Abortion Experiences of Unmarried Young Women in India: Evidence from a Facility-Based Study in Bihar and Jharkhand

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CONTEXT: Little is known about the experiences of unmarried young women in India who seek to terminate an unintended pregnancy.

METHODS: A survey was conducted among 549 unmarried women aged 15-24 who had obtained an abortion in 2007-2008 at one of 16 clinics run by the nongovernmental organization Janani in the states of Bihar and Jharkhand. Differences in background characteristics, and in obstacles to obtaining an abortion, between those who had an abortion in the first trimester and those who did so in the second trimester were compared, and logistic regression analysis identified associations between these factors and obtaining a second-trimester abortion.

RESULTS: Eighty-three percent of women realized they were pregnant within the first two months of their pregnancy, and 91% within the first trimester. Eighty-four percent decided before the end of the first trimester to have an abortion, but only 75% obtained one in this period. One in six participants said that pregnancy had resulted from a nonconsensual sexual encounter, and such reports were more frequent among those who obtained a second-trimester abortion. Women who were older or who had more schooling had a decreased likelihood of having a second-trimester abortion (odds ratios, 0.9 each), whereas those who lived in rural areas, those who did not receive full support from their partners and those who reported a forced encounter had an increased likelihood of having a late abortion (2.3-4.1).

CONCLUSIONS: Sex education programs that highlight the importance of recognizing a pregnancy early in gestation, and of obtaining an early abortion if a pregnancy is unwanted, are needed for unmarried young women and men. International Perspectives on Sexual and Reproductive Health, 2010, 36(2):62-71

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Premarital sex is widely discouraged in India, particularly for young women, yet there is evidence that significant minorities of young men and women have engaged in sex before marriage. In a recent survey of youth aged 1.5-24 in six states, 15% of men and 4% of women reported having had premarital sex. (1), (2) A review of a number of less representative studies found rates of 15-30% among young men and 1-10% among young women. (3) Evidence also suggests that sexually active unmarried youth rarely or inconsistently use contraceptives, which exposes many young women to the risks of unintended pregnancy and abortion. (2), (4)

Although evidence is sparse, in this conservative setting in which pregnancy among unmarried women is extremely stigmatized, such unintended pregnancies are almost always terminated. (4), (5) A better understanding of the contexts of abortion among unmarried youth--and their experiences in obtaining abortion services--is clearly needed to design programs that enable unmarried adolescents to exercise their right to safe abortion and so avoid the potentially adverse health consequences of an unsafe abortion. This descriptive, exploratory study examines the abortion-related experiences of unmarried women aged 15-24 who terminated an unintended pregnancy in 2007-2008 at clinics in the states of Bihar and Jharkhand in northern India.

BACKGROUND

In 2001, there were 219 million youth aged 15-24 in India, representing 21% of the population. (6) Marriage continues to occur early for young women: The proportion of 20-24-year-olds who had married before turning 18 declined from 50% in 1998-1999 to 47% in 2005-2006. (7) By age 25, almost all Indian women are married; indeed, only 6% of those aged 25-29 had not married by their 25th birthday. (7) Moreover, most marriages are arranged by parents; for example, a study in six Indian states found that 94% of married young women reported such arrangements. (8) Early childbearing among young women is also common: About one in six 15-19-year-olds had already given birth or become pregnant, and about half of India's total fertility rate was attributable to those aged 15-24. …