Institutional Violence

By Maryum Siddiqui & Farah Shah, Shirkat Gah – Women’s Resource Centre

More than often we come across stories where women are denied services to safe and legal abortion as a result of which they resort to services that are unsafe in nature. The inaccessibility and the outright rejection of health care services to women remains the main challenge and the phenomenon of institutional violence correlated with restrictive abortion services disproportionately affects women who belong to a poor social strata.

Under Section 338 of the Pakistan Penal Code, abortion is only permissible for saving the life of the mother or providing her necessary treatment (until the organs of the child have formed, following which only the “life” exception applies). However, “necessary treatment” has never been defined by any organ of state. It has been time and again argued that the problem is not with the law – as no one has ever been prosecuted under it – but with service providers and their own moral reservations and biases.

Despite having an ethical obligation as per FIGO resolution to provide benefit and prevent harm,  and to refer patients who request the mentioned services to other service providers or practitioners in case it clashes with their values- most service providers in Pakistan outright refuse to neither give service nor provide a conscientious referral. Hence, options of abortion services are reduced to quacks or traditional birth attendants operating in backstreet clinics in a clandestine setting.

Accessing safe and legal abortion services should be the fundamental right of women everywhere. It is, at its core, about bodily autonomy. It’s an individual woman’s body, therefore the individual decision ultimately lies with her. Abortion becomes a tremendously difficult process to go through due to the stigma and laws restricting it. In other words, creating such strict conditions for abortion does not stop abortion from happening. Despite of rigid restrictions on abortion an estimate of 2.2 million induced abortions takes place every year. The restriction does lead to unsafe occurrences; whereby the data explicitly suggests that 696,000 women are treated annually in public health facilities and private hospitals for complications whereas 5.6% of the maternal deaths are attributed to unsafe abortion. Thus, putting women at an alarmingly high risk. Additionally, the unmet need for family planning is still high at 20%, total fertility rate at 4 and the contraceptive prevalence rate remains dismal at 35%. That seems the biggest contradiction because the lack of accessible birth control will ultimately lead to unwanted pregnancies that would lead unsafe abortions that are illegally performed.

The overarching argument often tends to be that every life is sacred and that abortion violates that very sanctity of life. While the whole idea of sanctity of life does seem grand and even worth all our empathy on the surface, one really needs to take into consideration the life of the person who is existing and living: The mother. It is of fundamental importance to recognize that the right of the woman, the person who is to bear the consequences of having a child, the person who is not yet to go through any development process to become a living person. She already is a living and so, her rights triumph the rights of the unborn fetus inside her.


In conclusion, it is of paramount importance that the stigma connotated and associated with abortion should be addressed as it makes the services inaccessible, unaffordable and leads to exclusion of abortion services from the normative reproductive health care- hence creating a prevalence paradox and leading to institutional violence.

Below are a compilation of short stories whereby women were denied safe RH services.

Voices from the field:

“Girls or women who get pregnant out of wedlock have to access abortion services through local dais (traditional birth attendants) due to restrictions. Dai charges double the amount of what they usually do. How will a person who cannot afford a decent meal a day pay a heavy amount of Rs. 20,000 ($200) for abortion services?”
– Shehdadkot, Sindh

“My friend had a missed abortion and she was bleeding profusely. The lady doctor however refused to give her treatment unless her family submitted the money in advance!”
– Jaffarabad, Balochistan

“There is unavailability of comprehensive health care at the nearest BHU and the uncaring and rigid attitude of service providers towards their patients in public health care facilities, forces us to opt for private clinics and hospitals.”
– Shikarpur, Sindh