In India, a new study looks at ways to effectively share messages about safe abortion services

Tuesday, November 20, 2012

Community gathering in India with IEC materialsGroup meetings used interactive games and other materials to raise awareness about the legality of abortion and availability of safe services.

India adopted a relatively liberal abortion law more than 40 years ago, but millions of women still turn to unqualified providers for care each year and nearly 10,000 Indian women die annually from abortion-related causes.

new study says that one way to reduce these numbers is through educational campaigns to raise public awareness about the legality of abortion and the existence of safe services at government health-care facilities. The four-year study focused on two largely rural Indian states, Bihar and Jharkhand, where early marriage and childbearing is common. It was conducted by Ipas India in cooperation with the health ministries in those states.

“When we began this intervention in 2008, we found that people were absolutely without information on abortion,” says Ipas Senior Research and Evaluation Advisor Sushanta K. Banerjee, one of the study authors. “What we found is that getting information out—starting with the message that ‘abortion is legal’— is the platform for change.”

The study tested two types of communications models to raise community awareness about abortion. The “high-intensity” model used wall signs, street theater, distribution of low-literacy reference materials, and interpersonal communications, such as group meetings and interactive games. The “low-intensity” model relied on wall signs and community intermediaries who were oriented on the legality and availability of abortion services.

While both models increased women’s exposure to information on abortion issues, the study found that the high-intensity model is the most effective,  possibly because it increases the likelihood that messages will reach women multiple times. “This finding suggests that to increase knowledge about abortion where levels of knowledge are low, it is important [to]…ensure that women receive multiple exposures to these messages,” the study says.

Also key, notes Banerjee, is the use of “very simple and lucid communications materials.”  Even where literacy levels are low, he says, wall signs (which were used in both the high- and low-intensity models) are effective because they spark discussion. “People see them and ask, ‘What is written there? Can you please explain?’”

The study also measured changes in women’s utilization of abortion services during the study period. “Though it is encouraging that use of more modern abortion methods and postabortion contraception increased,” the study says, “...there was also evidence that use of informal providers and the percentage of women reporting postabortion complications increased.” This could indicate that “as women become aware of the legality of abortion services, they seek services from informal providers because they are perceived to be less expensive and easier to access than medical doctors in health facilities.”  

The authors recommend that future communications campaigns place more emphasis on the consequences of abortion with untrained providers. Because the study also found that women are approaching private-sector doctors for abortion services, they urge that more efforts be made to engage private-sector doctors who can provide services in rural areas.

The study notes that public education campaigns have been used successfully in India to raise awareness on HIV/AIDS and family planning issues, but have rarely been used in association with abortion issues. That is about to change, however.

“In 2008, we were not sure that a campaign such as this on abortion would be taken positively,” says Banerjee. “Now, in 2012, many ground-level NGOs and stakeholders have joined hands to promote awareness on safe abortion. That is the change we’ve seen, and it’s very encouraging.”