abortion service-delivery interventions such as offering post-training
support to providers can increase postabortion contraceptive uptake and
reduce unintended pregnancy, according to a large-scale Ipas study recently published in Studies in Family Planning.
The analysis looked at the prevalence and attributes of postabortion
contraceptive acceptance at 2,456 health facilities in six major Indian
states, among nearly 292,508 women who received abortion care services
from July 2011 through June 2014. It is the largest study of its kind
ever undertaken in India.
“Nearly 10 million women receive abortion-related care in India each
year, which includes induced and spontaneous abortion,” says Sushanta K.
Banerjee, senior director of Ipas Development Foundation (IDF) in India
and a co-author of the study. “But existing data indicated that women
who wanted to adopt a postabortion contraceptive method were getting
inadequate or no postabortion services. One of the things our analysis
examined was whether a post-training, provider-support intervention
would have a significant effect on postabortion contraceptive acceptance
and method mix. We found that it did.”
The three-year study was carried out at health facilities in both
rural and urban areas where IDF, a partner organization of Ipas in
India, works with state health systems to reduce deaths from unsafe
abortion by implementing a comprehensive abortion care model. The model
includes training on abortion care and treatment of postabortion care,
including contraceptive counseling, and efforts are made to ensure that
adequate supplies of contraceptive methods are maintained. Providers
trained after June 2011 received individual post-training follow-up
support; those trained before July 2011 did not.
Study findings and conclusions
- Eighty-one percent of women accepted postabortion contraception
(53 percent short-term methods [condoms or pills], 11 percent
intrauterine devices [IUDs], 16 percent sterilization).
- Acceptance was highest among women who were aged 25 or older,
received first-trimester services, received induced abortion, attended
primary-level health facilities, and had medical abortion.
- Providers who received long-term, post-training support provided
better contraceptive services than their counterparts who trained
before July 2011 and received no post-training support.
- Doctors receiving post-training support were also more likely to
offer contraceptives, but no association was observed between such
support and acceptance of IUDs or sterilization.
“What this study highlights,” says Kathryn Andersen, Ipas senior
research and evaluation advisor and study co-author, “is that the
millions of Indian women who received abortion-related care can be
provided with effective contraceptive methods if they are provided with
effective postabortion counseling and if the method mix is improved and
offers contraceptive choice. Our findings can be used to scale up
postabortion contraceptive services across all states of India.”
One of the study’s conclusions is that policies are needed to expand women’s choice of modern contraceptive methods by introducing implants and improving the availability of injectables in public-sector health facilities. It also urges India’s national and state governments to increase resources for commodities and supplies of all modern methods.
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