Lack of legal clarity forces thousands of women to endure backstreet abortions in Pakistan. A helpline is providing information and support, but fears losing funding after Trump reinstated the global gag rule

Sonia woke up in dingy room with searing pain in her stomach. All she remembered was being accompanied by her husband to a clinic for an ultrasound. She’d recently found out she was pregnant; her husband had often been abusive and didn’t react well to the news. Today was supposed to be different: he insisted on going to the clinic so he could see the scan and Sonia hoped that reflected a change of heart.

However, slowly Sonia realised she had been drugged and given an abortion without her consent at a private clinic. It took years for her to come to terms with the violence she suffered.

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Islamic scholars permit an abortion within 120 days of pregnancy in Pakistan. But despite this framework for permitting abortions, health professionals are reluctant to carry out the procedure. Many women resort to ingesting drugs, using sharp objects, or physically abusing their body resulting in long-term health complications. In 2012, an estimated 623,000 Pakistani women were treated for complications resulting from induced abortions. In Sonia’s case, her ex-husband was able to pay an unqualified provider to conduct a procedure she hadn’t not consented to. Her story highlights the danger to women’s health when the only option for is an unhygienic facility clinic with untrained staff.

In such dangerous circumstances, who is filling the gap? Saba Ismail, co-founder of the Pakistani women’s group Aware Girls, launched an abortion hotline in June 2010.

Aware Girls has received US Aid funding in the past but now will have to depend on grants from European foundations after President Trump reinstated the global gag rule which prohibits US funding to NGOs which provide information about abortions.

“We have not heard any donor withdrawing our funding on this basis yet, but we will become automatically ineligible for US Aid and other state department grants on this basis, and that’s the challenge,” says Ismail. “We fear that Trump’s decision will affect Pakistan because any organisation, hospital or clinic working on abortion will not be able to get any US funding.”

A woman told us to stop talking about abortions or contraceptives and instead educate women on how to be better wives Saba Ismail, co-founder of Aware Girls

US Aid spent $54.1m dollars funding family planning and reproductive health in Pakistan in 2015 and Marie Stopes International, the family planning NGO which receives funding from US Aid says that its work in Pakistan over the past decade has “averted 4.6 million unintended pregnancies, 1.9 million unsafe abortions and 6,000 maternal deaths”.

Aware Girls provides an anonymous toll-free service called “Saheli” (Urdu for “friend”) to educate on abortions and contraceptives: “When we first launched the helpline we were told that we were promoting murder; that abortion wasn’t about choice but about murder. This stigma and taboo is what bothered us the most.”

Over the course of six years Ismail and her colleagues have faced harsh criticism and threats. “In the beginning we started with 30 calls a month and now we average about 180 calls,” she says. “This is because we went into the communities and spoke to women about their health informing them about the helpline. At one of the events a woman approached me, identified herself as a representative of the Taliban, and told us to stop talking about abortions or contraceptives and instead educate women on how to be better wives to their husbands.” This didn’t stop her, although threats forced them to temporarily close down for six months in 2014.

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Ismail’s helpline follows the World Health Organisation’s guidelines on safe methods of abortions that can be performed at home for women under nine weeks pregnant. Misoprostol, a drug used to induce abortions, is available over the counter in many countries including Pakistan because it is also used to prevent stomach ulcers. Ismail’s staff asks women to provide details about their health and verify the length of the pregnancy, and takes them through the process of abortion.

“People think that most women that call us are sex workers or unmarried women. While we do not judge and only ask reasons for abortion for our research purposes, I can tell you that the we get a large diversity of calls. From women aged 17 to 50, women that are married, who have recently given birth, who already have a lot of children and even women who have been raped by their own family members,” Ismail recalls the story of 21-year-old Sameena who was raped by her own cousin and was refused help at a hospital.

An extensive women’s health report conducted in 2012 found that of the 9 million pregnancies in 2012, 4.2 million were unintended; 54% of these unintended pregnancies resulted in induced abortions and 34% in unplanned births.

I attend to calls even when I am in a family gathering, in a funeral or anywhere, I never miss a single call Tahira Khan, helpline counsellor

The vast majority of the helpline’s calls are about abortions, only 4% of the callers ask about contraceptives. Nonetheless, each caller receives information on the use of contraception. The contraceptive prevalence rate is low in Pakistan – out of a population of more than 190 million, only 35% of women aged 15–49 use it. The reasons for this range from lack of sex education and awareness, and the fact that contraception is still considered a taboo and, in some places, seen as a western concept. Last year, Pakistan banned advertising for contraceptives.

The counsellors on the helplines are young women with no medical background who are trained with the WHO’s clinical handbook [pdf] on safe abortions. Tahira Khan says the helpline has now become more than just a job: “This hotline is a part of my life now, I attend to calls even when I am in a family gathering, in a funeral or anywhere, I never miss a single call, I always call back. When I help women, I feel satisfaction and happiness. Before starting counselling, I thought I could never do it, but with the passage of time, I am now an expert.”

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The hotline has received over 25,000 calls so far and this is increasing by the day. Ismail’s organisation can only help women who are under nine weeks pregnant, but in some cases they have to provide referrals for surgical abortions at selective clinics that conduct these procedures under hygienic and medically approved conditions.

Ismail is determined to continue her work but she knows she is treating a symptom rather than a root cause. “My fight is against the taboos that tell women that their bodies aren’t theirs,” she says. “Unless women are seen as human beings who have a choice and right to their own body nothing will change.”

Some names have been changed.

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