By demonstrating the effectiveness of a comprehensive abortion care model, researchers identified ways of expanding access to safe abortion in rural India.
Given the lack of easily accessible and trained providers, millions of Indian women undergo unsafe abortions each year, risking injury and death. This limited access has resulted in unsafe abortion becoming one of the leading causes of maternal mortality in India, with 8% of all maternal deaths attributed to complications from unsafe procedures. Women in poor, rural areas are disproportionately affected, as their access to safe abortion by trained providers is particularly limited.
The Consortium for Safe Abortions in India was a collaboration between eight partner organizations, including the Population Council and coordinated by Ipas. The Consortium sought to increase access to safe, legal, and comprehensive abortion services in rural India through demonstrating evidence-based models. Ipas and the Family Planning Association of India (FPAI) developed models for comprehensive abortion care (CAC) aimed at:
- Strengthening the capacity of community and primary health centers to offer abortion services in selected districts of each state;
- Increasing women’s awareness and recognition of their right to seek abortion; and
- Making recommendations to policymakers and program implementers regarding expanding the model, if successful, into programs that aim to increase access to safe abortion care in India.
The model was implemented in rural areas of two states—Maharashtra and Rajasthan—by Ipas and FPAI. Both undertook community-level sensitization using murals, community theater, home health visits, and local media to raise awareness about the right to safe abortion, the location of safe abortion services, and the importance of seeking early care. The organizations also improved the availability of safe abortion services by supporting provider training to conduct safe abortions, and ensuring that facilities were appropriately equipped.
The Population Council evaluated the extent to which this model was effective in:
- expanding access to abortion;
- raising women’s awareness of abortion;
- reducing delays in seeking abortion services; and
- increasing facility and provider readiness to provide safe abortion services.
Baseline and endline surveys were conducted in intervention districts and in similar districts in which the model was not implemented. Researchers interviewed married women (aged 15–39) at health facilities and in the community. Women who had undergone abortion procedures in the ten years prior to the assessment were interviewed extensively.
The assessment showed that the CAC model increased the availability of safe abortion services in public-sector facilities. In both states, the model resulted in an increase in the number of trained and certified abortion providers and improvement in the availability of functioning essential equipment in primary health centers. Provider awareness about women’s abortion-related rights improved, as did the number of safe abortions provided in public-sector facilities.
In both states, the intervention significantly improved awareness among women and in communities about the legality and availability of abortion services. It raised awareness of medical abortion and successfully dispelled misperceptions about abortion-related issues. Moreover, by endline, fewer procedures reported by women who had undergone a recent abortion involved dilation and curettage (D&C), a more invasive method than other methods, such as manual vacuum aspiration and medical abortion.
One of the first efforts to evaluate safe abortion provision in India, the Council’s assessment affirmed that the Consortium’s model was effective in expanding access and eliminating several barriers to safe abortion in rural India. Further, the assessment provided evidence on the need for and feasibility of implementing a comprehensive program focused on both expanding the availability of safe abortion services and increasing community awareness.
Following the assessment, implementing partners have replicated aspects of the Consortium’s CAC model in other areas of Maharashtra and elsewhere. Through the expansion of equipped facilities, trained providers, and community awareness that occurred during and after the intervention, the project has greatly improved the availability of safe abortion services in rural areas and increased rural women’s access to safe abortion services.