Advancing reproductive rights in Pakistan: Recommendations for enhancing access to abortion and post-abortion care

The current narrative review was planned to develop evidence and rights-based recommendations for improving access, quality, and integration of safe abortion and post-abortion care services in Pakistan, guided by national evidence, global guidelines, and stakeholder consensus. A comprehensive literature review was conducted to assess trends, inequities, legal and religious frameworks, and health-system barriers related to abortion and post-abortion care in Pakistan. Draft recommendations were formulated based on findings from the 2023 Population Council-Guttmacher Institute national study and international evidence. These recommendations were reviewed and refined through consultations with experts from professional societies, civil society organisations, and health-system stakeholders. A hybrid consensus-building meeting and an online validation exercise were conducted to finalise the recommendations. Key gaps identified included restrictive legal interpretations of 'necessary treatment', provider biases, limited clinical autonomy, inadequate training, poor infrastructure, stigma and insufficient awareness of reproductive rights. Variations in practice further compromised quality of care. The validated recommendations focussed on strengthening legal and policy frameworks, improving awareness of reproductive rights, standardising clinical guidelines, promoting safe uterine evacuation methods, expanding telemedicine and self-care models, integrating post-abortion care and family planning, ensuring supply-chain readiness, and investing in comprehensive pre-service and in-service training. Implementation of these recommendations grounded in human rights, clinical evidence and stakeholder consensus can strengthen quality, equity and continuity of reproductive health services.