This study looked at the socio-economic profile of women seeking abortion services in public health facilities across Madhya Pradesh state and at out of pocket cost accessing abortion services. In particular, it examined the level of access that poor women have to safe abortion services in Madhya Pradesh. Findings highlight that, overall, 57% of women who received abortion care at public health facilities were poor, followed by 21% moderate and 22% rich. Improved availability of safe abortion services at the primary level in Madhya Pradesh has helped meeting the need of safe abortion services among poor, which eventually will help reducing the maternal mortality and morbidity due to unsafe abortion.
‘How shall we survive’: A qualitative study of women’s experiences following denial of menstrual regulation (MR) services in Bangladesh
About one quarter of women in Bangladesh are denied menstrual regulation (MR) due to advanced gestation. Little is known about whether women denied MR seek abortion elsewhere, self-induce, or continue the pregnancy.
Intimate partner violence and constraints to reproductive autonomy and reproductive health among women seeking abortion services in Bangladesh
The objective of this study was to understand intersections between intimate partner violence (IPV) and other constraints to women’s reproductive autonomy, and the influence of IPV on reproductive health. There were 457 participants included in the analysis and 118 (25.8%) had experienced IPV in the preceding year. IPV was associated with discordance in fertility intentions with husbands/partners and in-laws, with in-law opposition to contraception, with perceived religious prohibition of contraception, and with presenting unaccompanied. Ensuring women’s reproductive freedom requires addressing IPV and related constraints.
Evaluating the relative effectiveness of high-intensity and low-intensity models of behaviour change communication interventions for abortion care-seeking in Bihar and Jharkhand, India: A cross-sectional study
This study aimed to compare the effectiveness of a high-intensity model (HIM) and a low-intensity model (LIM) of behaviour change communication interventions in Bihar and Jharkhand states of India designed to improve women’s knowledge and usage of safe abortion services. Although both intervention types improved abortion knowledge, the HIM intervention was more effective.
Associations between abortion services and acceptance of postabortion contraception in six Indian states
Women receiving induced abortions or postabortion care are at high risk of subsequent unintended pregnancy, and intervals of less than six months between abortion and subsequent pregnancy may be associated with adverse outcomes. This study highlights the prevalence and attributes of postabortion contraceptive acceptance from 2,456 health facilities in six major Indian states, among 292,508 women who received abortion care services from July 2011 through June 2014.
This study sought to understand women’s experiences using medication for menstrual regulation in Bangladesh. In-depth interviews were conducted with 20 rural and urban women.The majority had had positive experiences with medication for menstrual regulation and successful outcomes. Continued efforts to improve counselling by providers about the dose, medication and side-effects of medication for menstrual regulation, along with education of the community about medication as an option for menstrual regulation, will help to de-stigmatise the procedure and the women who seek it.
Expansion of safe abortion services in Nepal through auxiliary nurse-midwife provision of medical abortion, 2011-2013
Comprehensive abortion care services remain out of reach for many women in rural and remote areas of Nepal. This article describes a training and support strategy to train auxiliary nurse-midwives (ANMs), already certified as skilled birth attendants, as medical abortion providers and expand geographic access to safe abortion care to the community level in Nepal.
Abortion has been legal in Nepal since 2002, and post-abortion care has been successfully integrated into hospitals. But that does not mean that women can easily obtain safe abortion services. The barriers are many, and women are often stigmatized for the decision to end a pregnancy.
Contraception is an essential element of high-quality abortion care. However, women seeking abortion often leave health facilities without receiving contraceptive counselling or methods, increasing their risk of unintended pregnancy. This paper describes contraceptive uptake in 319,385 women seeking abortion in 2,326 public-sector health facilities in eight African and Asian countries. Ministries of Health integrated contraceptive and abortion services, with technical assistance from Ipas. Overall, postabortion contraceptive uptake was 73 percent. The findings demonstrate high contraceptive uptake when it is delivered at the time of the abortion, a wide range of contraceptive commodities is available, and ongoing monitoring of services occurs.
Lessons learned from integration of postabortion care, menstrual regulation, and family planning services in Bangladesh
Lessons learned from integration of postabortion care, menstrual regulation, and family planning services in Bangladesh. This study recommended working toward improved post-procedure contraception delivery and evidence-based appropriate technology use for all procedures by improving collaboration and integration between Bangladesh’s Directorate General of Health Services (DGHS) and Directorate General of Family Planning (DGFP).
Unsafe abortion’s significant contribution to maternal mortality and morbidity was a critical factor leading to liberalization of Nepal’s restrictive abortion law in 2002. Careful, comprehensive planning among a range of multisectoral stakeholders, led by Nepal’s Ministry of Health and Population, enabled the country subsequently to introduce and scale-up safe abortion services in a remarkably short timeframe. This paper examines factors that contributed to rapid, successful implementation of legal abortion in this mountainous republic, including deliberate attention to the key areas of policy, health system capacity, equipment and supplies, and information dissemination.
Despite liberalization of the Nepal abortion law, young women continue to experience barriers to safe abortion services. This study evaluated differences in reproductive knowledge and attitudes by marital status. Participants were surveyed on demographics, romantic experiences, media habits, reproductive information, and abortion knowledge and attitudes. Only 45% responded that they knew that abortion was legal, and fewer ever-married women were aware of abortion legality. Never-married women expected more negative responses from having an abortion than ever-married women. Findings highlight the need for providing sexual and reproductive health care information and services to young women regardless of marital status.
This paper assesses women’s awareness of the liberalization of abortion law and their knowledge of a place for obtaining abortion services in Nepal. The data are from the 2011 Nepal Demographic and Health Survey. The results are compared with data from a similar survey conducted in 2006. The results suggest the need to intensify efforts to educate women in Nepal, particularly the most disadvantaged women, about abortion law, including the conditions under which abortion is permitted, and where to access safe abortion services.
Evaluation of a multi-pronged intervention to improve access to safe abortion care in two districts in Jharkhand
Despite the adoption of the Medical Termination of Pregnancy Act in 1972, access to safe abortion services remains limited in India. Awareness of the legality of abortion also remains low, leading many women to seek services outside the health system.
Where abortion is illegal, women suffer. Before 2002 when abortion was illegal in Nepal, women were imprisoned, half of all hospital admissions were due to complications from clandestine abortions, and hundreds of women died each year.
Are young women in India prepared to deal with sexual and reproductive health issues? A case study of Jharkhand, India
Young Indian women often face social, economic, logistical, policy and health system barriers when accessing sexual and reproductive health services, including safe abortion care. A cross-sectional household survey was conducted in July – August 2012 in Jharkhand, India. We interviewed 1,381 young women (15-24 years) to assess their knowledge, agency, and skills on SRH issues, including safe abortion, and to identify barriers and influencers that lead to particular behaviors, decisions, or service utilization.
Accreditation of Private Sector Health Facilities for Provision of Comprehensive Abortion Care Services: An Initiative of the Government of Bihar
Recognizing the need to increase access to safe abortion services to reduce maternal mortality and morbidity, in 2011 the Government of Bihar developed a new mechanism of accrediting and subsidizing private health care facilities. The program, Yukti Yojana (“a scheme for solution”), accredits eligible health facilities and supports them in providing abortion-related services free of charge to low-income women. This is the first PPP model in India to ensure access to safe abortion services free of cost at accredited private facilities. This study evaluates the efficacy of the first phase of intervention for scaling up further and replicating the same model in other states.