Cockrill, K., Herold, S., Blanchard, K., Grossman, D., Upadhyay, U., Baum, S. (2013) Addressing Abortion Stigma through Service Delivery - A White Paper. Retrieved from Sea Change Program, Ibis Reproductive Health, ANSIRH: http://seachangeprogram.org/wp-content/uploads/2015/09/SC-White-Paper-v05.pdf, page 3
Ibid, page 3
Sathar Z et al., Induced abortion and unintended pregnancies in Pakistan, Studies in Family Planning, 2014, 45(4):471–491
Depo Provera is a contraceptive injection containing progestogen. It is commonly referred to as "the injection" or "DP". Progestogen is similar to one of the hormones produced naturally by a woman's ovaries. The injection is given every 3 months.
Abortion Stigma:
The unseen barrier to young people's access to SRH services
Rahnuma – Family Planning Association of Pakistan
Abortion Stigma: The unseen barrier to young people's access to SRH services
Copyright @ 2016 by Rahnuma – FPAP
3-A, Temple Road, Lahore 54000 Pakistan
UAN: +92-42-111223366 Fax: +92-42-36368692
Email:
[email protected] URL: http://www.fpapak.org
Table of Contents
ACKNOWLEDGEMENTS 4
ACRONYMS 5
1. INTRODUCTION 6
1.1. The Concept 6
1.2. The Context 6
1.3. The Project 7
2. SUCCESS STORIES 8
2.1. District Chakwal 8
2.2. District Faisalabad 9
2.3. District Rawalpindi 10
3. BEST PRACTICES 12
4. LESSONS LEARNT 14
ANNEXURE: CASE STUDIES 16
ACKNOWLEDGEMENTS
ACRONYMS
ASK Access, Services, Knowledge
BTL Bilateral Tubal Ligation
CVS Chronic Villous Sampling
D&C Dilation and Curettage
FHC Family Health Clinic
FHMC Family Health Clinic
GCACI Global Comprehensive Abortion Care Initiative
IEC Information, Education, Communication
IPPF International Planned Parenthood Federation
IUD Intra Uterine Device
LHV Lady Health Visitor
MA Medical Abortion
MR Menstrual Regulation
MVA Manual Vacuum Aspiration
NGO Non-Government Organisation
PAC Post Abortion Care
R-FPAP Rahnuma – Family Planning Association of Pakistan
SRH Sexual and Reproductive Health
VCAT Value Clarification and Attitudinal Transformation
YRC Youth Resource Centre
1. INTRODUCTION
1.1. The Concept
Abortion stigma can be defined as a shared understanding that abortion is morally wrong and/or socially unacceptable. The stigma of abortion manifests within multiple levels, including media, law and policy, institutions, communities, relationships, and individuals. Abortion stigma is experienced through a) negative attitudes, affect, and behaviors related to abortion and b) inferior status experienced by women who seek abortions or who have abortions, abortion providers, and others involved in abortion care. Abortion stigma leads to the social, medical, and legal marginalization of abortion care around the world and is a barrier to access to high quality, safe abortion care.
Abortion stigma is a major barrier to adequate reproductive health care for women and a primary challenge for service delivery providers to address. Stigma contributes to legal restrictions on abortion that are accompanied by criminal penalties directed at women and abortion providers. In addition to the legal barriers, stigma shames and silences women who seek abortion services, marginalizes abortion providers, and contributes to myths and misperceptions about abortion in communities. Abortion stigma appears in many parts of the world, though it manifests differently according to law, culture, and religion. It is within these stigmatizing environments that organizations, communities, and individuals are engaged in innovative service-delivery programs to bring safe abortion services to women. Dedicated people, sometimes in incredibly difficult circumstances, conduct these programs.
1.2. The Context
In Pakistan, abortion is legally allowed only to save the life of a woman or to provide "necessary treatment" early in pregnancy. Given a lack of clarity in interpreting the law, legal abortion services are difficult to obtain, and most women who have an abortion resort to clandestine and unsafe procedures.
In 2012, there were approximately nine million pregnancies in Pakistan, of which 4.2 million (46%) were unintended (it was 38% in 2002). The unintended pregnancy rate increased between 2002 and 2012, rising from 71 to 93 per 1,000 women aged 15–49. Of these unintended pregnancies, 54% resulted in induced abortions and 34% in unplanned births.
The national abortion rate was 50 abortions per 1,000 women aged 15-49 (it was 27 in 2002). There were an estimated 2.25 million induced abortions, most of them clandestine, placing women's health and lives at risk. In 2012, an estimated 623,000 Pakistani women were treated for complications resulting from induced abortions, the vast majority of which were performed by unqualified providers or involved traditional methods. About 63% of treated women obtained post-abortion care in private facilities. The national treatment rate for complications from induced abortion was 13.9 per 1,000 women aged 15–49 (it is 5 to 10 per 1,000 women in most countries).
According to figures provided by line departments and NGOs working in the Pakistani health sector, every year 8,90,000 unsafe abortions occurred, resulting in 1,97,000 hospitalizations due to complications, and 800 deaths. However, a large number of cases handled by unauthorized persons went unreported.
1.3. The Project
The project 'Abortion Stigma, The Unseen Barrier to Young People' was designed to address the manifestations of stigma at the individual, community and organizational level that prevents young women / girls from accessing abortion services. The specific objectives were:
Sharing, learning, developing IEC material & advocacy with community and service providers;
Encourage young people through frequent visits, sensitization sessions to feel free and comfortable in accessing services with frequent interactive session
Overcome socio-cultural barriers through capacity building training conducted with providers, peer educators and counselors on VCAT & de-stigmatization, and
Documentation and dissemination of project outcome and learning.
Analysis of youth abortion services at Rahnuma-FPAP Head Office revealed that abortion services among youth in three districts Chakwal, Faisalabad and Rawalpindi needed to be strengthened. R-FPAP was already providing abortion services in these districts through programs like ASK (Access, Services, Knowledge), GCACI (Global Comprehensive Abortion Care Initiative), and CHOICE. It was decided to integrate these programs in the districts to address the issue of abortion stigma.
A two-year project was launched in 2014 by R-FPAP with a USD $74,436 grant from the Packard Foundation through IPPF, with the possibility of an extension to a long term project based on performance. The project success indicators included the following:
Number of abortion and abortion related services provided to girls/ women under 25 years of age
Level of stigma at the clinic level as measured by client self assessment questionnaire
Percentage of young women who access abortion and abortion related services and report being satisfied with quality of care received
Level of stigma at the community level as measured by the number of referral for abortion or abortion related services made by peer educators or other community members
2. SUCCESS STORIES
There are a large number of stories of successful outcomes for young women and girls as a result of project activities. A few of these were documented by staff working directly with women in Chakwal, Faisalabad and Rawalpindi districts. These successes are described in the following pages. The names of the beneficiaries have been converted into abbreviations to avoid identification and maintain confidentiality, which is a major contributory factor in increasing access to and satisfaction from project activities. The pictures in the text are unrelated to the actual cases.
In addition a number of clients have themselves described their positive experience of the project, and expressed their thankfulness to R-FPAP for helping them out in their time of need. These stories are given in the Annexure as Case Studies.
2.1. District Chakwal
CU, Chak Umra, Chakwal
CU was 16 years old from a middle class family. She was depressed as she had been raped by her cousin, and was considering suicide. She came to Family Health Clinic (FHC) Chak Umra, but, due to feelings of shame, she did not share her problem. The LHV observed her depressed face and tried to console her. After a while CU agreed to share her feelings, and starting weeping. The LHV counselled her in a very friendly way, and assured her of the confidentiality of all information, because of which CU agreed to avail her services. The LHV conducted her Medical Abortion (MA) and asked her to pay a follow up visit.
During the follow up visit CU was very happy and said "You are a life saviour. If you did not help me I would have committed suicide." Now she is very satisfied with her decision and is living her life in a positive and healthy manner. She was very thankful to the entire R-FPAP team.
NB, Chak Umra, Chakwal
NB belongs to a middle class family. Her husband is a daily wage labourer. She was depressed due to an unwanted pregnancy. She did not want to continue the pregnancy because of poor health and her pre-occupation with her other children. She came to the Family Health Clinic (FHC) Chak Umra for some guidance to relieve the unwanted and unplanned pregnancy. She disclosed that her husband did not want to use family planning, nor was he willing to take any action regarding her unwanted pregnancy. After taking some test at the FHC, she was counselled regarding how to lead a healthy life and termination of the unwanted pregnancy. The LHV provide her Menstrual Regulation (MR) services. When NB returned after 15 days for follow-up services, she requested for a Bilateral Tubal Ligation (BTL). The LHV referred her to the R-FPAP Model Clinic, where she received BTL services from a trained service provider.
Now NB is highly satisfied by her decision, and her health has also improved. She was very thankful to the entire R-FPAP team, and said that she would refer other clients to availing the services, as she was much impressed by the advantages of BTL services.
ZA, FHC Karyala, Chakwal
I am Sonia, LHV in-charge of FHC Karyala. ZA, a young girl of village Karyala, was engaged with her cousin who lives in Rawalpindi. She visited Rawalpindi on her cousin sister's marriage. There she met her fiancé, and got pregnant. She visited the FHC Karyala. After the counselling procedure, I conducted her pregnancy test, which was positive. I suggested a medical abortion, to which she agreed. We conducted her medical abortion, thereby saving her honour and her future life.
RP, Village Pir Pholai, Khanpur, Chakwal
RP, age 45, has eight children and her husband is a daily wage labourer, while she also works outside the home. She was pregnant, but due to her poor financial condition, she could not afford another child. Moreover, her daughter was married, and RP thought that having another child would have a negative impact on her family. RP was afraid of getting an abortion, but was convinced by SH, an R-FPAP client who was very happy from our services. RP came to our centre with SH, and after receiving counselling and assurance of complete confidentiality, she agreed to have an abortion. Now her medical abortion is completed, and she is very satisfied with the services.
2.2. District Faisalabad
SJ, Faisalabad
SJ is 38 years old. She has four children and comes from a poor family. She is 15 years younger than her husband and got married at the young age of fifteen. In the initial years of her marriage, she was treated by a local untrained birth attendant and tried several home remedies for conceiving a child. When none of the efforts worked, she adopted her sister's daughter.
After eight years of marriage, SJ conceived her first girl child and thereafter delivered four children without using any contraception. Her husband was not in favour of birth spacing and also wanted more children, as SJ conceived their first child late by traditional standards. Her health started worsening because of the lack of birth spacing and due to excessive workload and a malnourished diet.
When she delivered her fourth child, SJ immediately became pregnant again, but she was not mentally or physically prepared for this pregnancy. She got some pills to abort the foetus. Her health worsened and she went to the hospital in emergency, where she had to disclose that she had taken medicine for terminating the pregnancy. Her husband blamed her, and her entire family labelled her a "Murderer" or "Killer", as induced abortion was considered murder in local traditions. This incident isolated her from the community and scarred her emotionally and psychologically, leaving her depressed. Out of frustration and to relieve the stress, she started beating her children and animals.
SJ shared her feelings and guilt about her abortion with her friend, who was also a peer educator. The peer educator counsellor cleared all her apprehensions related to religion, and invited her to attend an awareness sensitization session. At the session SJ learnt that Islam permitted abortion up to 120 days. Although there is no actual approval of abortion in Islam, there is no permanent ban on it either. In fact there are no precise guidelines/instructions with regard to the issue of abortion in Islam, and it is possible if carried out as necessary medical treatment (which includes mental and psychological health of a pregnant female during the initial stages of pregnancy).
When SJ aborted her foetus, she was physically unable to bear anymore children. Her confidence and self-esteem helped eliminate her guilt about this. According to her the awareness session entirely changed her opinions and feelings, which helped her to face her family and friends and also enabled her to understand that every woman has the fundamental right to decide the number of children she wants.
ZB Faisalabad
ZB is a 30 years old woman who has passed primary school (class five). She got married at the age of 20. Her husband was unemployed at the time of their marriage and had to start working immediately after on various vegetable farms to earn a living.
Her first pregnancy ended in a miscarriage, as she was unaware that she was pregnant. Six months after getting a D&C done, she got pregnant again. Subsequently, she delivered all three of her children one after the other without any birth spacing. But after her third child she started taking contraceptive pills. These had an adverse effect on her health, causing chronic allergy and irregularity of menstrual cycle. She suffered infections, vomiting and weakness throughout all her pregnancies.
ZB was informed about the advantages of the awareness session. Her husband was supportive regarding her participating in the session and her decision to opt for the MVA service at the clinic. However, he only had limited information regarding safe abortion, which was not feasible for her. Now she gets monthly contraceptive injections free of cost. She also wanted R-FPAP to organize more awareness and advocacy related sessions, as the demand for SRH was high but availability of information was extremely limited.
2.3. District Rawalpindi
AB, Rawalpindi
AB and her husband had a history of thalassemia, because of which their son was receiving regular blood transfusion. She was worried that she might be carrying a baby with thalassemia major. She was advised CVS (Chronic Villous Sampling), and the report showed that the baby was suffering from thalassemia major. AB did not want to have another baby with thalassemia, as she already had a son with thalassemia, and could not bear the additional burden. She underwent MVA at UCD-4 clinic, successfully recovered with good health, and adopted contraception after recovering.
AB is enlisted as a satisfied client and is a peer educator regarding abortion services at our clinic. She is an active member of our sessions under abortion stigma at our clinic, and participates in all our activities.
XY, Rawalpindi
XY is 19 years old, unmarried with a primary education. She is the youngest of 5 siblings. Her father is a wage-labourer. One day, she along with her parents, went to their village in Peshawar to attend a family marriage. While she was asleep, and all the members of the family were away, an unknown person came and raped her. Due to family clashes and rivalries she could not disclose her experience in the village. On returning to Rawalpindi she narrated the whole story to her family. Her mother was extremely upset, as the social stigma and the economic and cultural repercussions of this act were too much to bear. She approached the Family Health Clinic in UCD-4. After proper consultation, counselling, and lab investigations her MVA (Manual Vacuum Aspiration) was planned, and was successfully conducted by the team at UCD-4. The patient was advised to follow up again after a week for check-up or for any problem that she felt. After one week she came back with her mother. She was satisfied and said that her problem was safely guarded and solved by our team. She is now our regular patient, and frequently visits with her problems regarding her health.
CD, Rawalpindi
CD visited UCD-4 Clinic for contraceptive services. She was worried as her son-in-law had sexual relationships during postpartum period of her daughter, and she was afraid that her daughter would conceive again. She could not afford another pregnancy immediately after having a baby. CD was counselled about the ways to prevent unwanted pregnancy and provided emergency contraceptive pills to cater the problem. She went back satisfied.
CD is a regular visitor of family planning services. She is enlisted as a satisfied client and a peer educator regarding family planning services at our clinic. Her four unmarried young daughters joined the Youth Resource Centre (YRC) for stitching course. They are active members of our sessions under Access, Services and Knowledge (ASK) project at UCD-4 clinic and participate in all our activities.
3. BEST PRACTICES
An analysis of the success stories and case studies reveals a number of best practices carried out by the project which have contributed to the successful outcomes identified by clients and service providers.
The project identified and presented the laws of the country with regard to abortion in a clear and unambiguous manner. One of the critical points was the Shariat Court of Pakistan ruling regarding the consensus among the major schools of Islamic thought that there was ensoulment in the foetus at 120 days. Moreover, Islam considers the life already present in the world as taking precedence over the one that is yet to come. Hence, if after 120 days, termination of pregnancy is required to save the mother's life, then it is permitted.
Post-abortion care is an appropriate intervention regardless of the country's legal status regarding abortion. Thus the project effectively used the following elements of post-abortion care:
Treatment of incomplete and unsafe abortion and abortion related complications
Counseling to identify and respond to women s emotional and physical need
Contraceptive and family planning counseling and referral to help women prevent unwanted pregnancies.
Reproductive and other health services
Community and service providers' partnership to prevent unwanted and unsafe pregnancies.
The project also made good use of IEC materials to get the message across, both for men and women, young and old. The material was contextualized to increase its relevance and impact. For example, a movie "Betiyan" (daughters) highlighted the problems related to abortion faced by young women and girls in Pakistan from two different perspectives and social classes. The facilitated discussion that followed was able to bring out the impact of the movie on the viewers, including a subtle change in their values as they found themselves in the shoes of the protagonist young women and girls. In the words of a viewer: "One's values and experiences change when one is in the situation himself as opposed to when one is taking decisions for others." The project was also able to directly measure the impact of IEC materials by having participants fill out a post-workshop test.
Another effective technique used by the project for attitude change was VCAT (Values Clarification and Attitude Transformation). Through this approach the project was able to increase understanding and change negative attitudes toward abortion of service providers, community members, and the young women and girls themselves. This was a direct approach to influence abortion stigma, and it proved quite effective.
Engagement of youth peer educators was also an effective project strategy. Many of the women in the success stories and case studies mentioned the role of peer educators in informing them of the existence of SRH facilities, with a number of them accompanying women to the clinics and reassuring them regarding the quality and confidentiality of services.
In many of the success stories clients emphasized the fear of disclosure, or having to answer embarrassing questions, and being relieved when the service provider dealt with them in a non-judgmental, empathetic (not sympathetic) and professional manner, and also re-assured them both with regard to the confidentiality and the outcome of SRH services. In addition, the low cost and high quality of services were critical factors in helping women to benefit from the services, and in turn spreading the message in their family and social circle. Thus the project was also able to reach clients not directly targeted by the project. This also expanded the referral system of the project.
In the stories one can see the clear difference between the practices followed by the private sector health services, and those followed by the project. In the private sector, the main focus is on making a fast buck, with little attention to the quality of services (e.g. unqualified and untrained providers), the attention to sterilization and sanitization (often resulting in infections), the lack of protocols (e.g. educating the client about services, getting consent of client or husband, etc.). On the other hand the project made great effort to inform the client about the services, getting their consent and, where essential, the written consent of their husband, and following strict hygienic principles. And all services were provided by qualified and trained staff, who also had been trained in empathetic communication and counselling skills.
4. LESSONS LEARNT
Family planning was high on the agenda of governments during the first thirty years of Pakistan, resulting in a significant slowing down in the population growth rate during that period. However, the advent of a regressive and reactionary government in the seventies resulted in viewing family planning as 'un-Islamic', leading to decreasing budgets and disbanding of national media campaigns for child spacing and use of contraceptives. As a result the steady growth in contraceptive practices and decreasing family size slowed down, and Pakistan was left far behind other Muslim and Asian countries with regard to population control.
The project corroborates the evidence emerging from research studies that there is a high unmet need for contraceptive services in families - in 2012 46% of all pregnancies in Pakistan were unwanted. The state's failure to meet its constitutional obligation of providing free quality health care to its citizens is reflected in the meagre budget for health care, most of which is spent on tertiary rather than primary health, with an emphasis on curative as opposed to preventive health, and regressive laws, which leave no room for abortion of unwanted pregnancies.
The gap is mainly filled by private providers, many of whom lack the skills, commitment, and resources to provide the required services, while many take advantage of weaknesses in the abortion laws to provide clandestine services of dubious quality at a high cost, putting women, families and babies both at health and financial risks.
The project has shown that the issue is complex, and needs to be tackled at multiple levels, including education of the community, access to safe and low cost abortion services which protect all client rights (e.g. privacy, confidentiality, informed decision making, choice of number of children, child spacing, and contraceptive method), involvement of youth and peer educators, encouraging satisfied clients to bring new clients to the service.
The project has been strategic in focusing on services which are legal and non-controversial (e.g. unwanted pregnancies of married couples, women whose life is at risk, etc.), while avoiding highly controversial issues (e.g. abortion of pregnancies resulting from extra-marital sex). At the same time the project did not adopt a simple legalistic approach; rather it used a rights based approach where women and families desiring to abort pregnancies for valid reasons (e.g. rape, family complete, need for spacing, non-affordability, health reasons) were provided necessary services in a discreet manner. Also when women had legitimate and urgent reasons to get an abortion but were not in a position to disclose it to their in laws or get their permission, the project provided women the space to make their own choices and to get safe abortion services in a discreet manner.
The presence of a large number of satisfied clients and peer educators has created a positive momentum which, if maintained and supported, could lead to shifts in societal attitudes towards abortion and other SRH issues which could, in the long term, lead to changes in the country's legal structure as well. However, this would be a long and arduous journey, and would require champions at many levels to see such a movement grow and flourish. A close collaboration between government agencies, civil society actors, SRH providers, and community leaders can go a long way in building and sustaining a movement for the improved health of mother and children in Pakistan.
ANNEXURE: CASE STUDIES
DISTRICT CHAKWAL
AZ, Chakwal
I am AZ. When I was 12 or 13 years old and had my first menses, I was sold in forced marriage to a 45 years old married man based in Peshawar (my four sisters had also undergone a similar experience). I had to live with my husband's wife and children. My husband and his wife often beat me, and my husband also abused me sexually.
After the birth of my third baby I was expecting again, but my in-laws accused me of having illicit relationship with someone else. I was thrown out of my home and, finding no refuge, I had to come back to my parents. As my parents were vulnerable and poor, I started working as a domestic servant. The daughter of another servant was working with some NGO. She took me to a session where I got awareness on how to get out of this problem safely.
Since then, AZ has attended several awareness sessions and meetings arranged by R-FPAP. After her participation in the sessions that addressed most of her concerns pertaining to safe abortion services, she got a medical abortion. Due to AZ's determination and active participation, she was nominated to be a champion for supporting women in accessing safe SRH services within her community.
TH, Bhagwal, Chakwal
My name is TH. I have two children. My younger child is 6 years old and I conceived again. When I shared the news with my husband, he did not take it positively and said that he could not afford another baby. I got nervous and decided to visit the FHC Bhagwal for consultation. I shared my problem with the LHV in-charge. She patiently listened to my reasons for wanting the abortion, and advised me to take a medicine, adding that it would do the needful, and nobody will know about it, included my in- laws. She said that it would be like a regular menstruation. I took the medicine, and the issue was resolved. Nobody expect my husband knew about it. The method was so impressive, and I am very happy and satisfied from it. If my friends are in any trouble like me, I will refer them with confidence to the FHC for consultation and treatment.
MV, FHMC, Chakwal
I don't want to share my name, but I am narrating my MVA story. When I discovered that I was three months pregnant, I was in shock as my family was already complete. I visited a nearby private hospital and told them about my unplanned pregnancy. They charged ten thousand rupees and aborted the pregnancy. At home I felt pain in my abdomen and started bleeding. I again visited the hospital, where they gave me two injections, and said everything would be alright soon. On the second day, I was suffering from panic bleeding and fever. My neighbour visited my house and showed concern on my situation. She suggested that I visit the FHMC. I discussed with my husband and he agreed to accompany me.
At the FHMC I shared my situation and medical history. They examined me very deeply, and the doctor suggested Manual Vacuum Aspiration (MVA), a fast and safe way to empty the womb. I agreed and got the procedure done, along with medication. The doctor advised me to use the authentic family planning method the next time.
The atmosphere of the FHMC impressed me, and the MVA method was less painful. I am very satisfied. I pray for all those concerned staff that saved my life. Now I refer people to the FHMC to avail the services in confidence.
SS, FHMC, Chakwal
My name is SS. I have three children. I am using Depo Injection for family planning. Because of my casualness, I conceived. When I told my husband, he did not take it seriously. I was in deep stress because my husband said that he could not afford another child. I got nervous and discussed it with a family member, who referred me to the FHMC Chakwal. At the FHMC the doctor conducted a detailed examination, and listened to my reasons for the abortion in an empathetic manner. She gave me the consent form to be signed by my husband. After the completion of formalities, the doctor advised me medicines for two weeks. On my next visit after two weeks, I was relieved to learn that the pregnancy had been aborted. The doctor recommended that I be very regular in using the family planning method (Depo injection). I am following her instructions, and have been free from pregnancy since.
DISTRICT FAISALABAD
SQ, FHC Malikpur, Faisalabad
My name is SQ. I am 24 years old. I live in Malikpur Chak No. 203 RB Faisalabad. Eight months ago I visited FHC Malikpur with severe pain and vaginal bleeding. The doctor checked me carefully, and informed me that I had undergone a miscarriage, but the abortion was incomplete. She recommended that I undergo an MVA, and explained the whole procedure. I was very scared, but, thanks to her excellent counselling, I agreed to the MVA. After the MVA I was informed regarding contraceptive measures, and I had the Copper T IUD inserted. I have been free of pregnancy since, and am in good health. I have referred many people to the FHC, and they are also highly satisfied with their services. Thank you, Rahnuma!
SA, FHC Malikpur, Faisalabad
My name is Sana and I am 18 years old. I got married 8 months ago, and got pregnant 3 months after marriage. Two months into my pregnancy I experienced severe pain. My mother-in-law took me to a local dai (untrained mid-wife), who told me that I had miscarried and the womb would have to be cleaned. With the permission of my mother-in-law the dai cleaned my womb. The procedure was very painful, and I had continuous bleeding for a week. My mother-in-law took me to the same dai three times. She gave different medicines, but there was no improvement.
On seeing my condition a friend advised me to get checked up from the Youth Resource Centre (YRC) where she was a peer educator. I took my husband's permission and went to FHC Malikpur with my friend. The doctor checked me thoroughly and also conducted an ultrasound. She told me that the cleaning was incomplete, and many pieces of the foetus were inside. She advised an MVA, and explained the procedure. She conducted the MVA, gave me medicines, and also explained various contraceptive methods. With my husband's permission I had a Copper T IUD inserted. I am fine now, and wonder that if my friend had not brought me to the clinic, I may not have been alive today.
Thank you, Rahnuma!
SL, FHC Malikpur, Faisalabad
My name is SL. I am 22 years old. I live near the Pasha General Store in Malikpur. I became pregnant 11 months ago, but I did not want to become a mother. A friend of mine told me that if I went to FHC Malikpur, the doctors and staff there would help. I went to the clinic with my friend. I was worried that they would ask me many questions, but they did not ask any questions except those related to my health. They told me about MVA, and performed the procedure with my consent. It was painless and trouble free. Later the doctor told me about various contraceptive procedures, and I selected the condom for this purpose. I am happy that this clinic is helping needy women like me. Thank you, Rahnuma!