Providing quality abortion care: Findings from a study of six states in India.

OBJECTIVE

Although abortion has been legal in India since 1971, but very little research has been done so far on the issue of the quality of abortion services. To fill this gap, this paper examines whether the quality of abortion services provided in the country is in line with the WHO's recommendations.

STUDY DESIGN

We analyse a cross-sectional health facilities survey conducted in six Indian states, representing different sociocultural and geographical regions, as part of a study done in 2015.

MAIN OUTCOME MEASURES

Percentage of facilities offering different abortion methods, type of anaesthesia given, audio-visual privacy level, compliance with the law by obtaining woman's consent only, imposing the requirement of adopting a contraceptive method as a precondition to receive abortion.

RESULTS

Except for the state of Madhya Pradesh, fewer than half of the facilities in the other states offer safe abortion services. Fewer than half of the facilities offer the WHO recommended manual vacuum aspiration method. Only 6-26% facilities across the states seek the woman's consent alone for providing abortion. About 8-26% facilities across the states also require that women adopt some method of contraception before receiving abortion.

CONCLUSION

To provide comprehensive quality abortion care, India needs to expand the provider base by including doctors from the Ayurveda, Unani, Siddha, and Homeopathy streams as also nurses and auxiliary midwives after providing them necessary skills. Medical and nursing colleges and training institutions should expand their curriculum by offering an in-service short-term training on vacuum aspiration (VA) and medical methods of abortion.