Faiza Ilyas | Metropolitan > Karachi |

KARACHI, Jan 14: Although abortion is legal in Pakistan and a consensus exists among Islamic scholars on its permissibility in certain conditions, a majority of medical professionals look upon it as an un-Islamic act and refuse treatment to women, compelling them to seek the help of untrained healthcare providers and risk their lives.

According to estimates, about 890,000 induced abortions are carried out every year in the country and the procedure — contrary to the general perception that it is sought by unmarried women — is wanted by married women, with four to five children, who consider abortion an ‘easier family planning tool’ rather than using contraceptives.

These were some of the points highlighted at a seminar, The politics of abortion, organised by the Society of Obstetricians and Gynecologists of Pakistan (SOGP) at the PMA House on Saturday.

Giving a presentation on abortion and maternal health in Pakistan, Dr Shershah Syed, a senior gynaecologist, said most victims of the ailing social mindset were poor women because the rich could pay huge amounts to get the procedure done by trained professionals.

“The politics of abortion is that to keep silent and not to create awareness of the subject,” he said.

Giving some statistics, he said 30,000 women died every year in Pakistan because of pregnancy-associated complications that put the maternal mortality rate to about 276 per 100,000 live births.

Complications of miscarriages/ abortions, he said, accounted for 10 to 12 per cent of maternal deaths while one out of six pregnancies was terminated by induced abortion through a risky method.

“Due to a lack of health services and access to modern family planning methods, a large number of abortion-related complications worsen the maternal health situation in our country. Besides, cases of abortion are mismanaged by untrained healthcare providers,” he said, adding that about 36.81pc of abortions were conducted by unskilled traditional birth attendants.

Reproductive and sexual health issues, including early marriages, unplanned pregnancies and sexually transmitted diseases, he said, increased the burden on women’s health.

Referring to a report in a foreign publication, he said about 75,000 women who tried to abort pregnancies by inserting different objects into their bodies died every year worldwide. Most of them, he said, belonged to South Asian and African countries.

Painting a picture of what’s happening in the United States, Dr Huma Farid, clinical fellow in obstetrics, gynaecology and reproductive biology, Brigham Women’s Hospital in Boston, Massachusetts, said the abortion issue had been politicised in America and it was no longer viewed as a health subject.

“The US is perceived as a liberal country, but what is happening there on the abortion issue could have dangerous repercussions in the coming years,” she said, while explaining that though abortion was legal in the US, a number of states under the strong influence of conservative Christians had started passing anti-abortion laws.

“The risk of death from a legal abortion performed by a licensed provider is 0.4 per 100,000 cases while the risk increases to 17pc in cases of illegal abortion,” she said.

The US, she said, had a high rate of unplanned pregnancies (49pc); of those unplanned pregnancies, 42pc ended in abortion; 19pc of abortions were among teenagers; 67pc of women who sought abortions were unmarried and almost half of American women had terminated at least one pregnancy.

She also traced the history of abortion and pointed out that in the early 1600s the procedure was legal. Two centuries later, the states started passing anti-abortion laws and by 1900 abortion was illegal in every state in the US.

“Since abortions were illegal, the procedure was performed in hiding (about 200,000 to 1.2 million cases annually) and in a highly unsafe environment and represented 18pc of maternal deaths in 1930,” she said.

The case, she said, finally went to the US Supreme Court, which ruled in 1973 that the right of personal privacy included the abortion decision.

Citing a survey, Dr Nighat Shah, representing the SOGP, said that 80pc of doctors wanted stricter laws on abortion instead of favouring relaxation of rules. She also stressed that abortion was purely a health issue and must not be confused with religion and culture.

Imtiaz Kamal, president of the Midwifery Association of Pakistan, said Pakistan laws permitted that abortion could be done to save a life and to carry out necessary treatment.

Islamic scholars, she said, permitted the procedure to be done within 120 days of pregnancy.

“Professional values are more important than personal beliefs. Healthcare providers must refer the patient seeking abortion to the right place if they are not willing to carry out the procedure,” she said.

Aware Girls was trained by Women on Waves/Women on Web and has launched a safe abortion hotline in Pakistan    

An abortion hotline which has been set up in Pakistan is facing violent opposition. Islamic groups and political parties have condemned the hotline, which was launched yesterday, as “anti-Islamic” and “colonial”, even though it will save the lives of thousands of women who die each year in backstreet abortion clinics. They have warned the organisers that they are at risk of reprisals.

The hotline, set up by a collection of women’s groups in Pakistan and the Dutch pro-choice group Women on Waves, advises women how to use a drug to induce miscarriage safely and aims to reduce the estimated 890,000 unsafe illegal abortions performed in Pakistan every year.

“There will be very strong opposition,” said Ahsan Iqbal, of the Pakistan Muslim League. “This could create misuse. It cannot be done as free choice under our law and our religion.”

Access to abortion in Pakistan is very limited. Forbidden under Islamic law unless the mother’s life is in danger, terminating a pregnancy carries a massive social stigma in the country, which is 97 per cent Muslim. As a result, a flourishing trade in backstreet abortion clinics has developed.

Figures from the Population Council of Pakistan show that the country has one of the highest rates of maternal mortality in the world, with 320 women dying for every 100,000 live births – compared to 13 per 100,000 in the UK. The Guttmacher Institute, which researches sexual and reproductive health, estimates that as many as one in six deaths are a result of illegal abortions.

“We want to save women’s lives,” said Gulalai Ismail, founder of the Pakistani women’s group Aware Girls, which is helping to set up the hotline. “We are empowering women, and trying to give them information to help them take control of their bodies. Any groups which try to help women will have problems with extremist and fundamentalist groups. Ninety-nine per cent of clerics will oppose this.”

As well as the hotline, trained Pakistani staff will offer abortion information in communities in rural Pakistan, particularly in the tribal areas of the North-West Frontier Province, where opposition is expected to be fiercest.

Massoud Shadjareh, chairman of the Islamic Human Rights Commission, warned the organisers that they risked reprisals. “To go against the majority like this might be seen sympathetically in the West, but it will be counterproductive and will create huge problems. At best, they are misguided, at worst they are trying to provoke,” he said. “It is part of the colonial idea that the West’s way is the best, and that is not the case.”

Women on Waves, created in 1999 by the Dutch physician Rebecca Gomperts, operates a controversial “abortion boat”, which offers free terminations in international waters around countries where abortion is illegal or difficult to obtain. In 2004, the ship was prevented from entering Portuguese waters after the government blocked its way with a warship; on another occasion, a flotilla of anti-abortion campaigners surrounded the vessel when it docked in the Spanish port of Valencia, and hundreds of protesters lined the streets. However, there are no plans for it to moor off the coast of Pakistan.

“While the debate continues on whether terminating a pregnancy is allowed or not, and under what conditions, thousands of women are dying as a result of unsafe backstreet abortions,” said Shaista Gohir, executive director of Muslim Women’s Network. “The Pakistani government is failing in its duty to provide adequate family planning services,” she said.

A 2002 survey found that most women seeking abortions were married, aged in their thirties and already had four children. Globally, an estimated 20 million women have illegal abortions every year, around 68,000 of whom die as a result.

A hotline that gives women practical information about sexual and reproductive health in general and the use of a medicine called misoprostol to prevent heavy bleeding of women after giving birth and for inducing safe miscarriage at home, will be launched on Saturday the 25th June. Misoprostol is registered as an essential medicine on the list of the World Health Organization and registered in Pakistan under the brand names Arthrotec, Cytotec, Cytopan, and ST Mom®.

Where: press conference at Hotel Ambassador, 7 Davis Road, Lahore, Pakistan
When: 13:00 hrs, Saturday, 26th June, 2010.

The launch is being carried out by the coalition of Pakistani Organization who support women’s rights  – Aware Girls from Khyber Pukhtoonkhwa, Peace Foundation from Sindh and Wake Up Call International from Lahore, The hotline is supported by Asia Safe Abortion Partnership, Women on Waves and Women on Web.

Press inquiries:

0315-947 33 66 (Sindh)
0307-494 08 08  (Punjab)
0315-917 04 09 (Khyber Pukhtoonkhwa)
+31-6-52052561 (Women on Waves)

Women needing information in Pakistan/ hotline numbers:

0307 – 494 07 07 – (Urdu, Punjabi)
0315 – 917 04 08 – (Urdu, Pastho)
0315 – 947 33 99 – (Urdu, Sindhi)

Further information:

Pakistan has one of the highest rates of maternal deaths in Asia. Each
year 30 000 women die due to pregnancy related reasons. Nearly 90% of
women deliver at home in the absence of skilled birth attendants. Only
1 in 20 women reaches the emergency obstetric care. Heavy bleeding
after giving birth (PPH, postpartum hemorrhage) is the main cause of
maternal deaths. 80% of maternal deaths happen during home birth.
The abortion rate in Pakistan is 14 in every 100 live births,
approximately 890.000 are performed each year.

An estimated 11-15% of maternal mortality in Pakistan is caused by
unsafe abortions. (more…)