Research, Guttmacher Institute, New York, New York, USA
Research, Guttmacher Institute, New York, New York, USA.
BMJ Glob Health. 2020 Jul;5(7). doi: 10.1136/bmjgh-2020-002372.
Abortion has been legal under broad criteria in India since 1971. However, access to legal abortion services remains poor. In the past decade, medication abortion (MA) has become widely available in India and use of this method outside of health facilities accounts for over 70% of all abortions. Morbidity from unsafe abortion remains an important health issue. The informal providers who are the primary source of MA may have poor knowledge of the method and may offer inadequate or inaccurate advice on use of the method. Misuse of the method can result in women seeking treatment for true complications as well as during the normal processes of MA. An estimated 5% of all abortions are done using highly unsafe methods and performed by unskilled providers, also contributing to abortion morbidity. This paper provides new representative abortion-related morbidity measures at the national and subnational levels from a large-scale 2015 study of six Indian states-Assam, Bihar, Gujarat, Madhya Pradesh, Tamil Nadu and Uttar Pradesh. The outcomes include the number and treatment rates of women with complications resulting from induced abortion and the type of complications. The total number of women treated for abortion complications at the national level is 5.2 million, and the rate is 15.7 per 1000 women of reproductive age per year. In all six study states, a high proportion of all women receiving postabortion care were admitted with incomplete abortion from use of MA-ranging from 33% in Tamil Nadu to 65% in Assam. The paper fills an important gap by providing new evidence that can inform policy-makers and health planners at all levels and lead to improvements in the provision of postabortion care and legal abortion services-improvements that would greatly reduce abortion-related morbidity and its costs to Indian women, their families and the healthcare system.
自 1971 年以来，印度在广泛的标准下将堕胎合法化。然而，获得合法堕胎服务的机会仍然很差。在过去的十年中，药物流产（MA）在印度已广泛普及，并且在医疗设施外使用这种方法的比例超过了所有堕胎的 70%。不安全堕胎造成的发病率仍然是一个重要的健康问题。作为 MA 的主要来源的非正规提供者可能对该方法了解甚少，并且可能在使用该方法方面提供不足或不准确的建议。该方法的滥用可能导致妇女在真正的并发症出现时以及在 MA 的正常过程中寻求治疗。据估计，所有堕胎中有 5%是使用非常不安全的方法并由非熟练提供者进行的，这也导致了堕胎发病率的增加。本文从印度六个邦（阿萨姆邦、比哈尔邦、古吉拉特邦、中央邦、泰米尔纳德邦和北方邦）的一项大规模 2015 年研究中提供了国家和次国家层面上的新的、具有代表性的堕胎相关发病率指标。研究结果包括因人工流产导致并发症和并发症类型而接受治疗的妇女人数和治疗率。在国家一级，因堕胎并发症而接受治疗的妇女总数为 520 万，发生率为每 1000 名育龄妇女每年 15.7 例。在所有六个研究邦中，所有接受堕胎后护理的妇女中，有很大一部分是因 MA 不完全流产而入院的，其中在泰米尔纳德邦为 33%，在阿萨姆邦为 65%。该论文通过提供新的证据填补了一个重要空白，这些证据可以为各级决策者和卫生规划者提供信息，并导致改进堕胎后护理和合法堕胎服务的提供，这些改进将大大降低与堕胎相关的发病率及其对印度妇女、其家庭和医疗保健系统的成本。
