Can community health workers play a greater role in increasing access to medical abortion services? A qualitative study

Abstract

BackgroundDespite being legally available in India since 1971, barriers to safe and legal abortion remain, and unsafe and/or illegal abortion continues to be a problem. Community health workers have been involved in improving access to health information and care for maternal and child health in resource poor settings, but their role in facilitating accurate information about and access to safe abortion has been relatively unexplored. A qualitative study was conducted in Rajasthan, India to study acceptability, perspectives and preferences of women and community health workers, regarding the involvement of community health workers in medical abortion referrals.MethodsIn-depth interviews were conducted with 24 women seeking early medical abortion at legal abortion facilities or presenting at these facilities for a follow-up assessment after medical abortion. Ten community health workers who were trained to assess eligibility for early medical abortion and/or to assess whether women needed a follow-up visit after early medical abortion were also interviewed. The transcripts were coded using ATLAS-ti 7 (version 7.1.4) in the local language and reports were generated for all the codes, emerging themes were identified and the findings were analysed.ResultsCommunity health workers (CHWs) were willing to play a role in assessing eligibility for medical abortion and in identifying women who are in need of follow-up care after early medical abortion, when provided with appropriate training, regular supplies and job aids. Women however had apprehensions about contacting CHWs in relation to abortions. Important barriers that prevented women from seeking information and assistance from community health workers were fear of breach of confidentiality and a perception that they would be pressurised to undergo sterilisation.ConclusionsOur findings support a potential for greater role of CHWs in making safe abortion information and services accessible to women, while highlighting the need to address women’s concerns about approaching CHWs in case of unwanted pregnancy. Further intervention research would be needed to shed light on the effectiveness of role of CHWs in facilitating access to safe abortion and to outline specific components in a programme setting.Trial registrationNot applicable.

Trends in abortion services and sociodemographic profile of women those availed abortion services at Parivar Seva clinics in India

“…The finding is supported by previous studies where it is suggested that there is potential for a great role on part of community health workers in supporting women's access to safe abortion services, although they don't perform abortions, they have the opportunity to help those who want to terminate a pregnancy and find needed services. 14,32…”

Levels, trends and predictors of unintended pregnancy among adolescents and young women aged 15-14 in India: An analysis from NFHS-4 and 5 Survey

“…With the introduction of female community health workers, called the Accredited Social Health Activists (ASHAs) at the village level under the National Rural Health Mission (NRHM), in 2005, barriers between women and health workers have been reduced. They are well positioned to play a vital role in guiding women about unwanted pregnancies and safe abortion services, educating them about family planning methods and reproductive health in general (27). Lastly, higher parity was associated with a higher risk of unintended pregnancy.…”

“Like a mother-daughter relationship”: Community health intermediaries' knowledge of and attitudes to abortion in Karnataka, India

“…These programmes are less-established than family planning or maternal and child health programmes. In one study, ASHAs trained to facilitate access to safe abortion, felt restricted by competing programme pressures (Gupta et al, 2017).…”

“…Women or their partners/relatives interact with CHIs at different points in their care-seeking trajectories-pregnancy confirmation, information provision including referrals (Coast and Murray, 2014), procuring medical abortion pills (Kalyanvala et al, 2010), emotional support (Ganatra et al, 2010) and in post-abortion care-provision (Gupta et al, 2017). Das et al (2012) find that prevailing contextual norms, histories and priorities influence or constrain CHI behaviour in care-provision.…”