Even still, information about where to get an abortion gets passed around like a game of telephone said Sana, a 33-year-old mother of four, who got the operation done at a private clinic in Rawalpindi after an extensive search for providers. Going to a hospital wasn’t an option, Sana, whose name has been changed to protect her from possible repercussions, thought. She had already asked her former classmate, a gynecologist, who told her it was illegal. It’s not surprising that even doctors don’t know what’s allowed and what’s not, Sadiah Ahsan Pal, a well-known gynecologist in Karachi, told VICE World News. Pal said topics related to sexual health were generally brushed aside when she was studying gynecology or discussed with sinful connotations attached. “In medical school, we weren’t taught. And when we were taught it was in such a way that at that age as a girl it was very unpleasant,” she said. “And most girls in my class would just walk out of that class the way it was being taught. It was very disrespectful.”According to the Guttmacher Institute, a research organization that has done numerous studies on sexual health in Pakistan, around 3.8 million unintended pregnancies take place there every year. And since contraceptive use is not widespread—only 34 percent of married women use it—many rely on abortions as a form of birth control. Sana was getting her second abortion that day at the clinic because, she said, her “family is complete.”An autopsy confirmed a different cause of death than a motorbike accident: criminal abortion and its complications.
Despite the family’s skepticism, an investigator on the case, Tassaduq Khokhar, said all evidence—including the postmortem report showing retained fetal parts—suggests this was a failed abortion. Ijaz, the boyfriend, confessed to his involvement in ending the pregnancy. His paternal aunt, who Khokhar said investigators believe performed the operation in her apartment, is also a suspect. DNA tests are currently underway for items found in Ijaz’s aunt’s apartment, and on the fetus. If convicted, Khokhar said Ijaz and his aunt could face life imprisonment or death under the 302 section of Pakistan’s Penal Code. “The problem here is people don’t want to say what they are doing,” Dr. Rubina Sohail, a professor of gynecology and obstetrics at Services Institute of Medical Sciences, a teaching hospital in Lahore, told VICE World News. Sohail said doctors assess situations on a case-by-case basis, and certain circumstances require them to confer as a group. It is possible to make arguments for exceptional cases; Sohail cited an example of a young girl she suspected had been impregnated by someone in the family that was allowed to receive an abortion. But for most general requests, the hospital has to refer the patient to other providers. Sohail emphasizes to hospital staff that they must advise women in need even if they don’t feel comfortable dealing with abortion cases themselves. But addressing deeply held beliefs can be an uphill battle. “You cannot change the mindset of everybody,” she said.Since contraceptive use is not widespread—only 34 percent of married women use it—many rely on abortions as a form of birth control.
Providers supported by the private sector or humanitarian organizations are encouraged to provide care and counseling as needed, but even those allowed have their reservations. “It’s not that the hospital administration does not allow us to perform abortions, we don’t do them ourselves. We are afraid of God,” said Rukya Bibi, a lady health worker, the designation for a community-based women’s healthcare provider, at a small women’s clinic near Sargodha.Reluctance to do abortions, or reluctance to admit to doing them, is also about appearance. In insular communities, where terminating pregnancies early can bring shame and judgment on families, providers—though many of them are well known and even viewed as necessary in areas that lack healthcare facilities—are precariously positioned to do their work.It’s a matter of life and death, but many of the most qualified doctors aren’t willing to do the operation.
Further efforts to make information about abortion more accessible do exist, but they are limited. Saba Ismail, an activist and co-founder of Aware Girls, a women’s rights organization, started an abortion hotline to help people learn about their options back in 2010. “We were straightforward: this is an abortion hotline and women should contact it,” Ismail told VICE World News. Now, more than a decade after the hotline started, the same questions of accessibility remain. “If they don’t have this information, how will they end up?” asked Ismail. “They will end up in some backstreet abortion clinic, which are so unsafe.” Safe abortion advocates in Pakistan also hold trainings for providers to address any biases they might have about the procedure. The organizations providing these trainings said many doctors don’t even know abortion is legal until they attend the sessions, and some don’t realize how many prejudices they hold until they’re asked to confront them. Some private providers have also tried to rebrand abortion services in a way that makes them less daunting. In Karachi, there’s an abortion clinic that resembles an upscale salon replete with mood lighting and reclining chairs in the room where women rest after getting the operation. The organization that partnered with the clinic said it was trying to make the service more accessible for urban working people to discourage them from ending pregnancies in ways that could kill them.Mariyam Sheikh, one doctor at a basic health unit in Moach Goth in Karachi, said women in her area don’t even go to healthcare centers when she refers them there because, in many cases, they can’t pay for the bus ticket.