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Women's Abortion Seeking Experience in Rural Chakwal, Pakistan Open Access


Other title
provider views
abortion access
abortion services
Type of item
Degree grantor
University of Alberta
Author or creator
Chahal, Harneet K
Supervisor and department
Mumtaz, Zubia (Department of Public Health Sciences)
Examining committee member and department
Saunders, Duncan (Department of Public Health Sciences)
Kaler, Amy (Sociology)
Department of Public Health Sciences
Global Health
Date accepted
Graduation date
Master of Science
Degree level
Background: In Pakistan, abortions occupy a highly contentious space. Legal and religious restrictions have created a substantial social stigma around this procedure. Irrespective of this restrictive environment however, women continue to pursue abortion services often turning to clandestine means in order to keep the procedure a secret. While this does allow women to maintain privacy, these unsafe services greatly elevate risks of maternal morbidity and mortality. Nonetheless, the topic of unsafe abortion and its impacts on maternal health remains understudied. To gain a better understanding of the abortion landscape in Pakistan, this study investigated women’s abortion seeking behavior in the rural setting of Chakwal, Pakistan. Specifically, this study explored why demand for abortions has increased, and whether providers are willing to meet the increased demand. Methods: A focused ethnography was conducted in Chakwal, Pakistan from September to December of 2013. Participants were recruited from the Rahnuma Family Planning Association of Pakistan, a non-governmental organization that provides family planning and reproductive health services, including abortions. Twenty three in-depth interviews were conducted with women seeking, or that had received an abortion and fourteen in-depth interviews were conducted with the facility’s healthcare providers. One focus group discussion was conducted with providers. Results: Findings revealed women had a strong desire to control fertility, but this need was not being met through contraceptives. Where confronted with an unplanned pregnancy women turned to abortions, specifically through the drug misoprostol to limit their fertility. The ease of this abortifacient’s use not only enabled an increased reliance on abortion to terminate unplanned pregnancy but possibly as a preferred means of fertility regulation. Furthermore, safe abortion services were found to exist within a clinical setting. Two NGO’s were providing safe, clinical abortion services through trained providers. But at the interface between patients and the health system, providers emerged as a key barrier in women’s ability to access safe abortion services. Provider’s negative views of the procedure and a system of patronage led to restrictive provision of this service. Conclusions: To support women’s access to safe abortions we recommend training mid-level providers to safely administer misoprostol within women’s homes, as part of their existing home based care. Improving contraception uptake will also be important to prevent abortions in the first place. Furthermore, there is a need for greater attention to be given in hiring providers who are willing to conduct abortions, to improve providers counseling skills, and expand family planning services.
Permission is hereby granted to the University of Alberta Libraries to reproduce single copies of this thesis and to lend or sell such copies for private, scholarly or scientific research purposes only. The author reserves all other publication and other rights in association with the copyright in the thesis and, except as herein before provided, neither the thesis nor any substantial portion thereof may be printed or otherwise reproduced in any material form whatsoever without the author's prior written permission.
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