Women’s Access to Safe Abortion and Postabortion Care Services in Pakistan: The Role of Gender and Related Factors

This chapter describes how gender and other intersectional factors play a role in unintended pregnancy, access to safe abortion, and postabortion care in Pakistan. The chapter draws on qualitative data from a national study on postabortion care carried out in 2011–2012 among women who had undergone an abortion in the previous 6 months, service providers, and men and women from urban and rural communities in five districts of Punjab and Sindh provinces. The data are reanalyzed to throw light on the broader context that shapes women’s access to abortion in Pakistan where unmet needs have remained persistently and high and wide disparities exist in access to healthcare. Women in Pakistan shoulder the burden of reproductive health in their families and communities. Decisions on seeking abortion and postabortion care are often made by husbands or with mutual agreement between partners but rarely by women alone. Other factors driving women’s abortion decisions include dire poverty, the burden of caregiving, and son preference. The structure and delivery of reproductive healthcare impede health-seeking for low-income women residing in rural areas, including scarce service availability, unaffordability of formal private healthcare, and the poor quality of services available at government health facilities. Pakistan requires a gender-transformative approach to programming for contraceptive services, abortion, and postabortion care that leverages public support and women’s agency. There needs to be further expansion of the abortion law, greater public investment in the healthcare system to ensure access to non-fee levying or affordable reproductive health services, training of health professionals to provide gender-sensitive and accountable contraceptive and abortion services, and health programs that promote the use of reproductive health services by both men and women.