Provision of medical methods of abortion in facilities in India in 2015: A six state comparison

ABSTRACT

Medical methods of abortion, MMA, has been legal in India since 2002. Guidelines stipulate that it should be administered by a provider or acquired via prescription. 1.2 million women having abortions in India use MMA acquired from health facilities [Singh, S., Shekhar, C., Acharya, R., Moore, A. M., Stillman, M., Pradhan, M. R., … Browne, A. (2018). The incidence of abortion and unintended pregnancy in India, 2015. The Lancet Global Health, 6(1), e111–e120. doi:10.1016/S2214-109X(17)30453-9]. We undertook a study of abortion in Assam, Bihar, Gujarat, Madhya Pradesh, Tamil Nadu and Uttar Pradesh in 2015 to better understand under what conditions and how MMA is being administered in facilities. The majority of facilities that provide MMA are in the private sector and located in urban areas. Most facilities offer MMA both at the facility and as a prescription, although some facilities only offer MMA as a prescription. A high proportion of facilities report that women typically take the medication at home. (Re)training providers in MMA protocols and counselling, increasing the number of facilities offering MMA, and stocking of the drugs would help improve women’s access to MMA and the information they need to be able to use this method safely.

Key Messages:

• In the six states in our sample, Assam, Bihar, Gujarat, Madhya Pradesh, Tamil Nadu and Uttar Pradesh, 8% of abortions in 2015 were done using medical methods of abortion (MMA) acquired from health facilities.

• The majority of facilities that provide MMA in the six states are in the private sector and are located in urban areas.

• Health facilities in Madhya Pradesh and Tamil Nadu are comparatively better in their provision of MMA with Assam, Bihar, Gujarat and Uttar Pradesh demonstrating poorer provision of MMA.

• There are many opportunities for improvement in the practices of MMA provision through improved training of providers, accessibility to the medications and better support of women using MMA.

KEYWORDS:

• Medical abortion
• India
• health facilities

Disclosure statement

No potential conflict of interest was reported by the authors.

ORCID

Ann M. Moore http://orcid.org/0000-0002-6914-1974

Melissa Stillman http://orcid.org/0000-0002-1318-2419

Chander Shekhar http://orcid.org/0000-0002-6090-8470

Rajib Acharya http://orcid.org/0000-0003-4586-0859

Susheela Singh http://orcid.org/0000-0001-9108-6206

Manas R. Pradhan http://orcid.org/0000-0002-7011-894X

Manoj Alagarajan http://orcid.org/0000-0003-0470-1763

Notes

1 MMA includes both the combined regimen of mifepristone and misoprostol (packaged separately or together in a ‘Combipack’) as well as misoprostol alone. Combipacks are the most common way of providing MMA at health facilities in India.

Additional information

Funding

This research was made possible by grants from the Government of UK Department for International Development (until 2015), the David and Lucile Packard Foundation and the John D. and Catherine T. MacArthur Foundation the Ford Foundation. Support for this project was provided in part by the Guttmacher Center for Population Research Innovation and Dissemination (NIH [grant number 1R24HD074034-01A1]).