Gupta Madhu, Iyengar Kirti, Singla Neena, Kaur Kiranjit, Verma Madhur, Singla Rimpi, Rohilla Minakshi, Suri Vanita, Aggarwal Neelam, Singh Tarundeep, Pal Swarnika, Dhiman Anchal, Goel Poonam, Goel N K, Pant Reena, Gaur Kusum Lata, Gehlot Hanslata, Bhati Indra, Verma Manoj, Agarwal Sudesh, Acharya Rekha, Singh Keerti, Chauhan Madhubala, Rastogi Radha, Bedi Renu, Pancholi Poornima, Nayak Bipin, Modi Bhavesh, Nakum Kanaklata, Trivedi Atul, Aggarwal Shonali, Patel Sangita
Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India.
United Nations Population Fund, New Delhi, India.
Contracept Reprod Med. 2024 Nov 14;9(1):58. doi: 10.1186/s40834-024-00316-5.
There is a need to assess and strengthen reproductive rights-based family planning and abortion services in Indian medical schools that play a key role in medical education and service delivery. This study presents the findings of baseline assessment across nine schools in two states and one union territory with objective to assess, identify the gaps and improve the status of reproductive rights and evidence-based family planning and abortion services in Indian medical schools.
A convergent parallel mixed methods study was conducted in nine medical schools in Rajasthan, Gujarat, and Chandigarh a Union territory in India from October 2018 to June 2019. In-depth interviews with 33 faculty from the Department of Obstetrics and Gynaecology were conducted. The COM-B (Capability, Opportunity, and Motivation) model of behaviours was used to qualitatively identify barriers and facilitators of reproductive rights-based family planning and abortion services. Reproductive health services provided to 104 women for family planning and abortion were observed quantitatively using a pre-tested checklist.
Providers' preference bias in recommending contraceptive methods to specific clients (wherein sterilisation was offered to women with two or more children and IUCD to women with one child) was observed as barrier to reproductive rights. The facilitators of rights based reproductive services included well-informed faculty regarding providing dignified and respectful care. Barriers included infrastructure gaps, high workload, insufficient human resources affecting privacy, and lower awareness and decision-making power of clients. Family planning counselling using the cafeteria approach was offered in 69.4% of cases, 31.6% of women seeking abortion services were offered counselling on both family planning and abortion. Sterilisation or IUD insertion was a pre-condition in 36.8% of women requesting an abortion.
Right-based reproductive services around family planning counselling and abortion services were delivered partially despite the medical schools' trained faculty, mainly due to provider bias, high workload, and less autonomy and lower awareness of reproductive rights among women.
有必要评估并加强印度医学院校中基于生殖权利的计划生育和堕胎服务，这些院校在医学教育和服务提供中发挥着关键作用。本研究展示了对两个邦和一个联邦属地的九所院校进行基线评估的结果，目的是评估、找出差距并改善印度医学院校中生殖权利以及循证计划生育和堕胎服务的现状。
2018年10月至2019年6月，在印度拉贾斯坦邦、古吉拉特邦的九所医学院校以及联邦属地昌迪加尔开展了一项聚合平行混合方法研究。对33名妇产科系教员进行了深入访谈。运用行为的COM-B（能力、机会和动机）模型定性识别基于生殖权利的计划生育和堕胎服务的障碍及促进因素。使用预先测试的清单对为104名妇女提供的计划生育和堕胎生殖健康服务进行了定量观察。
观察到提供者在向特定客户推荐避孕方法时存在偏好偏差（向有两个或更多孩子的妇女提供绝育服务，向有一个孩子的妇女提供宫内节育器），这是生殖权利的障碍。基于权利的生殖服务的促进因素包括教员对提供有尊严和尊重的护理有充分了解。障碍包括基础设施差距、工作量大、影响隐私的人力资源不足，以及客户的意识和决策权较低。69.4%的案例采用了自助式计划生育咨询，31.6%寻求堕胎服务的妇女同时接受了计划生育和堕胎咨询。36.8%要求堕胎的妇女将绝育或放置宫内节育器作为前提条件。
尽管医学院校有经过培训的教员，但围绕计划生育咨询和堕胎服务的基于权利的生殖服务仅部分得到提供，主要原因是提供者的偏见、工作量大以及妇女的生殖权利自主权较低和意识不足。
