Factors associated with second trimester abortion in rural Maharashtra and Rajasthan, India

Abstract

Many married women in India experience abortion in their second trimester of pregnancy. While there is an impression that second trimester abortions are now overwhelmingly used for sex selection, little is known about the extent to which second trimester abortions are indeed associated with son preference and sex selection motives, relative to other factors. Using data from a community-based study in rural Maharashtra and Rajasthan, research highlights the role of limited access in explaining second trimester abortion. While women with a single child who was a daughter were indeed more likely than other women to have terminated a pregnancy carrying a female foetus in the second trimester, more strikingly, exclusion from abortion-related decision-making, unsuccessful prior attempts to terminate the pregnancy, and distance from the facility in which their abortion was performed, were significantly associated with second trimester abortion, even after controlling for confounding factors. The study calls for greater efficiency in implementing the PCPNDT Act and addressing deep-rooted son preference. At the same time, findings that poverty and limited access to facilities are as, if not more, important drivers of second trimester abortion, highlight the need to meet commitments to ensure accessible abortion facilities for poor rural women.

Unsafe abortion and abortion-related death among 1.8 million women in India

“…Although it was not possible to examine the safety of abortion among women who died, this variable serves as a proxy for unsafe abortion, supporting the evidence that an abortion-related death is most likely to occur after an unsafe abortion 14. The process of seeking an abortion, or care for complications of spontaneous or induced abortion, can involve multiple visits to different providers, resulting in delays, with potentially devastating consequences 28–30. In India, preventing unwanted pregnancies through family planning is a key strategy for reducing abortion rates 31 32.…”

Clinical Outcomes and Women’s Experiences before and after the Introduction of Mifepristone into Second-Trimester Medical Abortion Services in South Africa

“…South Africa’s abortion legislation of 1996 allows for abortion between 12 and 20 weeks for several indications, including on socio-economic grounds [3]. In the Western Cape Province of South Africa, 28% of all abortions are performed in the second trimester, which is higher than reported for the United States, United Kingdom, Nepal and the Russian Federation [4–8], although lower than in some parts of India [9, 10]. …”

How risky are second trimester clandestine abortions in Cameroon: a retrospective descriptive study

“…Concerning marital status STA was more observed among married women as also observed in India [16]. This might be due in our series, to the late recognition of pregnancy status (some might have conceived few months after a delivery before the return of their normal cycle) or to the fact that married women might be hesitating for longer periods between pregnancy termination and conservation.…”

“…This is often observed in our setting among women with four or more living children who sometimes hesitate for long, as concerns having future childbirths. Contrarily in rural India, unsuccessful prior attempts to terminate the pregnancy, poverty, limited access to health facilities and sex selection were significantly associated with second trimester abortion [16]. FTA in our study was usually carried out by single women (82.4%).…”