Pakistan

OVERVIEW

In Pakistan, contraception (birth control) can be legally obtained without a prescription. While many Pakistani women do not use modern contraceptive methods, you can find condoms, birth control pills, IUDs, shots, injectables and more. You can also purchase emergency contraception (the morning after pill) without a prescription at pharmacies, health centers or clinics, and there are no age restrictions. The lowest cadre of health worker who is allowed to sell or dispense EC are auxiliary nurse midwives. You can receive STD/STI tests in Karachi, and there are no travel or residency restrictions attached to HIV status. Currently, there are no national programs in place for PrEP or HPV vaccines. Maternity care is provided for generally 45 days. If you are seeking out an abortion, it is only permitted in a few special circumstances, which we detail below. Many women in Pakistan resort to unsafe clandestine abortions every year, which are not recommended. Rather, if a woman is interested in seeking out an abortion, we provide recommended resources to help you in the "Abortion" section below.

Contraception (Birth Control)

General Note: There are many types of contraceptives, also known as "birth control," including IUDs, oral contraceptives, patches, shots, and condoms, etc. If you would like to view a full list, click here.

Laws & Social Stigmas

In Pakistan, contraception (birth control) is available without a prescription. It is estimated that 38.5% of Pakistani women use some form of contraception. The most popular methods are male condom (9.9%), female sterilization (9.8%), withdrawal (8.4%), injectable (3.2%) and IUD (2.6%). The Pakistani government is concerned about the surging population and maternal mortality rate, so it has sought to emphasize family planning. However, contraceptive usage remains fairly low. This can be partially understood through the social, political and religious lens of modern Pakistan.

The Family Planning Association of Pakistan (FPAP) was founded in 1953. The founder, Saeeda Waheed, was an advocate of birth control. FPAP was a part of Third Five Year Plan (1965–1970), which helped lay the foundation for Pakistani family planning strategy. During that period, the main contraceptive method switched from condoms to IUDs. Yet, in 1977, the government of General Zia ul-Haq banned publicity for family planning, amidst extreme political turmoil and the declaration of martial law. After Zia's power ended, family planning and population control went under the Ministry of Health, which has unfortunately remained fairly unchanged for the last 35 years. In recent years, there has been an effort to bring health care providers to women's homes, similar to the successful Bangladeshi door-to-door services. Yet, Pakistan's family planning policies still lag behind other Muslim nations, like Iran and Bangladesh, while military spending takes precedence over many other aspects of Pakistani society, including family planning. As reported by the Washington Post in 2011, "Over 50 years, Pakistan’s fertility rate has dropped from about six children per woman to an average of about four. But the decline has been far too slow for the country to reach its target of 2.2 children per woman by 2020."

Aside from political issues, cultural and religious issues also play a large role. In Pakistani society, husbands, mullahs and mother-in-laws can play crucial roles in determining women's decisions. Contraception is shunned in traditional Islam, and the Pakistani religious political party has called contraception "un-Islamic." However, the largest determining factor does not appear to be religion. Rather, it is the familial pressure (especially from husbands and mother-in-laws) to have large families. When most Pakistani women get married, they move into their husband's family's home. At that house, they are often expected to become mothers to many children. When health care workers visit these homes, the mother-in-law usually answers the door, and it is common for the mother-in-laws to see no need for their son's wives to take contraceptives. Furthermore, husbands commonly feel that contraceptive decisions for their wives should be determined by Islam or their own mothers (who "know best").

Currently, Greenstar and Marie Stopes are some of the leading providers of family planning in Pakistan. However, the organizations recognize that they are a "drop in the bucket" and that family planning must be embraced community by community.

What to Get & Where to Get It

• Condoms - While you can find condoms sold in many stores, especially in larger cities like Karachi, it's often difficult for women to purchase them. This is because store owners may refuse to sell condoms to unmarried women. Furthermore, women may feel too uncomfortable to purchase condoms, and men may not feel as strong of an inclination to purchase them. To read more about the challenges related to purchasing condoms in Pakistan, click here.
• Birth Control Pills - While many women face social or religious pressure in Pakistani society, they have the legal right to purchase birth control. Some birth control pill brands in Pakistan are Ovral, Famila-28, Lo-Femenal, Microgynon-30, Novodol, Yasmin, Desogen, Alesse and Nordette. You can get birth control pills at pharmacies, health centers or online. One of the main family planning providers in Pakistan is Greenstar. If you want to get birth control pills from Greenstar, they offer one brand: Novodol. Click here to learn more information. If you would like to buy birth control pills online, you can buy them Yasmin (Rs. 314.29), Desogen (Rs. 124.68) and Generic Alesse (Rs. 104.75) from Pakistan Pharmacy.
• Injectables - If you're interested in injectables, you can get them at Greenstar. They have Femiject (lasts for 1 month), Novaject (lasts for 2 months) or Depo-Provera (lasts for 3 months). Click here for more information.
• Intrauterine Contraception (IUD) - If you're interested in IUDs, you can get them at Greenstar. they have Protect 5 (which is non-hormonal) and Safeload (which is non-hormonal). Click here for more information.

Emergency Contraception (Morning After Pill)

Important Notes: Emergency contraception may prevent pregnancy for three days (72 hours) and sometimes five days (120 hours) after unprotected sex. Take EC as soon as possible after unprotected sex. If you don't have access to dedicated EC, oral contraceptives can be used as replacement EC, but remember the following: 1) Only some contraceptives work as EC 2) Different contraceptives require different dosages and time schedules to work as EC 3) You must only use the first 21 pills in 28-day packs and 4) They may be less effective than dedicated EC. For general information on emergency contraceptives, click here and here.

Laws & Social Stigmas

In Pakistan, emergency contraception ("the morning after pill") is available without a prescription. There are no age restrictions to purchase EC. You can find emergency contraception in public clinics, private clinics, pharmacies and through community health programs, among other places. In the public and private sectors, he lowest cadre of health worker that is allowed to sell or dispense emergency contraception is auxiliary nurse midwives. According to studies in 2012-13, it was found that 24.1% of married Pakistani women had knowledge of emergency contraception and 1% of married women had ever used it.

What to Get & Where to Get It

• In Pakistan, you don't need a prescription to purchase emergency contraception ("the morning after pill"), and there are no age restrictions. You can go to a pharmacy or clinic and request EC. One EC brands you can expect to see are Emkit Plus (take 1 pill within 120 hours after unprotected sex). You may also see ECP, Emkit or Postinor-2 (for all of these brands, take 2 pills within 120 hours after unprotected sex). While we're not 100% sure you'll find Postinor-2 (since it's not officially registered in Pakistan), you'll be able to find at least one of these brands.
• If you cannot go to a pharmacy or feel nervous to get EC, we recommend you visit Greenstar or Marie Stopes. They can give you EC, and they're very understanding of some of the concerns and questions of women who may be thinking about taking EC. Click here for more information on EC at Greenstar. Click here for EC information at Marie Stopes.
• If you can't access dedicated emergency contraception, you can use regular oral contraceptives (birth control pills) as emergency contraception. For combined pills (progestin-estrogen), you'll need to remember that, in 28-day packs, only the first 21 pills can be used. You can take Ovral (take 2 pills within 120 hours after unprotected sex and take 2 more pills 12 hours later). You can also take Famila-28, Lo-Femenal, Microgynon-30 or Nordette (for all of these, take 4 pills within 120 hours after unprotected sex and take 4 more pills 12 hours later).
• You can have an IUD inserted to prevent pregnancy. Please refer to the "Contraception" section for details.

Sexually Transmitted Infections (STIs/STDs)

Important Notes - Learn about PEP and PrEP: If you think that you've been recently exposed to HIV (i.e. within 72 hours), seek out PEP (Post-Exposure Prophylaxis). It's a month-long treatment to prevent HIV infection after exposure, and it may be available in your city. Take PEP as soon as possible. For more information, click here. If you are at risk of HIV exposure, seek out PrEP (Pre-Exposure Prophylaxis). It's a daily oral pill that can prevent HIV infection before exposure. To learn more about PrEP, click here.

Laws & Social Stigmas

The are no travel restrictions related to HIV status. Some people report that recruitment agencies (for teaching jobs) have asked prospective employees to take an HIV test. However, HIV tests are not required to obtain a work permit.

Regarding HPV: "Current estimates indicate that every year 5233 women are diagnosed with cervical cancer and 2876 die from the disease. Cervical cancer ranks as the 3rd most frequent cancer among women in Pakistan and the 2nd most frequent cancer among women between 15 and 44 years of age. About 0.5% of women in the general population are estimated to harbour cervical HPV-16/18 infection at a given time, and 88.1% of invasive cervical cancers are attributed to HPVs 16 or 18."

Testing Facilities

Please visit the city pages, like the Karachi page, for local recommendations.

Support

• New Light AIDS - Control Awareness Group: 766/5-D1; Green Town; Lahore. Punjab, Pakistan.

Medications & Vaccines

What to Get & Where to Get It

• If you have a yeast infection, you can ask for Fluconazole.
• There is currently no national HPV vaccination program.
• There is currently no Pre-Exposure Prophylaxis (PrEP) in Pakistan.

Menstruation

Note: In addition to pads and tampons, you can also use menstrual cups and menstrual underwear for your period. To learn more about menstrual cups, click here. To learn more about menstrual underwear, click here.

What to Get & Where to Get It

In Pakistan, pads are the most commonly used menstrual product. They can be found in many stores. However, tampons are much more difficult to find, so your best bet is to look for them in supermarkets in large cities. You should be aware that the vast majority of pharmacy workers in Pakistan are men, and many male pharmacists do not understand menstrual products. Regarding menstrual cups, there appears to be no sellers of major brands (such as DivaCup, MoonCup, Lunette & LadyCup) In Pakistan, so if you want one, you should probably buy one online.

Gynecological Exams

Pregnancy

Laws & Social Stigmas

In Pakistan, maternity leave allows 45 days prior to confinement and 45 days after the confinement under rule 13 of the Revised Leave Rules, 1980. If you're under Armed Forced Nursing Service, it's 60 days.

What to Get & Where to Get It

Please visit the city pages, like the Karachi page, for local recommendations.

Abortion

Important Note: There are two main types of abortions: medical (also known as the "abortion pill") and surgical (also known as "in-clinic"). For medical abortions, you take a pill to induce abortion. For surgical abortions, a procedure is performed to induce abortion. For general information about medical and surgical abortions, click here.

Laws & Social Stigmas

In Pakistan, abortion is only legal under two circumstances. The first reason is when the woman's life is endangered by the pregnancy. The second reason is “necessary treatment” early in the pregnancy, which may be interpreted as when termination of the pregnancy would preserve the phyicial or mental health of the woman. However, in all other circumstances, including when the pregnancy is the result of rape or incest, when there is risk of fetal impairment, social or economic reasons or availability upon request, are not permitted. According to the Guttmacher Institute, "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."

Regarding punishment, according to a UN report, "On the one hand, the law retains features of the old law. Penalties for the crime are still dependent upon which of two stages of development the pregnancy has reached and on whether the woman consents or not. In some cases, they also include imprisonment, now denominated a ta’zir penalty. On the other hand, the law defines the stages of pregnancy in terms of the formation of organs or limbs according to Islamic law principles and it introduces the distinctive Islamic law penalty of compensation or diyah in the case of late-term pregnancies. Finally, the new law is somewhat ambiguous: there is no clear demarcation of the two stages of pregnancy or definition of what constitutes “necessary treatment”. Indeed, the law has been criticized for just this reason."

Pakistani law does impose penalties on abortions (typically, prison time, which varies depending on the length of the pregnancy at the time of the abortion). However, abortion -- particularly, underground and clandestine abortions -- continue to be performed in Pakistan each year. In 2012, there were an estimated 2.25 million induced abortions in Pakistan. Furthermore, "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." For these reasons, it is critical that, if you are seeking out abortion services, that you find a safe and experienced providers.

What to Get & Where to Get It

• If you're considering an abortion, it's recommended that you contact Marie Stopes Pakistan, Phone:(92-21) 111-538-538) or ASAP Asia - Phone: 0307-4940707 (Urdu, Punjabi), 0315-9473399 (Urdu, Punjabi, Hindi), 0315-9473399 (Urdu, Sindhi), 033 – 60231416 (Siraiki) for details. They can help advise you about local resources and what the best options may be for you.
• You can potentially get the "abortion pill" by mail. Check out this link for details.
• If you are considering leaving the country to obtain a legal abortion, you can legal abortions in Turkey, Bangladesh, India, China and Vietnam.

Costs

If you are pregnant and considering getting an abortion outside Pakistan, you will need to consider the following costs: transportation to the country where you will be obtaining an abortion, hotel or accommodation costs in that country, cost of the abortion in the country and the total amount of days you may need to be in the country both before and after the abortion.

Advocacy & Counseling

List of Additional Resources

• Auhung: "Established in 1994, Aahung is a Karachi-based NGO which aims to improve the Reproductive Health (RH) of men, women, and adolescents across Pakistan. The Aahung team works towards enhancing the scope and improving the quality of services that uphold health and rights, while advocating for an enabling environment where every individual’s health and rights are respected, protected, and fulfilled as an inalienable human right."
• T2F: "Coffeehouse tradition is all about sparking conversations and we are passionate about providing a platform for people to engage with each other. A community space for open dialogue, T2F features a café and bookshop and hosts poetry readings, meetups with writers, talks, debates, theatre performances, film screenings, open mic nights, jam sessions, and standup comedy." Address: 10-C, Sunset Lane 5, Phase 2 Extension, DHA, Karachi-75500. Phones: +(92-21) 3538-9033 and +(92-21) 3538-9043. E-mail: info@peaceniche.org.
• Peace Foundation Pakistan: "Free women from man made constrains and ideologies, a gender friendly environment, where separation of gender will not be based on physical and biological look. To work for sexually empowerment of women believing sovereignty power over her bodily decisions. Strive to bring about gender equality in sexual and reproductive related issues with participatory approaches." Call +92 233 876239.