Abortion Assessment Project, India, uncovers important lessons about abortion services

Abortion is legal in India, but lack of access to timely information means that many women still resort to unsafe abortion.

Photo courtesy of Peter Parker, Panos Pictures.

Unlike many developing countries, India's liberal abortion law allows women to seek abortion for a broad range of indications. However, “legal” often does not translate to “safe”: thirty percent of Asia’s maternal deaths occur in India, with approximately nine percent of all reported maternal deaths attributed to unsafe abortion.

In order to understand these statistics better and learn more about abortion care in India, a coalition of health and advocacy organizations launched the Abortion Assessment Project, India (AAP-I) in 2000. Funded by the Rockefeller, Ford and MacArthur Foundations, the AAP-I has undertaken a broad range of qualitative and quantitative research projects with an eye toward generating policy recommendations to improve abortion care. The project is a partnership among several Indian nongovernmental organizations, health-care professionals, researchers and advocates. The AAP-I is managed by the Centre for Equity into Health and Allied Themes (CEHAT) and a health-advocacy network, HealthWatch. Ipas has been a key partner in the AAP-I since its conceptualization in 1998.

The findings from the AAP-I were derived from a series of working papers and studies: a review of Indian abortion policy; a six-state survey of abortion facilities; eight community-based qualitative studies; a study on informal providers of abortion care; and a two-state household survey.

Key findings from the studies were disseminated at a national consultation in late December, 2004, and selectively published by the Indo-Asian News Service. Of particular note are data which indicate that the total number of abortions performed in India annually is at least six million, nearly 10 times the official estimate cited by government census data. Further, dilatation and curettage (D&C) remains the favored method for terminating pregnancies through the first trimester, rather than the less-invasive manual vacuum aspiration. Sociocultural stigmas attached to abortion remain a persistent problem inhibiting access to safe and legal services. This situation is compounded by the perceived difference in quality of care between public- and private-sector service provision.

A number of recommendations can be derived from the findings, among them the great need for strategic advocacy initiatives to increase awareness of the legality and availability of safe abortion care in India. Select recommendations from the report include:

• expanding the cadre of providers eligible to provide abortion services;
• integrating abortion services into routine service delivery through the government-administered Reproductive and Child Health (RCH) program;
• expanding the range of postabortion contraception options available to Indian women to prevent unwanted pregnancies.

Lastly, recommendations to further amend the country's abortion law and its governing Rules and Regulations to allow unmarried women access to services and include the right to terminate pregnancies through the first trimester.

The full article is available online.

An article delineating summary findings of the AAP-I is also available online.

Select study reports and working papers from the AAP-I co-authored by Ipas staff (names of Ipas staff appear in bold):

Batra, S. and S. Ravindran. 2003. Abortion training in India: A long way to go. AAP-I working paper. Mumbai, CEHAT.

Ganatra, B. 2003. 2003. Coercion, control or choice? Seminar 532: 20-23. Available online. Last accessed January 7, 2005.

Ganatra, B. and L Visaria. 2004. Informal providers of abortion services: Some exploratory studies. Ahemdabad, CEHAT, HealthWatch and Ipas.

George, Alex. 2003. From decoctions to instruments. Seminar 532: 52-56. Available online. Last accessed January 7, 2005.

Johnston, H. 2003. Abortion practice in India: A review of the literature. AAP-I working paper. Mumbai, CEHAT.

Visaria, L., V. Ramachandran, B. Ganatra and S. Kalyanwalla. 2004. Abortion in India: Emerging issues from qualitative studies. Economic and Political Weekly 39 (46 and 47): 5044-5052.

Visaria, L., V. Ramachandran, B. Ganatra and S. Kalyanwalla. 2003. Overview and synthesis of emerging issues from the qualitative studies. In AAP-I Qualitative Studies. New Delhi, CEHAT and HealthWatch, Tullika Publishers.

Bibliography

1. Government of India, Ministry of Health and Family Welfare. 2000. Annual report 2001-2002. New Delhi, Government of. Available online. Last accessed January 7, 2005.

2. Indo-Asian New Service. December 20, 2004. Health News. Six million annual abortions in India: Study. Available online. Last accessed January 7, 2005.

3. Shah, Iqbal and Elisabeth Åhman. Forthcoming. Regional variations in age patterns of unsafe abortion. Reproductive Health Matters.

For more information, contact:
Kirsten Sherk
Senior Associate, Media Relations
e-mail: sherkk@ipas.org
phone: 919.960.5612
fax: 919.929.0258