Pathways and consequences of unsafe abortion: A comparison among women with complications after induced and spontaneous abortions in Madhya Pradesh, India

Abstract

This study aimed to understand women's pathways of seeking care for postabortion complications in Madhya Pradesh, India. The study recruited 786 women between July and November 2007. Data were collected on service provision, abortion-related complications, care-seeking behavior, knowledge about abortion legality and availability, methods used, symptoms, referral source, and out-of-pocket costs. Women seeking care for complications from induced abortion followed more complex pathways to treatment than women with complications of spontaneous abortion. More complex pathways were associated with higher out-of-pocket costs. Improving community awareness on legal aspects, safe abortion methods, and trained providers are necessary to reduce morbidity associated with unsafe abortion.

Prenatal sex selection and female infant mortality are more common in India after firstborn and second-born daughters

“…It was estimated in 2007 that 10000–12 000 women were dying each year in India from abortion-related complications 34. It is likely that maternal deaths and ill-health caused by abortion-related complications have a greater impact on the survival of female than male infants, because the evidence tells us that the majority of sex-selective abortions involve women who have young daughters in their care.…”

Decrease in Use of Manual Vacuum Aspiration in Postabortion Care in Malawi: A Cross-Sectional Study from Three Public Hospitals, 2008–2012

“…Records of women who were admitted for other reasons were not included. Since complications of spontaneous and induced abortions often are difficult to distinguish [13], these were not separated. Women who were admitted, but did not need or receive surgical evacuation were not included in the study.…”

“…Complications that may occur are incomplete abortion, sepsis, haemorrhage, uterine perforation, chronic pain, infertility and death [9], [12]. It may be hard to distinguish complications from induced versus spontaneous abortions, as the symptoms can be similar [12], [13]. Additionally, shame and fear of being punished, among others, may make women conceal that the abortion was induced.…”

PPost abortion contraceptive behavior among Indian women

“…4 India accounts for 6.4 million induced abortion and approximately 4 million spontaneous abortions each year, most performed in unsafe conditions and often without any contraceptive counseling or services. [5][6][7] Although women request abortions for various reasons for these qualitative studies conducted as part of the abortion assessment project across multiple states in 2002, the majority of unintended pregnancies that were resolved through abortion occurred during periods when few were reportedly due to contraceptive failure. 8 Non-use of contraception often reflects an inadequate or uneven supply of contraceptive services, particularly temporary by unequal power structures within families that restrict women's access to contraceptive information and services and prevents women from being able to negotiate contraceptive use.…”