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The 2012–13 PDHS (Pakistan Demographic and Health Survey) shows that gains in contraceptive prevalence over the past decade have been small, and unmet need has remained high. Using data from a 2012 national study on post-abortion care, we estimate 2.2 million abortions occurred in Pakistan in 2012, and an annual abortion rate of 50 per 1,000 women. A previous study estimated an abortion rate of 27 for 2002. Even accounting for an underestimation of abortion incidence (private sector abortion services could not be included) in the prior study, the abortion rate in Pakistan has likely increased substantially between 2002 and 2012. There are significant differences in abortion incidence among Pakistan’s provinces, with higher abortion rates in Sindh and Baluchistan than in Punjab and Khyber Pakhtunkhwa. Combined with different contraceptive use patterns, these data suggest that strategies for coping with otherwise uniformly high unintended pregnancy rates differ across provinces. This report indicates that the need for an accelerated and fortified family planning program is greater than ever, as is the need for implementing strategies to improve the quality and coverage of safe abortion services.