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Afghan refugee women forced to have abortions in Pakistan

NOTE: This narrative contains language and details that may be disturbing to some readers.

Nargis* found out she was pregnant while living in Pakistan. The 24-year-old former prosecutor had left Afghanistan in December 2023 due to threats made to her life. She and her husband were waiting to see if their asylum cases to a European country would be approved, their initial requests had been accepted and they are waiting for a thorough review and process of their asylum case.

Since her marriage a year ago, she kept dreaming about becoming a mother and raising her first child with love and affection. Her first pregnancy would turn into a nightmare. Those she consulted warned her that if she gave birth then her asylum case would be delayed and might be rejected; in addition, her child would not be entitled to residency or a passport if born in Pakistan. 

“I fell into severe depression. I cried day and night,” Nargis tells Zan Times. “I was not feeling well. My husband said, “With your condition, if you give birth to a child, you will go crazy or psychotic, it is better to abort it.’”

Although abortion is technically legal in Pakistan if the mother’s health is in danger or there is a “need” for an abortion, the reality is that legal abortions are rare. Doctors and hospitals often refuse to perform them, believing they are illegal or refusing on moral or religious grounds, reports the U.S. outlet NPR. Yet Pakistan has one of the highest abortion rates in the world. While recent data is unavailable, a study from 2012 put the abortion rate at 50 abortions per 1,000 women aged 15 to 44. Birth control is difficult to obtain for many women in Pakistan. In a society that prefers males, the lack of family planning options compounds pressures on mothers who have given birth to girls. Some choose abortion rather than risk having another girl. The result is that abortions, either self-induced or at illegal clinics, are not only common but frequently endanger the lives of many of those women. 

Nargis and her husband first went to the nearest hospital in Islamabad to obtain an abortion, but the doctor told them that both the fetus and Nargis were healthy and that it was illegal to have an abortion.

On the advice of a friend who had undergone her own abortion, Nargis swallowed tablets that she’d obtained from a nearby pharmacy. Five hours later, she started experiencing severe discomfort. “I was writhing in pain and after a few moments I lost consciousness,” she recounts to Zan Times. 

Her husband called an ambulance. At the hospital, doctors informed them that the fetus was dead and a curettage was needed to remove it from her womb. “The curettage was the worst experience for me. Maybe if I had given birth, I would have endured less pain,” she says. Since then, she’s developed anemia. 

While Nargis and her husband were able to go to a hospital to save her life, that option is impossible for many Afghan refugee mothers who do not have a visa or legal residence permit in Pakistan. One such mother is Marzia*, 33, who almost died while having an abortion in Peshawar. She didn’t have legal residence in Pakistan and is already the mother of four children. So when Marzia discovered she was pregnant in July 2023, she went to a Pakistani midwife. Marzia says that the woman charged 20,000 rupees (CAD$100) for nine tablets that Marzia swallowed and another three that were put in her vagina. Almost immediately, Marzia began experiencing mild and then severe pain. “I felt like someone was stabbing me, and writhing in pain,” she tells Zan Times. 

Marzia lost consciousness. When she recovered, she realized that she was covered in blood. “I felt another sudden and intense pain and screamed loudly,” she says. Marzia’s husband entered the room and discovered that the midwife had cut a part of his wife’s uterus and that she was bleeding heavily. The midwife wasn’t concerned about her health. “When I screamed, the midwife cursed me in Urdu and told me to be quiet: ‘If the neighbors hear your screams, they will call the police. They will take both of us to prison.’”

In the end, when the midwife couldn’t stop the bleeding, Marzia and her husband were kicked out of the midwife’s house. When the woman saw that she could not stop the bleeding, Marzia and her husband were kicked out of her house and left on their own. “With great difficulty we went home. I spent a night in pain and bleeding. I thought it was the last night of my life,” says Marzia.

When they called the woman the next day to get more medicine, her number didn’t work. Marzia says that she spent weeks bleeding and in pain, but didn’t want to go to the hospital for fear of being arrested: “If I went to the hospital, they would find out that we had an intentional abortion, and they would imprison me for the crime.”

For two months, she treated herself at home, getting advice from friends who had medical experience. Finally, she went to a doctor who told her, “Your uterus is infected, you should  regularly take medicine and rest.” Marzia is still suffering from mild bleeding and severe pain, which has deprived her of the normal life she once enjoyed. 

The severe restrictions on abortion in Pakistan are shared by many countries around the world. According to a 2020 report of the World Population Review, abortion is completely legal in only 68 countries of the world. Though many have some restrictions on abortion, abortion is only legal in 42 countries “if a pregnancy would result in the mother’s death,” states the report. 

Even before the Taliban regained power, legal abortion in Afghanistan was permitted only when the continuation of pregnancy endangers the life of the mother. Though family planning was promoted by international NGOs in Afghanistan, contraception was still not easily available, especially in rural areas. Yet, there were also birth control awareness programs, which educated women on the health benefits of taking breaks between births, and even choosing to have fewer children. Those programs have been banned by the Taliban. 

When it comes to pregnancy, female refugees in Pakistan are in a particularly dire situation, especially as the government has announced the start of the second phase of the deportation of Afghan refugees in Pakistan. Rukhsar*, an Afghan woman midwife who currently works in a hospital in Islamabad, tells Zan Times that at least six Afghan women a month come to her looking to end their pregnancies. “They come to me to abort their child in the hospital, but we don’t do that,” she tells Zan Times. “When they get a rejection from us, they seek out illegal ways to have an abortion.”

She adds that the prevalence of home remedies for abortions as well as the use of unknown drugs has been a problem for her patients; several have died: “Pregnancy prevention is very important; when these women use traditional methods of abortion, they risk death.”

Raihan*, 32, who was a reporter in a local radio station before the Taliban, aborted her pregnancy after arriving in Pakistan. Her recovery was hampered because she can’t afford to eat properly due to financial problems. “I ate once every 24 hours” after the abortion, she explains, which “caused my body to shake violently and faint.” Unable to buy needed medicine, now there is not a single day that I am well,” says Raihan. 

Though Nargis was able to recover in hospital for two days before returning home, she is in torment because of the abortion, saying, “When I am alone, I hear the voice of my child.”

*Names have been changed to protect the identity of the interviewees and writer. Lala Shams is the pseudonym of a freelance journalist who is now a refugee in Pakistan.