Termination of pregnancy (TOP) services in Pakistan – A confiscated right

Objective:The aim of the study was to highlight the variousfactors which control women’s right to access to termination ofpregnancy (TOP) services.Methods:Data from 400 women aged 18–60 years seeking TOPand general services from clinics of the Family PlanningAssociation of Pakistan (FPAP) in Lahore and Karachi wasobtained through a structured questionnaire over 3 months anddescriptive analysis of data was done using SPSS version 17. Thequestionnaire was administered by clinic counsellors and coveredkey themes of knowledge on access to safe TOP, TOP-relatedstigma, reasons for seeking TOP service, decision-making onfamily size and demographic data.Results:During the study it was found that a majority of theTOP clients (59.8%) coming to six service delivery points had afamily monthly income of less than PKR 10 000. The average ageof TOP clients was 30 years (SD 6). Similarly, the average numberof children of TOP clients was 3 (SD 1.9). A large number ofTOP clients (39.5%) were illiterate and only 5% of TOP clientshad 16 years of education while 33.7% of their husbands wereilliterate and 4.2% had 16 years of education. When knowledge ofclients on the legal status of TOP was assessed it was found thatout of 400 clients, 49.3% considered TOP to be illegal. Theknowledge level between general clients and TOP clients was alsoobserved as 62% of general clients considered TOP to be illegal inPakistan while 36% of clients, who had availed themselves of TOPservices, considered it illegal. Out of 200 TOP clients, 54.2%associated stigma with TOP by not telling others that they hadsought TOP services. The reasons for seeking the TOP servicewere: cannot afford another child (28.4%), mothers’ healthconcerns (27.9%), last child too young (18.9%), contraceptivefailure (16.9%), too many children (5.5%), unmarried (1.9%) andseparation from husband (0.5%). Out of 400 clients, 47.2% werenot asked about their wish to have children and 48.2% were notinvolved in the decision about birth spacing. Moreover, the needfor family planning had not been met by 18% of TOP clients asthey had used TOP services more than once.Conclusion:Controlled access to family planning services, stigmaattached to TOP and low educational and economic status are thefactors which interfere with the right of women to seek TOPservices. Moreover, there is also a need to further study thisphenomenon and better understand how each of the factors(stigma, low education etc) affects access to and uptake of safeTOP services.