Jacobson Laura E, Brander Caila, Palanisamy Balasubramanian, Chandrasekaran Sruthi, Darney Blair G, Goodman Julia M, Jayaweera Ruvani, Gerdts Caitlin
Assistant Professor, Portland State University, OHSU-PSU School of Public Health, Portland, OR, USA; Independent Consultant, Ibis Reproductive Health, Oakland, CA, USA.
Senior Research Manager, Ibis Reproductive Health, Oakland, CA, USA.
Sex Reprod Health Matters. 2025 Dec;33(1):2531680. doi: 10.1080/26410397.2025.2531680. Epub 2025 Aug 13.
This qualitative study explored provider perspectives on self-managed abortion (SMA) in India, their roles, and how they share information about pathways to both clinician- and self-managed abortion care. We conducted 33 semi-structured interviews with a range of providers (medical, community health, and pharmacy) in three states in India: Jharkhand, Bihar, and Tamil Nadu. Using thematic analysis, we examined provider perspectives on SMA, their involvement in abortion care, and how they contribute to information sharing around access pathways. We categorised findings by provider type, direction of care pathways, abortion modality (clinician-managed vs. SMA), and the kind of care delivered. Our findings showed most providers described abortion as conditionally acceptable and primarily encouraged clinician-managed care. Concerns about SMA safety and potential liability often led them to discourage SMA. Nonetheless, participants acknowledged three areas where providers played a role in SMA: providing information, dispensing medication, and providing support (i.e. managing pain). Pharmacy workers and local providers shared information with abortion seekers on pathways to access SMA care. Some community health workers directed clients to pharmacies, but more often only provided SMA information and support. Despite provider concerns, support for and pathways to SMA exist in India. Understanding the dynamics of provider perspectives and roles can inform improvements to comprehensive reproductive health policies and programmes in order to promote person-centred abortion care - including SMA - and address provider concerns. Synergies are needed between the formal health sector and SMA support networks to advance person experiences and reinforce quality abortion care as a human right.
这项定性研究探讨了印度医疗服务提供者对自我管理堕胎（SMA）的看法、他们的角色，以及他们如何分享有关临床医生管理堕胎和自我管理堕胎护理途径的信息。我们在印度的三个邦——贾坎德邦、比哈尔邦和泰米尔纳德邦，对一系列医疗服务提供者（医学、社区卫生和药房）进行了33次半结构化访谈。通过主题分析，我们研究了医疗服务提供者对SMA的看法、他们在堕胎护理中的参与情况，以及他们如何促进围绕获取途径的信息共享。我们根据医疗服务提供者类型、护理途径方向、堕胎方式（临床医生管理与SMA）以及提供的护理类型对研究结果进行了分类。我们的研究结果表明，大多数医疗服务提供者将堕胎描述为有条件可接受的，并主要鼓励临床医生管理的护理。对SMA安全性和潜在责任的担忧常常导致他们不鼓励SMA。尽管如此，参与者承认医疗服务提供者在SMA中发挥作用的三个领域：提供信息、配药和提供支持（即管理疼痛）。药房工作人员和当地医疗服务提供者与寻求堕胎者分享了获取SMA护理途径的信息。一些社区卫生工作者将客户指引到药房，但更多时候只是提供SMA信息和支持。尽管医疗服务提供者存在担忧，但印度存在对SMA的支持和获取途径。了解医疗服务提供者观点和角色的动态情况可为改进全面的生殖健康政策和计划提供参考，以促进以人为本的堕胎护理——包括SMA——并解决医疗服务提供者的担忧。正规卫生部门与SMA支持网络之间需要协同合作，以提升个人体验，并强化将优质堕胎护理作为一项人权的理念。
