did not receive post-abortion family planning counseling.
ß Contraceptive failure rate is high as the majority of the women who had an induced abortion
were using a temporary method when they became pregnancy (9/17). The concept of
emergency contraception should be made available at pharmacies, near health centers, and
with private practitioners.
ß While dilatation and curretage is the most popular procedure for incomplete abortion, vacuum
aspiration is safer and more cost effective and should be adopted.
V. Dissemination of Study Findings:
Findings of this study pointed to the need to sensitize family health providers regarding
appropriate family planning counseling, post-abortion family planning counseling and emergency
contraceptive use to prevent unwanted pregnancy and to reduce the burden of reproductive
morbidity among women opting for induced abortions. As an initial step in this process, a series
of fifteen seminars, developed and implemented by investigators were held for medical
professionals in order to raise their awareness of the problem of and pertinent issues related to
clandestine abortions. These seminars were conducted for physicians at the Pakistan Medical
- 5 -
Association, junior gynecologists at Sobraj Maternity Home, LHVs at the Government School of
Public Health, various levels of providers, including traditional birth attendants, lady health
workers (LHWs), at Baqai Medical College, Ziauddin Medical College, Liaquat Medical College,
Jamshoro and providers attending training sessions for the World Bank Family Health Project in
Sindh.
Awareness building efforts have not solely been restricted to medical professionals. Study
findings have been disseminated and discussed at national level meetings held for diverse
audiences, including researchers and policy makers, at the Family Planning Association of
Pakistan (FPAP), The Population Council, and The Asia Foundation.
VI. Publications:
Jamil, Sarah, Fariyal F. Fikree. Determinants of Unsafe Abortion in Three Squatter Settlements
of Karachi, Pakistan. Karachi, Pakistan: The Aga Khan University, 1998.
Jamil, Sarah, Fariyal F. Fikree. Incomplete Abortion from Tertiary Hospitals of Karachi,
Pakistan, Final Report. Karachi, Pakistan: The Aga Khan University, 1998.
For more information please contact:
Faryial Fikree
Population Council
1 Dag Hammarskjold Plaza
9th Floor
New York, NY 10017
baharoon phool barsaao mera mundyaa ayaa hay
mundyaa I missed ya
anchal, o’phank u. im always around the world and pak politics section… fighting evil forces. u r most welcome to join. even though u r missing in action there is still plenty of it around to keep me busy.
I am polishing my skills
gotta beat you in the next Guppie Polls