Global Day of Action for Access to Safe and Legal Abortion
September 28 universally marks the Global Day of Action for Access to Safe and Legal Abortion. Whether that option for available abortion is easily accessible and safe is another concern. Let’s first make sure that we are all on the same page about what abortion means: Abortion is the termination of pregnancy so that it doesn’t result in the birth of a child. That being clear, women have the right to choose, at least theoretically. Practically speaking, universally binding laws or conventions such as CEDAW, which specifically highlight the rights of women, are not implemented successfully, if at all. However, just because there is a lack of accessible safe abortion clinics, it doesn’t mean that abortions don’t take place at all; abortions happen every day. The only difference is that they are conducted under dangerous circumstances, without the necessary and appropriate operating tools, severally harming women, both psychically and mentally.
Statistically, about 800,000- 900,000 abortions take place every year in Pakistan, majority of them being clandestine, putting the lives of women at a major risk. These numbers, collected by the Population Council of Pakistan and the Guttmacher Institute, were only through those women who were hospitalized for post abortion complications, which means that these numbers are most probably highly understated.
The current law in Pakistan only permits abortion to save the woman’s life, in order to preserve her psychical and mental health. Under Section 338 and 338 B of the revised Pakistan Penal Code (PPC), abortion is not provided in cases of rape and incest, foetal impairment, economic or social reasons and is not available on request. Ironically, according to several reports and surveys conducted with women who have gone through unsafe abortion processes, conclude that women’s reasons for terminating pregnancy were:
- Abnormal Fetus
- Desire for a smaller family
- Premarital affairs
- Extramarital affairs
- Contraceptive Failure
Furthermore, in cases where women are impregnated during premarital and extramarital affairs, the fear of raising the child alone and being financially incapable of raising the child, are of the top most reasons of pregnancy termination. Another very common reason for terminating pregnancy is known as “young age pregnancy”, which ultimately would affect the young girl’s life negatively, while restricting her mobility and opportunities.
Despite abortion being legal, whether abortion is safely provided or not is a separate matter. More often than not, the stigma attached to the action is so deeply engraved that health care providers are the reason why abortions do not take place. Many studies show that there is a lack of awareness about the procedure’s legality on part of legal professionals and medical service providers. There is obviously a lack of knowledge, awareness and access to family planning, the general lack of women’s power over their own bodies and a lack of access to appropriate medical professional services as there is a real fear of violence, finance, and the distance to be covered in order to get to the nearest hospital or clinic.
The absence of family planning is a major issue and maybe even one of the biggest catalysts for eventual abortion. In Pakistan, the percentage of married women who resort to terminating their pregnancy through abortion is relatively higher than that of single girls. Married women, then, see abortion as a method of contraception. In a seminar held on this topic, Professor Sheereen Z Bhutta, Vice President of Society of Obstetricians and Gynaecologists of Pakistan, claimed that almost 25 percent married women in Pakistan want to consider the option of family planning but they feel hesitate to approach doctors. Other reasons why contraceptives are not widely utilized amongst married couples are:
- Contraceptives are expensive in many areas of the country
- Couples who want to use contraceptives don’t have access to them
- Husbands don’t want to use condoms
- Myths about contraceptive pills are prevalent
- Simple laziness
- Religious excuses towards contraceptives
For the post part, the government is a serious agent in furthering these problems since its concerns towards such issues remain quite minimal. According to a United Nations report on abortion and reproductive health in Pakistan, there has been no conscious effort by the government to pay attention to or show concern for morbidity and mortality resulting from induced abortion, whereas, their concentration is situated more on the complications caused by childbearing and childbirth. Furthermore, a government backed inquiry commission for women, in 1997, recommended that abortion should be an absolute right until 120 days of pregnancy but this recommendation never made it into any policy. This is a clear example of how law and policy put negative connotations to abortion, which makes abortion into even more stigmatized issue and results in manipulating the way service providers think.
Abortion is a reality, which is why it is essential that women be provided with affordable and easily accessible service without any per-conceived notions and biases. An Asia Safe Abortion Partnership report found that 67% of medical professionals in Pakistan have an unfavorable attitude to abortion and of those wanting change to the existing law, 81 percent called for stricter laws to be introduced. Health care providers need to understand that abortion is not against the law (nor against religion, at least not in the first four months of pregnancy) and that all women who come to them seeking abortion should be treated with utmost respect. Service providers, especially in developing countries, need to be aware of and be sensitive to that fact that unsafe abortions cause complications such as hemorrhage, sepsis, peritonitis, trauma to the cervix, vagina and uterus. So, perhaps, if health workers are made aware of these severe consequences, their conservative mindsets and biases can be replaced with sympathy and most of all, logic, which is simply that performing a procedure that is legal goes more in favor for the health of women than to refuse them of the service, which could result in their death.
Post-abortion care is essential when it comes to making sure that disabilities caused by induced and self-induced abortions are properly taken care of because they can surely be prevented. According to a fact sheet by The Guttmacher Institute, published in 2013,
“A high proportion of facilities in Pakistan lack 24-hour coverage by personnel essential for the treatment of severe abortion complications. Overall, 59% of facilities lacked 24-hour coverage by a gynaecologist in 2012, and 41% lacked such coverage by an anaesthetist. Almost all surveyed providers agreed that post abortion care can save a woman’s life and that it should be more widely available. However, 42% perceived providers as having negative attitudes towards clients receiving such care, and 35% believed that providers are hesitant to treat post-abortion patients.”
Therefore, there is a lot the government can do in terms of forming and implementing women-centered policies which address safe abortion and contraceptives as an absolute human right.
Aside from the government, many civil society organizations focus on abortion related concerns. For example, PAPAC (The Pakistan Alliance for Post Abortion) is a national network of service delivery organizations, NGOs, government agencies, donors, UN bodies and professional associations, which aims to reach wider stakeholders, including the media and community-based organizations. PAPAC members hope to ensure increased access for women to quality post abortion care and related reproductive health services, including family planning, by sharing information, experiences and collaborating on strategic thinking and planning.
The government, however, needs to step up its game to ensure that sensitivity workshops are held, especially in rural areas to educate people on the legality of the issue, which would in turn help to remove the stigma attached to abortion; it needs to ensure that affordable contraceptives are readily available in all areas of the country; ensure that there are clean and safe abortion clinics in close proximity of villages and that training in the provision of post abortion care should be standard for all levels of healthcare providers who are permitted to perform such services; it needs to make sure that improved provision of family planning services are available and implemented, which would likely lower the number of unwanted pregnancies substantially and thus reduce the number of clandestine abortions and the complications and deaths that often result, and finally, a tracking system needs to be put into place which will solely record the number of abortions conducted and the outcomes of the procedures.
Under the 1990 revision in the PPC in regards to abortions, the conditions for legal abortions depend of the development stage of the fetus. Since 1997, under certain circumstances, abortion is conditionally legal in Pakistan, to provide “necessary treatment”. Legally speaking, Section 338 of the PPC, which addresses the subject of abortion is quite vague and does not fully elaborate on important terms like “necessary treatment”, which is why the law continues to be criticized. An amendment to this section needs to proposed in which all important terms are fully elaborated on and in which it is declared that abortion is not only a legal right for women but also as a human right in general.