Experience seeking abortion among unmarried young women in Bihar and Jharkhand, India: delays and disadvantages

Abstract

Studies suggest that the experiences of unmarried young women seeking abortion in India differ from those of their married counterparts, but the evidence is limited. Research was undertaken among nulliparous young women aged 15–24 who had abortions at the clinics of a leading NGO in Bihar and Jharkhand. Over a 14-month period in 2007–08, 246 married and 549 unmarried young abortion seekers were surveyed and 26 who were unmarried were interviewed in depth. Those who were unmarried were far more likely to report non-consensual sexual relations. As many as 25% of unmarried young women, compared to only 9% of married young women, had had a second trimester abortion. The unmarried were far more likely to report non-consensual sexual relations leading to pregnancy. They were also more likely to report such obstacles to timely abortion as failure to recognise the pregnancy promptly, exclusion from abortion-related decision-making, seeking confidentiality as paramount in selection of abortion facility, unsuccessful previous attempts to terminate the pregnancy, and lack of partner support. After controlling for background factors, findings suggest that unmarried young women who also experienced these obstacles were, compared to married young women, most likely to experience second trimester abortion. Programmes need to take steps to improve access to safe and timely abortion for unmarried young women.

Résumé

Les études semblent indiquer que les expériences des jeunes femmes célibataires souhaitant avorter en Inde diffèrent de celles des femmes mariées, mais les données sont limitées. Des recherches ont été entreprises auprès de jeunes nullipares âgées de 15-24 ans qui avaient avorté dans les dispensaires d'une ONG de premier plan au Bihar et au Jharkhand. Sur une période de 14 mois en 2007–08, l'enquête a porté sur 246 femmes mariées et 549 célibataires souhaitant avorter, alors que 26 célibataires faisaient l'objet d'un entretien approfondi. Les célibataires avaient beaucoup plus de probabilités de faire état de relations sexuelles non consensuelles. Jusqu'à 25% des célibataires, contre seulement 9% des jeunes épouses, avaient avorté au deuxième trimestre. Les célibataires risquaient aussi davantage de notifier des obstacles à un avortement précoce tels que la non-reconnaissance rapide de la grossesse, l'exclusion de la prise de décision liée à l'avortement, la confidentialité comme qualité primordiale dans la sélection d'un centre d'avortement, les tentatives préalables d'interruption de grossesse ayant échoué et le manque de soutien du partenaire. Après contrôle des facteurs circonstanciels, les conclusions suggèrent que les jeunes célibataires qui rencontraient aussi ces obstacles couraient plus de risques que les femmes mariées d'avorter au deuxième trimestre. Les programmes doivent prendre des mesures pour améliorer l'accès des jeunes célibataires à un avortement sûr et précoce.

Resumen

Los estudios indican que las experiencias de mujeres jóvenes solteras que buscan servicios de aborto en India difieren de las de las casadas, pero la evidencia es limitada. Se realizaron investigaciones entre mujeres jóvenes nulíparas, de 15 a 24 años de edad, que tuvieron abortos en clínicas de una de las principales ONG de Bihar y Jharkhand. En un plazo de 14 meses, en 2007–08, 246 jóvenes casadas y 549 solteras que buscaban servicios de aborto fueron encuestadas y 26 de las solteras fueron entrevistadas a profundidad. Entre las solteras, la probabilidad de que informaran relaciones sexuales no consensuales fue mucho mayor. Hasta un 25% de las jóvenes solteras, comparado con sólo el 9% de las jóvenes casadas, habían tenido un aborto en el segundo trimestre. Resultó mucho más probable que las solteras informaran embarazos productos de relaciones sexuales no consensuales. Además, presentaron más probabilidad de mencionar obstáculos a un aborto oportuno como no poder reconocer el embarazo con prontitud, ser excluida de la toma de decisiones relacionadas con el aborto, buscar confidencialidad como algo fundamental en la selección del servicio de aborto, haber fracasado en intentos anteriores de interrumpir el embarazo y no contar con el apoyo de su pareja. Tras controlar por factores de antecedentes, los hallazgos indican que las jóvenes solteras que también afrontaron estos obstáculos, comparadas con las jóvenes casadas, presentaron mayor probabilidad de tener un aborto en el segundo trimestre. Es imperativo que los programas tomen las medidas necesarias para mejorar el acceso a los servicios de aborto seguro y oportuno para las jóvenes solteras.

Key Words:

• unplanned pregnancy
• abortion services
• marital status
• adolescents and young people
• India

Acknowledgements

This project was supported by a grant to the Population Council from the Hewlett Foundation and a grant to the Consortium for Comprehensive Abortion Care from the Packard Foundation and the Swedish International Development Agency. Their support is gratefully acknowledged. We are grateful to Rajib Acharya, KG Santhya, Iqbal Shah and Ina Warriner for valuable comments and suggestions; to MA Jose and Komal Saxena for support in preparing the paper and to Anupa Burman, Rakhi Burman, Preeti Verma and our investigator team for their sensitive and sincere efforts at eliciting information on these difficult topics. We would also like to record our deep appreciation to our young study participants, who so willingly gave us their time and shared their personal experiences with us.

Notes

* Percentages were almost identical when restricted to those for whom the Janani clinic was the first and only facility visited, for the unmarried and married young women as regards the importance of confidentiality and the facility being far from home (data not shown).