Where Do Rural Women Obtain Postabortion Care? the Case of Uttar Pradesh, India
Johnston, Heidi Bart, Ved, Rajani, Lyall, Neena, Agarwal, Kavita, International Family Planning Perspectives
CONTEXT: Although Indian law permits abortion for a broad range of social and medical indications, millions of unsafe and illegal abortions and countless subsequent complications occur annually. Nonetheless, in the central Indian state of Uttar Pradesh, few women with abortion complications are reported to seek care at registered private and public health facilities. Information is needed about where rural women seek care for abortion complications and about the quality of care they receive.
METHODS: Qualitative data were collected in 1999 in four villages in rural Uttar Pradesh. The study team conducted community mapping exercises, focus group discussions with female and male community members, and in-depth interviews with women of reproductive age and with postabortion care providers.
RESULTS: Postabortion care is widely available in the villages studied, largely from untrained or inappropriately trained providers. Because village-level providers are the front line of care for many women, abortion complications may be exacerbated rather than alleviated, appropriate care delayed and the cost of treatment increased. Village-level postabortion care does not include family planning and contraceptive counseling services or links to reproductive and other health services.
CONCLUSIONS: Existing village-level postabortion care services are inadequate. There is an urgent need to increase women's access to higher-quality postabortion care. This can be done by simultaneously engaging village-level providers in the formal system of postabortion care service delivery, as appropriate, and addressing the prevailing social and cultural mores that discourage women with abortion complications from seeking higher-level care.
International Family Planning Perspectives, 2003, 29(4): 182-187
Although Indian law permits abortion for a broad range of social and medical indications, (1) only about 538,000 of the estimated 6.7 million pregnancy terminations occurring annually are performed by registered providers in licensed facilities. (2) Women with access to few resources--for example, low-income, rural women and adolescents--are among those most likely to receive unsafe services and experience complications of abortion. (3) Although data are limited, about 20,000 deaths--or approximately 18% of all maternal death., in India--are believed to be related to unsafe abortion. (4) The total number of abortion-related complications is thought to be much higher. With an estimated 68 induced abortions per 1,000 married women of reproductive age per year, Uttar Pradesh has one of the country's highest incidences of abortion, (5) reflecting the fact that only 18% of rural, married women of reproductive age in that state use a modern contraceptive method. (6)
A 1998 report on the quality of postabortion care services in Uttar Pradesh revealed that surprisingly few women with abortion complications presented at secondary-or tertiary level private or public facilities. (7) These results raised several questions: If women with abortion complications do not seek care at these facilities, where do they receive care, and what is the level of quality of the care they receive?
The objectives of this study were to document the availability and quality of postabortion care available to the women of four selected rural villages in India. Study results have immediate relevance for the design of reproductive health interventions in Uttar Pradesh, and also should be pertinent elsewhere, as information on access to postabortion care in rural areas is largely absent from the literature. The need for such information is great, as three-quarters of India's population live in rural areas, reflecting the situation in many developing countries. Our findings are presented according to three areas of postabortion care: treatment for complications, postabortion contraceptive counseling and services, and links to other reproductive health services. …