Most people think abortion is illegal in Pakistan, but according to an amendment in the law from 1997, abortion up to the first trimester is allowed if it is considered “necessary treatment” to preserve a mother’s health or life. The phrase is deliberately broad so that it covers emotional, mental, and physical health issues that threaten a mother’s well-being. And abortion is also permitted in the first trimester if it is a pregnancy resulting from rape or with gross fetal abnormalities. After that, it is permitted in order to save a woman’s life.
The previous law which criminalized abortion completely and punished providers with fines and jail terms was a remnant of the British Penal Code from 1860.
The current law was amended after consultation with Al-Azhar University by the government of the time, to make sure that it follows the Sharia. The scholars at Islam’s foremost authority deemed abortion in the first trimester permissible not just to save a mother’s life but also to save her health — an important distinction that also follows Islamic injunctions to privilege the mother’s life above that of an unborn fetus.
Medical science confirms that in the first trimester, a fetus has no heartbeat, cannot feel pain, and is not a sentient being in any way. What is astonishing is how compassionate Islam is towards women facing heartbreaking situations but who still need to have autonomy over their bodies.
Furthermore in Pakistan, while a service provider is allowed to voice a conscientious objection to providing a safe abortion, she or he must refer the patient to another provider. This can be found under Standard 26 of those guidelines, in article 8 under Conscientious Objection. If that isn’t possible, the service provider must provide the abortion, even while objecting. This is in both the federal and Punjab provincial guidelines on abortion services. (It is important to remember that there are two types of abortions, spontaneous, which is commonly called miscarriage, and induced)
Where we fall down is in the medico-legal textbooks, that omit mentioning this change in the law. As a result thousands of medical students and doctors do not realize that abortion is legal and also permissible in Sharia. In fact, most people use the term “illegal abortion” incorrectly. It does not refer to an abortion carried out on an unwed woman; but rather to an abortion carried out by someone who is not a licensed medical professional or health services provider.
However, the arrival of the abortion pill in Pakistan is a game changer and is revolutionizing the way Pakistani women are accessing safe abortions. Fewer D&C procedures are being given, with even midwives and dais are giving medication-induced abortions to their patients. And while family planning is the only way to reduce the number of terminations in Pakistan, the need for the service will never completely vanish.
Even now, 2.2 million women get abortions in Pakistan every year — that’s 350 abortions every hour. The vast majority of those women are married, with three or four children already, who cannot and do not want to have another child. Women will always find a way to have an abortion. It is up to us to decide if they will be able to do that safely and with dignity, or in a way that keeps the maternal mortality rate so high that the ratio between men and women in our population becomes even more unbalanced — it is already unequal because of maternal mortality, including death in high-risk pregnancy and childbirth.
And with women suffering from nightmarish complications from unsafe abortions, such as perforated uteruses or sepsis, and with backstreet abortion methods like stuffing rags dipped in sulfur into women’s vaginas, it should be pretty obvious what our responsibilities are towards women and their health.