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Nearly 40 years after India legalized abortion, Indian women continue to be unaware that safe services are available or unable to access them. Interviews with nearly 400 women who suffered postabortion complications shed new light on this situation. The results of these interviews, collected in the state of Madhya Pradesh, are summarized in a new Ipas report, Exploring the pathways of unsafe abortion.
“This study shows that policy alone will only have a limited effect on the health and lives of women,” says Vinoj Manning, director of Ipas’s India program. “Supporting access to safe abortion services and improving women’s awareness on abortion services — when it is legal, safe methods, and where to find approved providers — will be necessary to reduce deaths and injuries associated with unsafe abortion in India.”
The study illuminated the complicated decisionmaking process that women go through when seeking abortion care. Women routinely seek information from friends and relatives. However, these friends and relatives often do not know that safe services are available or where to find them, so they sometimes recommend unsafe or untrained health-care providers, or home-brewed concoctions to end pregnancy.
Stigma, and the erroneous belief that abortion services are not legal, often leads women to choose secrecy over safety: just over half the women presenting with postabortion complications first tried to end their pregnancies at home, most often through medicines or homemade concoctions.
The study reports that one out of four women seeking abortion-related services in the 10 participating hospitals had postabortion complications, indicating that those women had sought an abortion earlier and received it unsafely. The study also found that these complications were common in all levels of society.
“We have known for a long time that women living in rural communities and with low levels of education are often forced to seek unsafe abortions,” says Manning. “However, these interviews found that many women with postabortion complications were from urban centers, and many had gone to secondary school or received additional education. Clearly, the degree and consequences of unsafe abortion are much more widespread than previously estimated.”
Preventing these complications will require a committed and concerted effort, says Sushanta Banerjee, senior research and evaluation associate and lead author of the study. “Safe services can be dramatically expanded and improved, for example, by legalizing mid-level providers to offer comprehensive abortion care and training them in safe abortion technologies of manual vacuum aspiration and medical abortion."
Programs such as Ipas India’s street drama program, in which trained actors and actresses spoke to local communities about the importance of safe abortion services and where to seek them, can also promote awareness among women and members of their trusted networks, Banerjee says.
“Finally, we all need to work together. Collaborative action by government, nongovernment organizations and physician societies will best restrict untrained providers and unsafe technologies while promoting safe, accessible practices,” he adds.
For more information, contact media@ipas.org