Abortion and fertility control in Pakistan: the role of misoprostol

Objective To examine how availability of misoprostol has impacted women's abortion-seeking behaviour in Pakistan. Design Focused ethnography. Setting A facility providing reproductive health services, including induced abortions in Chakwal, a small town in Northern Punjab, Pakistan. Population Women who came to the clinic seeking an abortion or who had had one in the last 6 months (n=23) and all healthcare providers working in the facility (n=14). Methods Semi-structured interviews (n=37), a focus group discussion (n=1) and participant observation (n=41). Latent content analysis was conducted drawing on principles of constant comparison to generate key themes in reported experiences. Results All the respondents had sought an abortion to limit their fertility. Although some reported contraceptive use, improper use, undesirable side effects and restrictions on use had led to the unwanted pregnancy. All the women specifically requested misoprostol within days of their pregnancy, suggesting that they not only had knowledge of misoprostol as a backup in case of contraceptive failure, but may have pre-planned its use of in place of using contraception. Women reconciled their decision to undergo an abortion by describing it as a mistake, miscarriage or menstrual cycle issue. Conclusions Misoprostol's availability, ease of use and effectiveness have increased the role of abortion in fertility control.