In Pakistan, abortion is legal to save the life of the woman, but the law does not address the issues of
rape, incest, and fetal abnormalities. Due to stigma surrounding abortion, the narrow legal grounds for
abortion, and the lack of clarity in interpreting and implementing the law by both women and
healthcare providers, an estimated 623,000 women were treated in public and private sector facilities
for complications resulting from induced abortions in Pakistan in 2012.
Ipas Pakistan launched Values Clarification and Attitude Transformation (VCAT) workshops in 2009
to address stigma-related barriers to abortion care that were initially for senior obstetriciangynecologists
and faculty from teaching hospitals. From 2011-2014, Ipas Pakistan strengthened the
capacity of their partners and conducted 39 VCAT workshops for 720 people including doctors,
midlevel providers, NGO/CBO staff, health facility managerial and support staff, tutors, and
government officials.
To evaluate Ipas Pakistan’s VCAT workshops in improving providers’ knowledge and attitudes
pertaining to abortion and contraception, matched pre- and post-VCAT workshop surveys were
administered to 84 Ipas-trained clinical providers who attended VCAT workshops. The survey
evaluated the providers’ knowledge and attitudes toward abortion and contraception. Differences in
pre- and post-workshop answers were assessed using McNemar’s test, and statistical significance was
assessed at an alpha level of 0.05 for all analyses. In addition, 20 in-depth interviews were conducted
with Ipas-trained providers to understand their perspectives on behavior change resulting from
participation in the VCAT workshop. The interview transcripts were read and analyzed thematically.
Analysis of the pre- and post-workshop survey data showed that Ipas-trained providers significantly
increased their knowledge about both abortion and contraception by participating in VCAT
workshops. Significantly more providers supported the provision of abortion services as permitted by
law in Pakistan and could explain their personal values concerning abortion post-workshop. Analysis
of the in-depth interview data showed that as a result of attending the VCAT workshop, most
providers regarded provision of abortion services as a woman’s right and reported that they began to
treat their clients with more empathy. Providers also had an increased sense of professional
responsibility to provide abortion care and, when needed, they reported providing referrals for safe
abortion services.
Overall, VCAT workshops have been successful in Pakistan in improving providers’ knowledge,
attitudes and behaviors about abortion and abortion care. VCAT workshops are a promising approach
for helping providers clarify their personal values about abortion and to improve care for women,
especially in a conservative setting such as Pakistan.