Attitude of Healthcare Workers Towards the Termination of Pregnancy in Peshawar, Pakistan: Healthcare Workers Towards the Termination of Pregnancy

Emaan Arif; Amjad Ullah; Javeria Taj; Shafi Ullah; Asad Jamal; Romana Ayub; Aaira Taharat; Sada Anwar; Rabia Arshad; Reesha Aftab

doi:10.54393/pbmj.v8i6.1257

Authors

Emaan Arif Khyber Medical College, Peshawar, Pakistan
Amjad Ullah Khyber Medical College, Peshawar, Pakistan
Javeria Taj Khyber Medical College, Peshawar, Pakistan
Shafi Ullah Khyber Medical College, Peshawar, Pakistan
Asad Jamal Khyber Medical College, Peshawar, Pakistan
Romana Ayub Department of Community Medicine, Khyber Medical College, Peshawar, Pakistan
Aaira Taharat Khyber Medical College, Peshawar, Pakistan
Sada Anwar Khyber Medical College, Peshawar, Pakistan
Rabia Arshad Khyber Medical College, Peshawar, Pakistan
Reesha Aftab Khyber Medical College, Peshawar, Pakistan

DOI:

https://doi.org/10.54393/pbmj.v8i6.1257

Keywords:

Attitude, Healthcare Workers, Termination of Pregnancy, Abortion

Abstract

Unsafe abortion remains a major public health issue in Pakistan, including Peshawar, due to restrictive laws, stigma, and limited access to safe services. Objectives: To assess the healthcare workers’ perspective towards the termination of pregnancy and their legal and religious perceptions regarding it. Methods: A cross-sectional study was conducted among gynecologists, Lady Health Workers (LHWs), and nurses in the Gynecology and Obstetrics Department of public and private hospitals in Peshawar from January 2025 to March 2025. Structured questionnaires were distributed among 200 healthcare workers, and their responses were analyzed using SPSS version 20.0. The frequencies and percentages were calculated for qualitative variables, and the chi-square test was applied to check statistically significant association between different categorical variables, with a p-value<0.05 considered significant. Results: Among healthcare workers in Pakistan, nearly all (96.5%) agreed to terminate pregnancies when the mother's life was at risk, while approval was also high for severe fetal anomalies (87.5%). However, most disapproved of TOP for socio-economic reasons like unaffordability, unplanned pregnancy, or extramarital pregnancy. Though 66% were aware of Pakistan's TOP laws, many found them ambiguous, and 85.5% desired stricter regulations. Religion was the primary reason for not performing abortions. Significant differences in views were observed between specialities and sectors, with private providers holding more liberal attitudes on several TOP-related issues. Conclusions: Most healthcare workers showed a negative attitude toward abortion, largely influenced by religious beliefs, and many advocated for clearer and stricter abortion laws.

References

Engelbrecht MC. Termination of pregnancy policy and services: an appraisal of the implementation and operation of the Choice on Termination of Pregnancy Act (92 of 1996) (Doctoral dissertation, University of the Free State). 2005.

Heggie C, Tong L, Heran A, Bhambhani I, McKibbon S, Paynter M. The role of doulas and community birth workers in abortion and contraception care: An international scoping review. Contraception. 2024 May; 110482. doi: 10.1016/j. DOI: https://doi.org/10.1016/j.contraception.2024.110482

Baig M, Jan R, Lakhani A, Ali SA, Mubeen K, Ali SS et al. Knowledge, attitude, and practices of mid-level providers regarding post abortion care in Sindh, Pakistan. Journal of Asian Midwives. 2017; 4(1): 21-34.

Abhary MN, Shaghaghi F, Safinejad H, Asadi L, Mohebbi-Dehnavi Z. The Effects of Unsafe Abortion on the Health System from a Socio-economic Perspective: A Narrative Review. Journal of Midwifery & Reproductive Health. 2023 Oct; 1(4).

Sathar Z, Singh S, Shah IH, Niazi MR, Parveen T, Mulhern O et al. Abortion and unintended pregnancy in Pakistan: new evidence for 2023 and trends over the past decade. British Medical Journal Global Health. 2025 Jan; 10(1). doi: 10.1136/bmjgh-2024-017239. DOI: https://doi.org/10.1136/bmjgh-2024-017239

Singh S, Wulf D, Jones H. Health professionals' perceptions about induced abortion in South Central and Southeast Asia. International Family Planning Perspectives. 1997 Jun; 59-72. doi: org/10.2307/2950825. DOI: https://doi.org/10.2307/2950825

Kamran I and Mir AM. Women’s access to safe abortion and postabortion care services in Pakistan: the role of gender and related factors. In Handbook on Sex, Gender and Health: Perspectives from South Asia. Singapore: Springer Nature Singapore. 2024 Jul; 1-21. doi: 10.1007/978-981-19-9265-0_15-1. DOI: https://doi.org/10.1007/978-981-19-9265-0_15-1

Hussain R, Fikree FF, Siddiqui N. Laws, myths and the lived experience of abortion in Pakistan. Asian Journal of Women's Studies. 2021; 27(1): 35–53. doi:10.1080/12259276.2021.1879612.

Siddiqui A, Ullah H, Nisa Z. Training mid-level providers to deliver post-abortion care in KP: An implementation evaluation. Health Policy Plan. 2022: 37(9); 1239–48. doi: org/10.1093/heapol/czac058.

Nooreen S, Wahab S, Rehman K, Rehman R, Afridi SK. Determinants of Self-Induced Abortion In Unintended Pregnancies: Insights from Private Maternity Clinics Peshawar. Journal of Saidu Medical College Swat. 2025 May; 15(2): 184-91. doi: 10.52206/jsmc.2025.15.2.1035. DOI: https://doi.org/10.52206/jsmc.2025.15.2.1035

Ibrahim ZM, Mohamed ML, Taha OT, Ghoneim HM, Mohamed HS, Abdellah AM et al. Knowledge, attitude and practice towards abortion and post abortion care among Egyptian private obstetricians and gynecologists. The European Journal of Contraception and Reproductive Health Care. 2020 Jul; 25(4): 245-50. doi: 10.1080/13625187.2020.1760239. DOI: https://doi.org/10.1080/13625187.2020.1760239

Geta T, Israel E, Kebede C. Client satisfaction with abortion care service and its associated factors among women in Ethiopia: a systematic review and meta-analysis. BioMed Central Women's Health. 2024 May; 24(1): 287. doi: 10.1186/s12905-024-03139-3. DOI: https://doi.org/10.1186/s12905-024-03139-3

Dempsey B, Callaghan S, Higgins MF. Providers’ experiences with abortion care: A scoping review. PLOS ONE. 2024 Jul; 19(7): e0303601. doi: 10.1371/journal.pone.0303601. DOI: https://doi.org/10.1371/journal.pone.0303601

Khalid G, Saleh AM, Shabila N, Bogren M, Shakely D. Attitudes towards induced abortion among gynecologists in Kurdistan region of Iraq. BMC Women's Health. 2023 Nov; 23(1): 609. doi: 10.1186/s12905-023-02768-4 DOI: https://doi.org/10.1186/s12905-023-02768-4

Ackon AL. Knowledge, Attitudes and Practices of Medical Abortion Amongst Doctors at the Greater Accra Regional Hospital, Accra Ghana (Doctoral dissertation, University of Ghana). 2023.

Jadav D, C Bhargava D, Meshram V, S Shekhawat R, Kanchan T. Medical termination of pregnancy: A global perspective and Indian scenario. Medico-Legal Journal. 2024 Mar; 92(1): 34-42. doi: 10.1177/00258172231155317. DOI: https://doi.org/10.1177/00258172231155317

Dayananda I, Walker D, Atienzo EE, Haider S. Abortion practice in Mexico: a survey of health care providers. Contraception. 2012 Mar; 85(3): 304-10. doi: 10.1016/j.contraception.2011.07.011. DOI: https://doi.org/10.1016/j.contraception.2011.07.011

Lokubal P, Corcuera I, Balil JM, Frischer SR, Kayemba CN, Kurinczuk JJ et al. Abortion decision-making process trajectories and determinants in low-and middle-income countries: A mixed-methods systematic review and meta-analysis. E-Clinical Medicine. 2022 Dec; 54. doi: 10.1016/j.eclinm.2022.101694. DOI: https://doi.org/10.1016/j.eclinm.2022.101694

Muhammad T. From Objectives Resolution to Sharia Legislation: Tracing the Islamization of Laws in Pakistan. Tanazur. 2025 Jun; 6(3): 22-66.

Adair L, Lozano N, Ferenczi N. Abortion attitudes across cultural contexts. International Perspectives in Psychology. 2024 Jul. doi: 10.1027/2157-3891/a000101. DOI: https://doi.org/10.1027/2157-3891/a000101