Syed Mustafa Ali

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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 also

    observed 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.