In Pakistan, fewer than 35% of currently married women use modern contraceptive methods, and unintended pregnancy is common. Population Council study 2002 unfolds that nearly 900,000 induced abortions are performed each year in Pakistan and a recent national study (2012) found that almost 700,000 women sought medical treatment for complications at healthcare facilities, mostly due to clandestine procedures performed by traditional birth attendants or midlevel providers such as Lady Health Visitors, nurses and midwives. With the lack of family planning policies, women are unfortunately using unsafe abortion as a method for family planning. Punjab is the largest population province with almost 100 million people and constitutes about 60% of the population of Pakistan.
Postabortion care (PAC), a term originated by Ipas in the early 1990s, is an approach for reducing deaths and injuries from incomplete and unsafe abortions and their related complications. PAC includes five essential elements which not only respond to the medical treatment but also focuses on the broader sexual and reproductive health needs of women.
According to the World Health Organization’s Safe Abortion: Technical and Policy Guidance for Health Systems (2012), postabortion services can be safely provided by any properly trained health provider, including midlevel cadre that includes midwives, nurses, lady health visitors and community midwives etc. Training and equipping these health workers can help ensure appropriate service availability and accessibility without compromising safety, especially where doctors are few or not readily accessible.
Since 2012, Ipas Pakistan, in collaboration with WHO Punjab and partners, has worked with the Punjab government and the Pakistan Nursing Council (PNC) for sustained integration of postabortion care technologies into health system and midwifery training curriculum.
Ipas Pakistan and partners’ advocacy with Punjab Reproductive Health Technology Assessment Committee (PRHTAC) and later its recommendations, has contributed to a number of positive policy changes including PNC’s decision to include misoprostol for postabortion care (MPAC) into midlevel training curriculum, and Punjab government’s revision of Essential Package of Health Services with inclusion of misoprostol and manual vacuum aspirators (MVA) into the essential drug and equipment lists respectively for safe postabortion care.
Furthermore, through the unanimous recommendation of the PRHTAC, Punjab government has tasked Ipas and partners to develop the Standards and Guidelines for post-abortion care which are expected to be in place for implementation by the end of this year.
These policy outcomes, recent MPAC-FP (MPAC and family planning) trainings to 53 community midwifery and midlevel tutors, further commitment by maternal, newborn and child healthcare program (MNCHP) to trickling down MPAC-FP trainings to 5100 community midwives by 2015 and first time procurement of 250,000 misoprostol tablets and 5000 MVAs by Punjab government during FY14, would significantly help in improving the PAC that women receive. It would also ensure that they receive FP counseling and would reduce future cases, especially among under served rural and marginalized women in Punjab.
Dr. Ghulam Shabbir Awan
The author is a public health professional. He graduated from King Edward Medical College and did his Masters in Public Health from the Health Services Academy, Islamabad. He has more than 20 years’ experience of working in Reproductive Health and Family Planning in public sector, UNFPA and International non-government organizations. He is currently working as Country Manager of Ipas, Pakistan.