Academic journal article International Perspectives on Sexual and Reproductive Health

Effectiveness of a Behavior Change Communication Intervention to Improve Knowledge and Perceptions about Abortion in Bihar and Jharkhand, India

Academic journal article International Perspectives on Sexual and Reproductive Health

Effectiveness of a Behavior Change Communication Intervention to Improve Knowledge and Perceptions about Abortion in Bihar and Jharkhand, India

Article excerpt

CONTEXT: Although abortion became legal in India in 1971, many women are unaware of the law. Behavior change communication interventions may be an effective way to promote awareness of the law and change knowledge of and perceptions about abortion, particularly in settings in which abortion is stigmatized.

METHODS: To evaluate the effectiveness of a behavior change communication intervention to improve women's knowledge about India's abortion law and their perceptions about abortion, a quasi-experimental study was conducted in intervention and comparison districts in Bihar and Jharkhand. Household surveys were administered at baseline in 2008 and at follow-up in 2010 to independent, randomly selected cross-sectional samples of rural married women aged 15-49. Logistic regression difference-in-differences models were used to assess program effectiveness.

RESULTS: Analysis demonstrated program effectiveness in improving awareness and perceptions about abortion. The changes in the odds of knowing that abortion is legal and where to obtain safe abortion services were larger between baseline and follow-up in the intervention districts than the changes in odds observed in the comparison districts (odds ratios, 16.1 and 1.9, respectively). Similarly, the increase in women's perception of greater social support for abortion within their families and the increase in perceived self-efficacy with respect to family planning and abortion between baseline and follow-up was greater in the intervention districts than in the comparison districts (coefficients, 0.17 and 0.18, respectively).

CONCLUSIONS: Behavior change communication interventions can be effective in improving knowledge of and perceptions about abortion in settings in which lack of accurate knowledge hinders women's access to safe abortion services. Multiple approaches should be used when attempting to improve knowledge and perceptions about stigmatized health issues such as abortion.

International Perspectives on Sexual and Reproductive Health, 2013, 39(3):142-151, doi: 10.1363/3914213

High rates of maternal death from unsafe abortion persist in India despite passage of the Medical Termination of Pregnancy (MIT) Act in 1971. (1) This relatively liberal law permits a woman to obtain abortion services from a registered medical practitioner at any approved facility for many indications: to save her life, to preserve her physical and mental health, for economic or social reasons, in cases of rape or incest, when fetal impairment has been determined or, for married women, when pregnancy results from contraceptive failure. Amendments to the MIT Act in 2002 and 2003 aimed to expand access to safe abortion services by decentralizing abortion service regulation, including the monitoring of service delivery and the accreditation of private facilities providing first-trimester abortions., the amendments also allowed for delivery of medication abortion drugs by trained providers working in facilities not approved for surgical abortion. (2)

Forty years after the passage of the law, many women in India still seek abortion care from unqualified providers and die from unsafe abortion. Of the 6.4 million abortions performed every year in India, an estimated 3.6 million (56%) are unsafe. (3) It is estimated that 8-9% of maternal deaths are due to abortion-related complications, (1) and almost 10,000 abortion-related deaths occur each year in India. (4) Public health facilities are certified to provide abortion services; however, rural women may not use facilities with trained and certified providers because of difficulties reaching facilities (5) or lack of awareness of the legality of abortion or the availability of services and providers. (6), (7) On average, there are only 10 certified abortion facilities per one million population in India, (8) and one trained medical doctor per 224,000 rural popu1ation. (6) In addition, many women are not aware that abortion is legal and available at government facilities, or do not know which facilities are certified by the government to provide abortion services. …

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