Pioneering Accessible SRHR in Pakistan

Ulfat, a 30-year-old mother from Lyari, Pakistan, lives in a country with one of the highest abortion rates in the world.  Many of these procedures are performed under unsafe conditions, placing women like Ulfat in perilous situations. Coming from a conservative Pashtoon family, Ulfat has faced severe hardships. As a mother of three daughters and one son, she has endured years of physical and emotional abuse from her husband, who rejects family planning and blames her for bearing daughters. His relentless desire for more male children, coupled with his refusal to provide basic necessities for his daughters, has left Ulfat in a constant state of fear and desperation. Struggling to care for her children, she often relies on charity to meet their daily needs.

The pressure escalated when Ulfat discovered she was pregnant with her fifth child. Overwhelmed and terrified by multiple closely spaced pregnancies, she found herself in a critical situation with deteriorating health, uncertain of how to move forward, especially under the immense pressure to bear a son.  Her situation is not unique; many women in Pakistan face significant cultural and social barriers in accessing reproductive health services.

In a moment of profound need, Ulfat found hope through Saira, a dedicated Sitara Baji (community health worker) from Greenstar’s reproductive program.  During a door-to-door visit, Sitara Baji Saira provided Ulfat with crucial counseling on self-care needs and introduced her to misoprostol, a safe and affordable medication option that ensures the client’s comfort, safety, and confidentiality. Saira not only offered her health-related advice but also helped

her connect with Greenstar’s doctor, who supervised the entire process. The doctor explained signs and symptoms and followed up with Ulfat to ensure she felt guided and supported. This innovative approach saved Ulfat from another unwanted pregnancy and alleviated the societal pressure of bearing another girl child.

With the support from the OPTions Initiative, Greenstar has trained and deployed 10 Sitara Bajis, establishing 10 Sitara Houses — secure environments where women receive essential reproductive health services and counseling..

Each Sitara Baji has achieved financial independence while providing crucial services. Since the program’s launch, over 44,000 women have received reproductive health counseling, including on the self-administration of misoprostol. From October 2022 to June 2024, more than 6,283 women have accessed medical abortions through this initiative.

“Sitara Baji Saira and Greenstar did more than just provide me with termination of pregnancy options — they gave me the strength to stand up for myself. This service was more than just medical support. It was a lifeline that empowered me to reclaim control over my body and my future.” Ulfat said with gratitude in her voice.

The impact of this program is profound: 94% of women in the Sitara House catchment areas are now aware of self-managed abortion. Client satisfaction rates at Sitara Houses are exceptionally high (99.9%), far surpassing those of nearby providers (73%). This success is attributed to the program’s focus on affordability, respect, and ease of access. Additionally, the initiative has led to a 58% improvement in reproductive health knowledge in the community, highlighting the transformative effect of this innovative, community-driven approach.

“This intervention is transforming our community by providing accessible and respectful reproductive health services” said a representative from Greenstar. “It empowers women to make informed decisions about their health and future”.

Ulfat has found a renewed sense of hope and is determined to create a better future for herself and her children. “Now, I dream of a future where my daughters grow up in a world where their choices are respected, and their voices are heard,” she said.

 

Learn more about the innovator here.

This story is shared by Greenstar Social Marketing Pakistan.

Names of individuals in the story have been changed to protect their privacy.