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| (c) David and Lucille Packard Foundation |
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New research led by Ipas’s Bela Ganatra provides one of the first in-depth looks at women’s experiences with medical abortion in India. The study, published recently in the journal Global Public Health, provides valuable information about how women felt about medical abortion, how counseling influenced the process and their thoughts about making abortion with medications a less “medicalized” procedure.
“Medical abortion holds great potential for increasing women’s access to safe abortion services in India,” says Ganatra. “However, very little is currently known about Indian women’s experiences with this method. Learning more about how women think and feel about medical abortion will allow us to improve services and make them more accessible to women in India and in other parts of the developing world.”
Researchers interviewed 63 women who chose to end their pregnancies with mifepristone and misoprostol. Women having abortions at clinics in the cities of Delhi and Pune answered questions about how and why they chose medical abortion, their experiences of the abortion process, their reactions after the abortion and their experiences with postabortion contraception. Among other findings, the study found that:
• Just under half (48 percent) of the women had some knowledge of medical abortion beforehand; 10 percent specifically sought out this method.
• One in four women first tried over-the-counter (and often ineffective) medications to terminate an unwanted pregnancy, before seeking medical abortion from the clinic.
• Almost all (94 percent) of the women interviewed chose the method either because of its relative simplicity, or because it did not involve an invasive procedure.
• Most (59 percent) of the women felt that the procedure only added minor disruptions, such as need for additional rest, nausea or other mild side effects, to their daily routines. Women were more likely to find these disruptions acceptable when they received social support from their husbands and families.
• Clear information and empathetic counseling from providers about possible side effects increased tolerance for pain and bleeding and allayed fears about side effects and effect on future pregnancies. Nearly half the women reported feeling anxious about whether or not the abortion process was complete. Women reported that counseling about possible side effects and the need for follow-up either added to or eased this anxiety, depending on the way the provider offered this information.
• Almost all (95 percent) of the women reported being counseled about postabortion contraception, and most women counseled said they intended to use it. However, women also specified that converting intent to action would depend on the effort required to obtain contraception, the number of additional clinic visits required and their husband’s views on using contraception.
Although Ganatra warns that the sample size of interviewed women is too small to generalize to the women of India, she says the results of the study nevertheless provide valuable information, not only about who is currently using medical abortion, but about the challenges women face in accessing or accepting medical abortion. Fourteen of the women, for example, said that it was difficult for them to come to the clinic to receive the medications.
“There’s nothing wrong in coming,” one 35-year-old woman told the interviewers, “but I have to finish the household chores first. That can be difficult as I have to look after everything.” When asked if allowing women to take misoprostol at home would make this situation easier, most women said that it would depend on the level of support women received at home, as well as women’s own confidence in the process.
Some other women, either because of myths associated with medical abortion or lack of knowledge about medications, had inaccurate fears about medical abortion having permanent effects on the body. “I was scared. I’d never consumed foreign tablets before!” one 27-year-old woman told interviewers.
Finally, Ganatra says, the study pointed to the strong influence that health-care providers’ counseling and information have on women’s experiences and expectations. Clear information and sensitive counseling can help women understand what to expect and have confidence in the method.
This study was carried out by Ipas and the Population Council in partnership with KEM Hospital in Pune and Parivar Seva Sanstha hospital in Delhi.
For more information, contact media@ipas.org