To improve Pakistani doctors’ ability to provide better care to women, the National Committee for Maternal and Neonatal Health (NCMNH) and Ipas worked together to train doctors in postabortion care (PAC) in Karachi. The NCMNH works to reduce Pakistan’s high rate of maternal deaths, with the ultimate goal of providing enough skilled health-care personnel for every pregnant woman in the country.

Postabortion care provides effective, quick treatment of life-threatening consequences of miscarriages or induced abortions. Doctors learn how to use manual vacuum aspiration (MVA) and medication approaches to PAC. The training also includes contraceptive counseling skills and providing information about reproductive health services.

As a part of the project, NCMNH is in the process of modifying the Ipas PAC manual according to the social, cultural and religious environment in Pakistan.
During a clinical-skills training session in late October 2007, NCMNH and Ipas provided PAC training to 18 doctors, who will in time train other Pakistani health-care professionals in PAC.

The training sessions in Pakistan also included an advocacy component, providing information on women’s rights, the international human-rights movement, and the specifics of Pakistan’s abortion law in context with legal and religious frameworks. 

Health-care providers in Pakistan face an uphill battle. Long distances between rural communities and places to receive health care, limiting gender norms, and poorly maintained roads, prevent many women from even reaching health facilities. Hospitals and clinics are crowded, and they often lack funds and equipment. Like many other developing countries, Pakistan has a shortage of skilled health-care workers, particularly nurses, which strains all areas of provision of care.

Fortunately, the PAC training provided an enormous benefit to the doctors who received it, said Dr. Azra Ahsan, technical consultant to NCMNH and lead facilitator of the training. “The fact that, with this new technology, [services] can be provided literally at the patient’s doorsteps without the need for expensive resources and an anesthetist is a big advantage,” Ahsan said.

NCMNH and Ipas’s reputation for high-quality PAC training has spread throughout Pakistan and has created a demand for training in PAC both in the public and private sector.

Having seen firsthand the effects unsafe abortions and miscarriages without proper treatment can have on women, the doctors were eager to learn safer medical practices. Ipas’s Amina Mazhar, who spoke with the doctors about human rights, said she was pleasantly surprised by the doctors’ interest in learning about what services they could provide and how PAC fits in with human and women’s rights.

“We were approaching the issue very cautiously because of the stigma associated with abortion in Pakistan, but there was a very strong demand for information,” Mazhar said. “It was great to hear people demanding more material and resources.”

Mazhar was also impressed with the ingenuity of the lead trainers in Pakistan and of the hospital staff in overcoming obstacles to providing care. In the federal hospital where the doctors received their training, post-graduate fellows took on support roles to overcome shortages of nursing staff.  After visiting Nepal on an early training session, four Pakistani doctors re-equipped their procedure room, applying the best of what they saw from the Nepalese hospital, adapting it to their own situation and adding their own innovations.

The training session was part of what will be a continuing effort to improve postabortion care in Pakistan. A second workshop is scheduled for December 2007, in which some of the trained providers will impart their newly acquired skills to additional doctors in Pakistan.