(122) RIGHTS-BASED REPRODUCTIVE SERVICES IN THE MEDICAL SCHOOLS IN THREE STATES IN INDIA: BASELINE FINDINGS OF A MIXED METHODS IMPLEMENTATION RESEARCH

Abstract

Abstract Introduction Women’s sexual and reproductive health depends on their autonomy to decide, freedom to choose free from coercion, right to education and information, right to dignity, and equity in access to sexual and reproductive health services. These services, especially regarding family planning and abortion services, must be strengthened in the Indian medical schools. Hence, implementation research with baseline and endline comparison was conducted to strengthen reproductive rights and evidence-based practices related to family planning and abortion care services in these schools. This study presents the findings of baseline assessment. Objective To determine the status of reproductive rights and evidence-based family planning and abortion services in Indian medical schools Methods A concurrent mixed methods study design was used to conduct the baseline assessment in nine medical schools in Rajasthan, Gujarat, and Union territory in India from October 2018 to June 2019. Reproductive health services provided to 104 women during counseling for family planning (N=85) and abortion (N=19) were observed quantitatively using a predesigned, pre-tested checklist. In-depth interviews of 33 faculty members from the Department of Obstetrics and Gynecology were conducted to qualitatively explore their beliefs and practices regarding a rights-based approach to providing reproductive healthcare services. The Capability, Opportunity, and Motivation model of behaviors (COM-B) was used to qualitatively identify barriers and facilitators of reproductive rights while providing family planning and abortion services in medical schools. Results Family planning counseling services with a cafeteria approach were observed in 69.4% of cases. Among these, 7.1% were provided with couple counseling services. Auditory privacy could be provided to 22.2% of the family planning counseling sessions. The choice of three or more contraceptives was offered to 76.5% nullipara, 54.2% para one, and 75.6% multipara women. The average duration of counseling was 7.4 minutes. Counseling on family planning and abortion was provided to 31.6% of clients. For 36.8% of clients, sterilization/IUD insertion was kept as a pre-condition for abortion. Medical schools lacked space, staffing, and logistics to provide rights-based reproductive health services. Social barriers like the poor socio-economic status of the clients, lack of education and awareness of women's rights, less autonomy in decision-making, and social and gender bias compromised women's reproductive rights. As per the COM-B model, the reproductive rights-based approach facilitators included well-informed faculty regarding dignified and respectful care, ensuring total privacy and confidentiality. However, infrastructure gaps, limited space, high workload, insufficient human resources, and lack of standard operating procedures often compromise privacy and confidentiality during counseling. Conclusions Right-based reproductive services around family planning counseling and abortion services were delivered partially despite the medical schools' trained faculty. This was mainly due to limited workspace, high workload, less autonomy, and lower awareness of reproductive rights among women. Disclosure No.