Abortion Rather than Contraception: The Pathway to Fertility Transition in Pakistan

Zeba A. Sathar, Population Council
Susheela D. Singh, Guttmacher Institute
Iqbal Shah, Retired
Muhammad Niazi, Population Council
Tahira Parveen, Population Council
Octavia Mulhern, Guttmacher Institute
Ali M. Mir, Population Council

Background: Induced abortion and contraception are two alternative means for regulating fertility. In comparison to other countries in South Asia where fertility has declined primarily due to a greater use of modern contraceptives, their use remains low (25%) and stagnated in Pakistan. Despite abortion being highly legally restricted, the abortion rate in Pakistan is rising and probably substituting for contraception. We assess the increased reliance on abortion in Pakistan over the last decade and examine factors that underlie this increase, including greater availability of misoprostol and of pharmacies as a source of this medication, and persistent health concerns associated with modern contraception. Data: We use comparable data from nationally representative surveys of health facilities and health professionals conducted in Pakistan in 2012 and 2023. Research Methods: We apply indirect demographic techniques to estimate the incidence of abortion and unintended pregnancy and descriptive statistics. Findings: Between 2012 and 2023 the abortion rate increased by 25%; unintended pregnancies ending in abortion increased by 18%; and unplanned births declined by 26%, indicating increasing reliance on abortion to resolve unintended pregnancies. Increased availability of misoprostol and easier access through pharmacies facilitated access and have made abortion safer and an often-used reproductive strategy.

Keywords: Fertility, Family Planning and Contraception, Sexual and Reproductive Health and Rights, Data and Methods

See extended abstract.