Evaluation of a multi-pronged intervention to improve access to safe abortion care in two districts in Jharkhand

Abstract

BackgroundDespite the adoption of the Medical Termination of Pregnancy Act in 1972, access to safe abortion services remains limited in India. Awareness of the legality of abortion also remains low, leading many women to seek services outside the health system. Medical abortion (MA) is an option that has the potential to expand access to safe abortion services. A multi-pronged intervention covering a population of 161,000 in 253 villages in the Silli and Khunti blocks of Jharkhand was conducted between 2007 and 2009, seeking to improve medical abortion services and create awareness at the community level by providing information through community intermediaries and creating an enabling environment through a behavior change communication campaign. The study evaluates the changes in knowledge about abortion-related issues, changes in abortion care-seeking, and service utilization as a result of this intervention.MethodsA baseline cross-sectional survey was conducted pre-intervention (n = 1,253) followed by an endline survey (n = 1,290) one year after the completion of the intervention phase. In addition, monitoring data from intervention facilities was collected monthly over the study period.ResultsNearly 85% of respondents reported being exposed to safe abortion messaging as a result of the intervention. Awareness of the legality of abortion increased significantly from 19.7% to 57.6% for women, as did awareness of the specific conditions for which abortion is allowed. Results were similar for men. There was also a significant increase in the proportion of men and women who knew of a legal and safe provider and place from where abortion services could be obtained. Multivariate analysis showed positive associations between exposure to any component of the intervention and increased knowledge about legality and gestational age limits, however only interpersonal communication was associated with a significant increase in knowledge of where to obtain safe services (OR 4.8, SE 0.67). Utilization of safe abortion services, and in particular MA, increased at all intervention sites over the duration of the intervention with a shift towards women seeking care earlier in pregnancy.ConclusionThe evaluation demonstrates the success of the intervention and its potential for replication in similar contexts within India.

Associations Between Abortion Services and Acceptance of Postabortion Contraception in Six Indian States

“…Women who had an induced abortion in the facility had a much higher acceptance of any method, especially of long-acting methods or sterilization, than women seeking care for postabortion complications. These findings are in line with earlier studies in India (Banerjee et al 2014) that show providers' disinclination to offer contraception, and more specifically long-acting methods, immediately after postabortion care, primarily because of fear of infection (Banerjee and Manning 2010).…”

A hospital based exploratory study to assess the reasons and timings of seeking abortion services in a tertiary care hospital in Mumbai

“…There was a shift towards women seeking care earlier in pregnancy. 15 The demonstrated success of this intervention shows that with the necessary modifications there is a potential for replication on a larger scale. Although our study is restricted to one public hospital, it can serve as a starting point for larger prospective studies to identify target groups which should be the focus of intended counseling.…”

Perception of abortion and associated female rights: use of behavior change communication strategies

“…Study showed that higher level of exposure to messages related to abortion resulted in more accurate knowledge (18). Multi-pronged intervention through BCC in India was found to improve access to safe abortion care and this can be replicated in similar settings (19).…”

“…In current study, after BCC intervention, there was a measurable change in knowledge and perceptions regarding different aspects of reproductive health behavior related to abortion. Literature from South Asian region has demonstrated a strong relationship between exposure to health education messages on abortion and on the level of knowledge in a meaningful way (18,19). Socio-economic issues, limiting parity are found to be main reasons for seeking abortion and women often have more than one reason for deciding for abortion.…”