Document Type



School of Nursing and Midwifery, Pakistan


Background: In Pakistan, half of all pregnancies are unintended (4.2 million per year); out of which 2.2 million end in induced abortions. Almost 700,000 women seek medical treatment for post abortion complications every year. This necessitates access to quality Post-Abortion Care (PAC) services from skilled providers in Pakistan.
Purpose: This study aimed to assess the knowledge, attitude and practices of Mid-Level Providers (MLPs) regarding PAC services in Sindh, Pakistan.
Method: The study utilized a cross-sectional design. Convenience sampling was used to recruit 116 MLPs, including Nurse Midwives (NM), Lady Health Visitors (LHVs), and Community Midwives (CMWs) from different parts of Sindh. Data were collected using a self-administered questionnaire. Data were analyzed using SPSS version 19.
Key Findings: The participants comprised 47% NMs, 35% LHVs, and 18% CMWs. The median age of the participants was 30 years. Nearly half of the participants (45%) worked in their own private practices. The remainder were almost evenly divided into those working in primary health care centres and those in secondary care hospitals. The mean score on the knowledge component was 8.9±2.2, from a maximum total of 16. Almost all (98%) the participants had heard about PAC. However, only 29% were aware of the need for a community and service provider partnership as a key element of PAC. Most (81%) of the participants knew about counseling compared with 54% who knew about Manual Vacuum Aspiration (MVA) and 46% about misoprostol. The mean score on the attitude component was 14.9±2.0, from a maximum total of 21. Various gaps were identified in the practices of MLPs regarding PAC counseling, referral linkages, and in addressing reproductive and health issues.
Conclusion: The findings highlighted the need for providing comprehensive training and mentorship to the groups of midwives about PAC and building strong networks to enable improved referral processes. Moreover, it is crucial to expand this study at a national level to identify the gaps and to plan strategies to promote safe PAC services.