Syed Mustafa Ali
Speeches:
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Termination of pregnancy services in Pakistan –
a confiscated right
Ali, SM; Rizvi, A; Mahmood, N; Khanum, A
Rahnuma, Family Planning Association of Pakistan- an affiliate of
IPPF
Objective: The aim of the study was to highlight the various
factors which control women’s right to access to termination of
pregnancy (TOP) services.
Methods: Data from 400 women aged 18–60 years seeking TOP
and general services from clinics of the Family Planning
Association of Pakistan (FPAP) in Lahore and Karachi was
obtained through a structured questionnaire over 3 months and
descriptive analysis of data was done using SPSS version 17. The
questionnaire was administered by clinic counsellors and covered
key themes of knowledge on access to safe TOP, TOP-related
stigma, reasons for seeking TOP service, decision-making on
family size and demographic data.
Results: During the study it was found that a majority of the
TOP clients (59.8%) coming to six service delivery points had a
family monthly income of less than PKR 10 000. The average age
of TOP clients was 30 years (SD 6). Similarly, the average number
of children of TOP clients was 3 (SD 1.9). A large number of
TOP clients (39.5%) were illiterate and only 5% of TOP clients
had 16 years of education while 33.7% of their husbands were
illiterate and 4.2% had 16 years of education. When knowledge of
clients on the legal status of TOP was assessed it was found that
out of 400 clients, 49.3% considered TOP to be illegal. The
knowledge level between general clients and TOP clients was alsoobserved as 62% of general clients considered TOP to be illegal in
Pakistan while 36% of clients, who had availed themselves of TOP
services, considered it illegal. Out of 200 TOP clients, 54.2%
associated stigma with TOP by not telling others that they had
sought TOP services. The reasons for seeking the TOP service
were: cannot afford another child (28.4%), mothers’ health
concerns (27.9%), last child too young (18.9%), contraceptive
failure (16.9%), too many children (5.5%), unmarried (1.9%) and
separation from husband (0.5%). Out of 400 clients, 47.2% were
not asked about their wish to have children and 48.2% were not
involved in the decision about birth spacing. Moreover, the need
for family planning had not been met by 18% of TOP clients as
they had used TOP services more than once.
Conclusion: Controlled access to family planning services, stigma
attached to TOP and low educational and economic status are the
factors which interfere with the right of women to seek TOP
services. Moreover, there is also a need to further study this
phenomenon and better understand how each of the factors
(stigma, low education etc) affects access to and uptake of safe
TOP services.