Abortion and unintended pregnancy in Pakistan: new evidence for 2023 and trends over the past decade.

IF 6.1 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH BMJ Global Health Pub Date : 2025-01-30 DOI:10.1136/bmjgh-2024-017239

Zeba Sathar, Susheela Singh, Iqbal H Shah, Muhammad Rehan Niazi, Tahira Parveen, Octavia Mulhern, Ali Mohammad Mir

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Abstract

Background: Despite induced abortion being highly legally restricted in Pakistan, studies in 2002 and 2012 showed that many women rely on abortion when faced with an unintended pregnancy. Following the 2012 study, concerted efforts were made to improve contraceptive services and to strengthen postabortion care. The availability and use of misoprostol also expanded in the past decade. Our primary objective was to provide new evidence on the rates of unintended pregnancy, induced abortion and postabortion care in 2023 and to assess trends in these outcomes since 2012.

Methods: This is a cross-sectional study based on a Health Professional Survey, and a nationally representative Health Facilities Survey, conducted in 2023. A widely applied methodology is used to estimate rates of abortion and unintended pregnancy. Data sources and methods are comparable across the 2012 and 2023 studies.

Results: In 2023, an estimated six million unintended pregnancies occurred and 64% of them or 3.8 (95% CI 2.2 to 6.4) million resulted in induced abortions. This corresponds to an annual unintended pregnancy rate of 100 and an induced abortion rate of 66 (95% CI 38 to 111) per 1000 women aged 15-49. There was no significant change in the unintended pregnancy rate, but the abortion rate increased by 25% between 2012 and 2023. In 2023, 697 913 women were treated for postabortion complications, corresponding to an annual rate of 12.1 (95% CI 6.4 to 16.5) per 1000 women ages 15-49. This treatment rate declined by 16% between 2012 and 2023.

Conclusions: The unintended pregnancy rate has remained stable in the past decade. However, Pakistani women are increasingly relying on abortion to resolve unintended pregnancy. The treatment rate of postabortion complications has declined, owing largely to widespread access to misoprostol. This transformation of the abortion landscape calls for concerted efforts to increase contraceptive use and strengthen postabortion care.

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巴基斯坦的堕胎和意外怀孕：2023年的新证据和过去十年的趋势。

背景：尽管巴基斯坦严格限制人工流产，但2002年和2012年的研究表明，许多妇女在面临意外怀孕时依赖堕胎。在2012年的研究之后，为改善避孕服务和加强流产后护理作出了协调一致的努力。米索前列醇的可得性和使用在过去十年中也有所扩大。我们的主要目标是提供关于2023年意外怀孕、人工流产和人工流产后护理率的新证据，并评估自2012年以来这些结果的趋势。方法：这是一项基于2023年进行的卫生专业调查和全国代表性卫生设施调查的横断面研究。一种广泛应用的方法被用来估计堕胎和意外怀孕的比率。2012年和2023年研究的数据来源和方法具有可比性。结果：2023年，估计发生了600万例意外怀孕，其中64%或380万例（95% CI 2.2至640万）导致人工流产。这相当于每1000名15-49岁妇女每年意外怀孕率为100例，人工流产率为66例（95% CI 38 - 111）。意外怀孕率没有明显变化，但堕胎率在2012年至2023年间增加了25%。2023年，697 913名妇女因流产后并发症接受了治疗，相当于每1000名15-49岁妇女的年发生率为12.1（95%可信区间为6.4至16.5）。2012年至2023年期间，这一治疗率下降了16%。结论：近十年来意外妊娠率保持稳定。然而，巴基斯坦妇女越来越多地依靠堕胎来解决意外怀孕。流产后并发症的治疗率已经下降，这主要是由于米索前列醇的广泛使用。堕胎情况的这种转变要求各方共同努力，增加避孕药具的使用，加强堕胎后护理。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

BMJ Global Health Medicine-Health Policy

CiteScore

11.40

自引率

4.90%

发文量

429

审稿时长

18 weeks

期刊介绍： BMJ Global Health is an online Open Access journal from BMJ that focuses on publishing high-quality peer-reviewed content pertinent to individuals engaged in global health, including policy makers, funders, researchers, clinicians, and frontline healthcare workers. The journal encompasses all facets of global health, with a special emphasis on submissions addressing underfunded areas such as non-communicable diseases (NCDs). It welcomes research across all study phases and designs, from study protocols to phase I trials to meta-analyses, including small or specialized studies. The journal also encourages opinionated discussions on controversial topics.