Medical students are afraid to include abortion in their future practices: in-depth interviews in Maharastra, India.

Susanne Sjöström,Marie Klingberg-Allvin,Birgitta Essén,Kristina Gemzell-Danielsson

doi:10.1186/s12909-016-0532-5

Susanne Sjöström, Marie Klingberg-Allvin + Show 2 more

Open Access

https://doi.org/10.1186/s12909-016-0532-5

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Abstract

BackgroundUnsafe abortions are estimated to cause eight per-cent of maternal mortality in India. Lack of providers, especially in rural areas, is one reason unsafe abortions take place despite decades of legal abortion. Education and training in reproductive health services has been shown to influence attitudes and increase chances that medical students will provide abortion care services in their future practice. To further explore previous findings about poor attitudes toward abortion among medical students in Maharastra, India, we conducted in-depth interviews with medical students in their final year of education.MethodWe used a qualitative design conducting in-depth interviews with twenty-three medical students in Maharastra applying a topic guide. Data was organized using thematic analysis with an inductive approach.ResultsThe participants described a fear to provide abortion in their future practice. They lacked understanding of the law and confused the legal regulation of abortion with the law governing gender biased sex selection, and concluded that abortion is illegal in Maharastra. The interviewed medical students’ attitudes were supported by their experiences and perceptions from the clinical setting as well as traditions and norms in society. Medical abortion using mifepristone and misoprostol was believed to be unsafe and prohibited in Maharastra. The students perceived that nurse-midwives were knowledgeable in Sexual and Reproductive Health and many found that they could be trained to perform abortions in the future.ConclusionsTo increase chances that medical students in Maharastra will perform abortion care services in their future practice, it is important to strengthen their confidence and knowledge through improved medical education including value clarification and clinical training.

Highlights

Unsafe abortions are estimated to cause eight per-cent of maternal mortality in India
Despite a substantial reduction in the maternal mortality ratio (MMR) in India during the past decades, especially in urban areas, WHO estimates that 50,000 maternal deaths occurred in
Midlevel provision of medical and aspiration abortion has been shown to be feasible in India, and amendments to the law to approve midlevel provision of abortion care services are currently under consideration by the Ministry of Health and Family Welfare [12, 13]

Summary

Introduction

Unsafe abortions are estimated to cause eight per-cent of maternal mortality in India. Especially in rural areas, is one reason unsafe abortions take place despite decades of legal abortion. Education and training in reproductive health services has been shown to influence attitudes and increase chances that medical students will provide abortion care services in their future practice. Despite a substantial reduction in the maternal mortality ratio (MMR) in India during the past decades, especially in urban areas, WHO estimates that 50,000 maternal deaths occurred in Sjöström et al BMC Medical Education (2016) 16:8 likely to seek consultation in the community than at health facilities in those cases [6]. Shortage of trained health care providers and lack of properly equipped health facilities are common barriers to safe abortion, especially in rural areas [8,9,10]. Medical abortion using mifepristone and misoprostol is approved in India up to 63 days of gestation, and has been shown to be safe, reliable and effective [14], but awareness and knowledge is generally low among women and physicians, and implementation has been slow, especially in the public sector [15, 16]

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