Abstract
BackgroundAbortion services were legalized in India in 1972, however, the access to safe abortion services is restricted, especially in rural areas. In 2002, medical abortion using mifepristone- misoprostol was approved for termination of pregnancy, however, its use has been limited in primary care settings.MethodsThis paper describes a service delivery intervention for women attending with unwanted pregnancies over 14 years in four primary care clinics of Rajasthan, India. Prospective data was collected to document the profile of women, method of abortion provided, contraceptive use and follow-up rates after abortion. This analysis includes data collected during August 2001-March 2015.ResultsA total of 9076 women with unwanted pregnancies sought care from these clinics, and abortion services were provided to 70 % of these. Most abortion seekers were married, had one or more children. After 2003, the use of medical abortion increased over the years and ultimately accounted for 99 % of all abortions in 2014. About half the women returned for a follow-up visit, while the proportion using contraceptives declined from 74 % to 52 % from 2001 to 2014.ConclusionsThe results of our intervention indicate that integrating medical abortion into primary care settings is feasible and has a potential to improve access to safe abortion services in rural areas. Our experience can be used to guide program managers and service providers about reducing barriers and making abortion services more accessible to women.
Highlights
Abortion services were legalized in India in 1972, the access to safe abortion services is restricted, especially in rural areas
Women who were eligible for both methods of abortion at the time they presented to the clinic, were offered a choice of manual vacuum aspiration (MVA) or medical abortion
Between August 2001 and March 2015, a total of 9076 women presented at the three clinics with unwanted pregnancy
Summary
Abortion services were legalized in India in 1972, the access to safe abortion services is restricted, especially in rural areas. Abortion services were legalized in India in 1972 through the Medical Termination of Pregnancy Act (MTP Act), which permitted provision of abortion services under specified conditions up to 20 weeks of pregnancyn [1]. Access to safe abortion services continues to be poor [2], especially in rural areas of the country, due to skewed distribution of abortion facilities and providers, barriers related to service provision. Even in facilities that provide abortion services, various other barriers prevent women from accessing safe abortion. These include lack of confidentiality, and insistence on husband’s or relative’s consent, even though not mandated by the law. Several public health facilities are known to provide abortion services only on the condition that women adopt either sterilization or copper
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