An exploration of the socio-economic profile of women and costs of receiving abortion services at public health facilities of Madhya Pradesh, India.

BACKGROUND: Maternal mortality, which primarily burdens developing countries, reflects the greatest health divide between rich and poor. This is especially pronounced for access to safe abortion services which alone avert 1 of every 10 maternal deaths in India. Primarily due to confidentiality concerns, poor women in India prefer private services which are often offered by untrained providers and may be expensive. In 2006 the state government of Madhya Pradesh (population 73 million) began a concerted effort to ensure access to safe abortion services at public health facilities to both rural and urban poor women. This study aims to understand the socio-economic profile of women seeking abortion services in public health facilities across this state and out of pocket cost accessing abortion services. In particular, we examine the level of access that poor women have to safe abortion services in Madhya Pradesh. METHODS: This study consisted of a cross-sectional client follow-up design. A total of 19 facilities were selected using two-stage random sampling and 1036 women presenting to chosen facilities with abortion and post-abortion complications were interviewed between May and December 2014. A structured data collection tool was developed. A composite wealth index computed using principal component analysis derived weights from consumer durables and asset holding and classified women into three categories, poor, moderate, and rich. RESULTS: Findings highlight that overall 57% of women who received abortion care at public health facilities were poor, followed by 21% moderate and 22% rich. More poor women sought care at primary level facilities (58%) than secondary level facilities and among women presenting for postabortion complications (67%) than induced abortion. Women reported spending no money to access abortion services as abortion services are free of cost at public facilities. However, poor women spend INR 64 (1 USD) while visiting primary level facilities and INR 256 (USD 4) while visiting urban hospitals, primarily for transportation and food. CONCLUSIONS: Improved availability of safe abortion services at the primary level in Madhya Pradesh has helped meeting the need of safe abortion services among poor, which eventually will help reducing the maternal mortality and morbidity due to unsafe abortion.

Adapting the WHO recommendations on health worker roles for safe abortion to a country setting: A case study from India.

In 2015, the World Health Organization (WHO) published a guideline on the role of health workers in providing safe abortion and postabortion contraception, with evidence-based recommendations on the range of providers who can perform interventions to provide safe abortion, postabortion care, and postabortion contraception. The WHO guideline is global in nature and must be contextualized to individual country settings. The present paper compares the scenario in India, including the legal and policy frameworks, with the WHO guidelines. It provides legal and policy recommendations that are needed to improve access to comprehensive abortion care in India, with a focus on expanding the provider base. The process used to develop these recommendations was a combination of empirical evidence gathering and multistakeholder consultations. An outcome of this exercise was a policy brief entitled "Improving access to comprehensive abortion care in India with focus on expanding provider base," which is used as an advocacy tool.

Availability of medical abortion pills and the role of chemists: a study from Bihar and Jharkhand, India.

The clinical safety, efficacy and acceptability of mifepristone and misoprostol in the Indian context have been well studied, but little is known about how they are being used, who is using them, how women access them or how providers, chemists, women and their partners perceive medical abortion. This paper reports on part of a study on these issues, a survey of 209 chemists, in the Indian states of Bihar and Jharkhand in 2004. It found that only 34% of the interviewed chemists stocked mifepristone and misoprostol, sales volumes were low and there was more demand for cheaper, often ineffective preparations for abortion. Men were more likely to buy abortifacient drugs than women. Chemists knew mifepristone and misoprostol were prescription drugs but less about dosage and side effects. Most sales appeared to be prescription driven, but some over-the-counter sales did occur, especially when ability to pay seemed high or the chemist knew the customer. Chemists need accurate information on the drugs they sell as abortifacients, encouragement to promote pregnancy tests, training in encouraging women to see a provider prior to purchase, and visual and written material to hand out. Better adherence to existing regulations for all prescription drugs is important, but the best course is to increase the availability of low-cost, safe abortion services at primary care level.