A mother of three and just 24 years old, Parveen died a few months ago after using the services of a local, unskilled birth attendant for aborting what would have been her fourth baby.

A resident of Bhara Kahu, Parveen, wanted to abort the foetus for financial reasons and did not tell her mother about her plans, as she knew her mother would not approve of an abortion. After the abortion, Parveen had started bleeding heavily and was taken to the Pakistan Institute of Medical Sciences (Pims), where she died.

“Resorting to an abortion is a hard decision and even the word itself sounds awful,” Parveen’s mother said.

“I did not know my daughter was going through a difficult time. If she was open with me, I would have helped her,” she said. Due to poverty, lack of awareness and because the matter is taboo, many women like Parveen lose their life or develop complications after using the services of unskilled midwives. September 28 is observed as Global Day of Action for Safe, Legal Abortion and unfortunately, the number of unsafe abortions is increasing in Pakistan.

According to studies conducted by the Pakistan Population Council in 2002 and 2012, titled ‘Post Abortion Care In Pakistan: a national study’, the number of unsafe abortions has increased by three times in a decade.

The number of women treated in public health facilities or private teaching hospitals for complications from unsafe abortions was 197,000 in 2002 which swelled to 700,000 in 2012.

According to the WHO, 13pc of deaths are due to unsafe abortions out of which 99pc are in developing countries including Pakistan, where 10 to 12pc maternal deaths are caused due to unsafe abortions.

A hospital setting study conducted in 1990-2001 found that 11pc of maternal deaths during the study period were due to complications from unsafe abortions performed by untrained service providers in unhygienic conditions.

Dr Ghulam Shabbir Awan, country director of Ipas Pakistan, which is a non-profit organisation working on public health issues like unsafe abortions, told Dawn that since the recent policy change and the authorisation of mid-level health care providers by the Pakistan Nursing Council, there is a need for institutionalising training health care providers.

He said this was particularly important for training midwives in safe uterine evacuation and post abortion care technologies including Misoprostol and MVA, which are recommended by the WHO.

Dr Awan said unsafe abortions are almost entirely preventable as they are a result of the lack of family planning, contraceptive failure, the lack of information about contraception and restricted access to safe abortion services.

He said lady health workers should be used for raising awareness about the use of contraceptives and the consequences of unsafe abortions.

Talking to Dawn, women rights activist Dr Farzana Bari said women are using unsafe abortions as a family planning method.

“Women in our society are not given the right to make a decision about their own bodies. It is the husband who decides how many children she will deliver. Women should be given this right in order to save their lives and the government should ensure contraceptives are easily available in rural areas,” she said.

A gynaecologist at Pims, Dr Nasira Tasneem, said the hospital receives three or four abortion cases each day.

“At times it is hard to tell if it is a case of abortion or miscarriage as many women use home remedies to terminate their pregnancy,” she said. “When a patient comes to us for an abortion, we only conduct one if the baby is a risk to the woman’s mental or physical health,” she added.

“Most doctors are not clear about the legal status of an abortion in Pakistan. Abortions are not legal in this country. The law permits an abortion only to save a woman’s life or to provide her with ‘necessary treatment’. It is then left to the doctor to interpret the appropriate treatment for the patient,” Dr Tasneem said.

Published in Dawn, September 25th, 2016