Abortion has been legal under broad criteria in India since 1971, yet representative information on abortion incidence and access to abortion services in the country has been scarce. The results of a large-scale study titled Unintended Pregnancy and Abortion in India have now been released, filling a critical evidence gap. The results of the study—which was conducted jointly by researchers at the International Institute for Population Sciences (IIPS), Mumbai, the Population Council, New Delhi, and the New York–based Guttmacher Institute—include a wide range of data on abortion in six Indian states: Assam, Bihar, Gujarat, Madhya Pradesh, Uttar Pradesh and Tamil Nadu. These states are geographically and culturally diverse, and are home to nearly half of reproductive-age women in India.
While notable differences in abortion incidence, access to abortion and quality of abortion services exist between the study states, two findings in particular cut across states. The researchers found that in all six states only a small proportion of abortions occur in a health facility setting. And among facility-based abortions in five of the six states (Assam being the exception), the minority occur in the public sector, which is the main source of health care for rural and poor women.
The majority of abortions in all six states—ranging from 63% in Tamil Nadu to 83% in Uttar Pradesh—are achieved using medication abortion (which, in India, is commonly referred to as medical methods of abortion, or MMA) and take place in settings other than health facilities. MMA is safe and effective when administered properly, but when it is provided outside of the formal health care sector, the quality of instructions and support to use the medications correctly is often low.
Given the breadth of the study, the findings can inform policies and programs to expand and improve provision of safe abortion services in the six study states; they may also be relevant for improving services in similar settings in other parts the country.
The study puts forth a number of recommendations to improve the availability of abortion services in health facilities, including training and certifying more doctors to provide abortion care. The study also recommends permitting AYUSH doctors (practitioners trained in Indian systems of medicine), nurses, and auxiliary nurse midwives to provide MMA. This would substantially expand the number of providers—and facilities—qualified to offer safe abortion services. The researchers also note the importance of ensuring that public health facilities have the equipment and drug supplies necessary to provide surgical abortion care and MMA. To address the needs of women choosing to obtain MMA from sources other than health facilities, the authors offer strategies for providing accurate information on safe use of the method.
The study findings are published in a series of reports and fact sheets:
- A comparative report and accompanying fact sheet that summarize findings from the six states
- Six state-level fact sheets on the availability and accessibility of abortion and postabortion services
- Six in-depth state-level reports and accompanying fact sheets on unintended pregnancy, abortion and postabortion care