Key Points

• This report reviews and synthesizes the peer-reviewed literature, as well as important grey literature, published between 2002 and 2014 on abortion in India.

• Over the past decade, some key policy developments have contributed to improved avail- ability, accessibility and safety of induced abortion services; these include revised regulations expanding services to primary health centers, the approval of medical abortion for terminating early pregnancies, and the promotion of manual vacuum aspiration as the preferred method for early surgical abortion.

• The impact of these efforts has been dampened by difficulties in implementation. For ex- ample, the expansion of abortion services into lower-level facilities has been uneven, leaving many districts with few public facilities that provide the services. Studies indicate that many of the largest, least developed states are disproportionately underserved by certified facilities.

• National- and state-level studies suggest that the majority of women in India who seek abortion services do so to limit family size, space births or protect their health, or because of poverty and economic constraints. Only a small proportion of all abortions are likely performed for sex-selective reasons.

• The incidence of complications among women having unsafe abortions is poorly documented. Such complications appear to have declined over the past decade, but limited knowledge and poor access to safe and legal services mean that many women seeking abortion make at least one unsuccessful attempt before they end their pregnancy. Some of these attempts carry health consequences for the women.

• Young and unmarried women are particularly vulnerable to poor sexual and reproductive health in general, and they have especially poor access to safe abortion services, which leads to delays in obtaining services and reliance on unsafe providers.

• Estimates of abortion in India are based on a variety of indirect methods that likely underesti- mate its prevalence; improved incidence studies are an important area for future research.