Abortion has been legal under broad criteria in India since 1971. However, access to legal abortion services remains poor. In the past decade, medication abortion (MA) has become widely available in India and use of this method outside of health facilities accounts for over 70% of all abortions. Morbidity from unsafe abortion remains an important health issue. The informal providers who are the primary source of MA may have poor knowledge of the method and may offer inadequate or inaccurate advice on use of the method. Misuse of the method can result in women seeking treatment for true complications as well as during the normal processes of MA. An estimated 5% of all abortions are done using highly unsafe methods and performed by unskilled providers, also contributing to abortion morbidity. This paper provides new representative abortion-related morbidity measures at the national and subnational levels from a large-scale 2015 study of six Indian states—Assam, Bihar, Gujarat, Madhya Pradesh, Tamil Nadu and Uttar Pradesh. The outcomes include the number and treatment rates of women with complications resulting from induced abortion and the type of complications. The total number of women treated for abortion complications at the national level is 5.2 million, and the rate is 15.7 per 1000 women of reproductive age per year. In all six study states, a high proportion of all women receiving postabortion care were admitted with incomplete abortion from use of MA—ranging from 33% in Tamil Nadu to 65% in Assam. The paper fills an important gap by providing new evidence that can inform policy-makers and health planners at all levels and lead to improvements in the provision of postabortion care and legal abortion services—improvements that would greatly reduce abortion-related morbidity and its costs to Indian women, their families and the healthcare system.
- hospital-based study
- maternal health
- public health
- descriptive study
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Handling editor Sanni Yaya
Contributors SS and RH conceptualised the paper. SS developed the analysis plan, RH implemented the data analysis and MS contributed to data analysis. SS drafted the majority of the manuscript, and RH and AMM drafted sections of the manuscript. CS, RA, MS and AMM critically reviewed and provided comments on the first draft of the manuscript. SS, RH, AMM, MS, CS and RA contributed to revising the paper in response to reviewers comments. The entire team reviewed and approved the final version of the paper.
Funding This article is based on research funded by the Bill & Melinda Gates Foundation and the David and Lucile Packard Foundation.
Competing interests None declared.
Patient and public involvement Patients and the general public were not involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Methods section for further details.
Patient consent for publication Not required.
Ethics approval The study design and all protocols were approved by three Institutional Review Boards: the International Institute of Population Sciences, Mumbai; the Population Council, Delhi; and the Guttmacher Institute, New York. The research questions were established prior to the design of the study and informed the questions that were asked.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data are available on request. Deidentified facility data will be made available on request from a bona fide research institute or entity for use in a valid research study. Requests should be made via email to Suzette Audam (firstname.lastname@example.org), Senior Research Associate and Data Manager. Additional study materials, including questionnaires and survey sample design, are also available upon request. The online methodology for Singh et al is available under 'online supplementary materials' at https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(17)30453-9.
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