Abstract
BackgroundThe Medical Termination of Pregnancy (MTP) Act of 1971 liberalized abortion laws in India. This study examines changes in abortion service provision and characteristics of abortion providers in Bihar and Jharkhand states, India between 2004 and 2013.MethodsWe used state-representative data from cross-sectional surveys of reproductive health service providers we conducted in 2004 (N = 1,323) and 2012/2013 (N = 1,020). We employed chi-squared tests to examine and compare abortion providers’ characteristics, and fitted separate multivariate logistic regression models for provision of surgical, medical, and any abortion services, respectively, adjusting for potential confounders to identify factors associated with abortion service provision at the two survey time points.ResultsOf providers interviewed in 2004 and 2012/2013, 63.7% and 84.5%, respectively, offered abortion services. Among abortion providers, 21.1% offered surgical and 10.7% offered medical abortions in 2004; 15.8% and 94.1% did so, respectively, in 2012/2013. Private providers were more likely than public providers to offer abortion services at both time points. Compared to female providers, male providers were significantly less likely to provide both surgical and medical abortions in 2004, and significantly less likely to provide surgical abortions in 2012/2013. Pharmacists and community health workers played increasingly important roles in abortion service provision, especially medical abortion, during the period.ConclusionThis study documents important changes in abortion provision in the two Indian states during 2004–2013.
Highlights
In India, provision of abortion services is permitted at all public facilities with certified abortion providers, and at registered facilities in the private sector that are certified to offer abortions based on a set of government-set infrastructure and human resource criteria [1]
This study examines changes in abortion service provision and characteristics of abortion providers in Bihar and Jharkhand states, India between 2004 and 2013
We employed chi-squared tests to examine and compare abortion providers’ characteristics, and fitted separate multivariate logistic regression models for provision of surgical, medical, and any abortion services, respectively, adjusting for potential confounders to identify factors associated with abortion service provision at the two survey time points
Summary
In India, provision of abortion services is permitted at all public facilities with certified abortion providers, and at registered facilities in the private sector that are certified to offer abortions based on a set of government-set infrastructure and human resource criteria [1]. All types of providers are found offering abortion services, and medical abortion drugs can be obtained from rural medical practitioners and from pharmacies [1, 2] It was the Medical Termination of Pregnancy (MTP) Act of 1971 that liberalized abortion laws in India [3]. National comprehensive abortion care guidelines were released in 2010 and indicated that medical abortion with mifepristone and misoprostol may be provided up to 63 days of gestation [2] This indication has not yet been reflected in a change to the MTP Act, and neither were amendments to the MTP Act proposed in 2014 to allow mid-level providers and non-allopathic practitioners to terminate pregnancies and to expand the gestational age limit for abortion to 24 weeks [5,6]. This study examines changes in abortion service provision and characteristics of abortion providers in Bihar and Jharkhand states, India between 2004 and 2013
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