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      Running an obstacle-course: a qualitative study of women’s experiences with abortion-seeking in Tamil Nadu, India

      research-article
      Sexual and Reproductive Health Matters
      Taylor & Francis
      abortion, reproductive rights, client-provider, experience, qualitative, marginalised, vulnerable, disrespect, abuse, coercion

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          Abstract

          Irrespective of the legal status of abortion, access to abortion services for women is fraught with numerous challenges across the world. A recent study in India found that most women who had an abortion sought care outside an authorised facility or from a less qualified provider. An analysis of women’s experiences in seeking abortion services would provide a better understanding of the underlying reasons. This paper is based on a qualitative study of the experiences of 16 married women from rural Tamil Nadu, India. The in-depth interviews focused on their pregnancy and childbirth experiences and access to abortion services. The study highlights the obstacle course that women seeking to terminate an unwanted pregnancy have to traverse. Many women were not aware of the legal status of abortion, and frontline workers discouraged them and gave misleading information. The pathways to seeking an abortion were more complex for women from marginalised communities. Providers were judgemental and used delaying tactics or denied abortion services. For the less privileged women, abortion services from government health facilities were conditional on the acceptance of female sterilisation. The providers’ attitudes in government and private health facilities were disrespectful of the women seeking abortion services. To uphold the reproductive and human rights of women who seek abortion services, we need accessible and publicly funded health care services that respect the dignity of all women, are empathetic and uphold women’s right to safe abortion services.

          Résumé

          Quel que soit le statut juridique de l’avortement, l’accès des femmes aux services d’interruption de grossesse comporte de nombreuses embûches dans le monde. Une récente étude en Inde a révélé que la plupart des femmes ayant avorté avaient demandé des soins en dehors d’un centre agréé ou auprès d’un prestataire peu qualifié. Une analyse de l’expérience des femmes dans la demande de services d’avortement permettrait de mieux comprendre les raisons sous-jacentes de ce phénomène. Cet article est fondé sur une étude qualitative des expériences de 16 femmes mariées originaires du Tamil Nadu, Inde. Les entretiens approfondis se sont centrés sur leur expérience de la grossesse et de la naissance, ainsi que de l’accès aux services d’avortement. L’étude met en lumière la course d’obstacles que doivent entreprendre les femmes souhaitant interrompre une grossesse non désirée. Beaucoup de femmes ne connaissaient pas le statut juridique de l’avortement et les agents de première ligne les ont découragées et leur ont donné des informations fallacieuses. Les parcours pour demander un avortement étaient plus complexes pour les femmes issues de communautés marginalisées. Les prestataires étaient moralisateurs, avaient recours à des manœuvres dilatoires ou refusaient d’assurer les services d’avortement. Pour les femmes les moins privilégiées, les services d’avortement dans les centres de santé publics étaient subordonnés à leur acceptation de la stérilisation. Les comportements des prestataires dans les centres de santé privés et publics étaient irrespectueux des femmes demandant des services d’avortement. Pour faire appliquer les droits humains et reproductifs des femmes qui souhaitent avorter, nous avons besoin de services de soins de santé accessibles et financés par les fonds publics, qui respectent la dignité de toutes les femmes, soient empathiques et défendent le droit des femmes à des services d’avortement sans risque.

          Resumen

          Independientemente de la legalidad del aborto, el acceso de las mujeres a los servicios de aborto está plagado de numerosos retos en todo el mundo. Un reciente estudio en India encontró que la mayoría de las mujeres que habían tenido un aborto buscaron el servicio fuera de un establecimiento de salud autorizado o por medio de un prestador de servicios menos calificado. Un análisis de las experiencias de las mujeres que buscan servicios de aborto facilitaría entender mejor las razones subyacentes. Este artículo se basa en un estudio cualitativo de las experiencias de 16 mujeres casadas que vivían en zonas rurales de Tamil Nadu, en India. Las entrevistas a profundidad se enfocaron en sus experiencias de embarazo y parto y en su acceso a los servicios de aborto. El estudio destaca los obstáculos que enfrentan las mujeres que buscan interrumpir un embarazo no deseado. Muchas mujeres no eran conscientes del estado legal del aborto, y los trabajadores de primera línea las disuadieron y les dieron información engañosa. Las vías para buscar un aborto eran más complejas para las mujeres en comunidades marginadas. Los prestadores de servicios eran prejuiciosos y utilizaban tácticas para retrasar o negar los servicios de aborto. En el caso de las mujeres menos privilegiadas, los servicios de aborto proporcionados en establecimientos de salud del gobierno estaban supeditados a la aceptación de la esterilización femenina. Las actitudes de los prestadores de servicios en establecimientos de salud gubernamentales y privados eran irrespetuosas de las mujeres que buscaban servicios de aborto. Para que las mujeres que buscan servicios de aborto puedan ejercer sus derechos reproductivos y humanos, se necesitan servicios de salud accesibles, financiados con fondos públicos, que respeten la dignidad de todas las mujeres, sean empáticos y defiendan el derecho de las mujeres a obtener servicios de aborto seguro.

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          Denial of abortion because of provider gestational age limits in the United States.

          We examined the factors influencing delay in seeking abortion and the outcomes for women denied abortion care because of gestational age limits at abortion facilities.
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            Barriers to Abortion Care and Their Consequences For Patients Traveling for Services: Qualitative Findings from Two States

            CONTEXT Abortion availability and accessibility vary by state. Especially in areas where services are restricted or limited, some women travel to obtain abortion services in other states. Little is known about the experience of travel to obtain abortion. METHODS In January and February 2015, in-depth interviews were conducted with 29 patients seeking abortion services at six facilities in Michigan and New Mexico. Eligible women were 18 or older, spoke English, and had traveled either across state lines or more than 100 miles within the state. Respondents were asked to describe their experience from pregnancy discovery to the day of the abortion procedure. Barriers to accessing abortion care and consequences of these barriers were identified through inductive and deductive analysis. RESULTS Respondents described 15 barriers to abortion care while traveling to obtain services, and three major consequences of experiencing those barriers. Barriers were grouped into five categories: travel-related logistical issues, system navigation issues, limited clinic options, financial issues, and state or clinic restrictions. Consequences were delays in care, negative mental health impacts and considering self-induction. The experience of barriers complicated the process of obtaining an abortion, but the effect of any individual barrier was unclear. Instead, the experience of multiple barriers appeared to have a compounding effect, resulting in negative consequences for women traveling for abortion. CONCLUSION The amalgamation of barriers to abortion care experienced simultaneously can have significant consequences for patients.
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              The incidence of abortion and unintended pregnancy in India, 2015

              Summary Background Reliable information on the incidence of induced abortion in India is lacking. Official statistics and national surveys provide incomplete coverage. Since the early 2000s, medication abortion has become increasingly available, improving the way women obtain abortions. The aim of this study was to estimate the national incidence of abortion and unintended pregnancy for 2015. Methods National abortion incidence was estimated through three separate components: abortions (medication and surgical) in facilities (including private sector, public sector, and non-governmental organisations [NGOs]); medication abortions outside facilities; and abortions outside of facilities and with methods other than medication abortion. Facility-based abortions were estimated from the 2015 Health Facilities Survey of 4001 public and private health facilities in six Indian states (Assam, Bihar, Gujarat, Madhya Pradesh, Tamil Nadu, and Uttar Pradesh) and from NGO clinic data. National medication abortion drug sales and distribution data were obtained from IMS Health and six principal NGOs (DKT International, Marie Stopes International, Population Services International, World Health Partners, Parivar Seva Santha, and Janani). We estimated the total number of abortions that are not medication abortions and are not obtained in a health facility setting through an indirect technique based on findings from community-based study findings in two states in 2009, with adjustments to account for the rapid increase in use of medication abortion since 2009. The total number of women of reproductive age and livebirth data were obtained from UN population data, and the proportion of births from unplanned pregnancies and data on contraceptive use and need were obtained from the 2015–16 National Family Health Survey-4. Findings We estimate that 15·6 million abortions (14·1 million–17·3 million) occurred in India in 2015. The abortion rate was 47·0 abortions (42·2–52·1) per 1000 women aged 15–49 years. 3·4 million abortions (22%) were obtained in health facilities, 11·5 million (73%) abortions were medication abortions done outside of health facilities, and 0·8 million (5%) abortions were done outside of health facilities using methods other than medication abortion. Overall, 12·7 million (81%) abortions were medication abortions, 2·2 million (14%) abortions were surgical, and 0·8 million (5%) abortions were done through other methods that were probably unsafe. We estimated 48·1 million pregnancies, a rate of 144·7 pregnancies per 1000 women aged 15–49 years, and a rate of 70·1 unintended pregnancies per 1000 women aged 15–49 years. Abortions accounted for one third of all pregnancies, and nearly half of pregnancies were unintended. Interpretation Health facilities can have a greater role in abortion service provision and provide quality care, including post-abortion contraception. Interventions are needed to expand access to abortion services through better equipping existing facilities, ensuring adequate and continuous supplies of medication abortion drugs, and by increasing the number of trained providers. In view of how many women rely on self-administration of medication abortion drugs, interventions are needed to provide women with accurate information on these drugs and follow-up care when needed. Research is needed to test interventions that improve knowledge and practice in providing medication abortion, and the Indian Government at the national and state level needs to prioritise improving policies and practice to increase access to comprehensive abortion care and quality contraceptive services that prevent unintended pregnancy. Funding Government of UK Department for International Development (until 2015), the David and Lucile Packard Foundation, the John D. and Catherine T. MacArthur Foundation, and the Ford Foundation.
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                Author and article information

                Journal
                Sex Reprod Health Matters
                Sex Reprod Health Matters
                Sexual and Reproductive Health Matters
                Taylor & Francis
                2641-0397
                15 October 2021
                2022
                15 October 2021
                : 29
                : 2 , South Asia Region
                Affiliations
                Director-Research, ARMMAN , Mumbai, India. Correspondence: buvanas@ 123456gmail.com
                Author notes
                [*]

                At the time of research, author was affiliated to the Tata Institute of Social Sciences, Mumbai, India.

                Article
                1966218
                10.1080/26410397.2021.1966218
                8525933
                34651568
                0c5971f8-d079-4778-bfff-5465b60192d9
                © 2021 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group

                This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License ( http://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                Page count
                Figures: 2, Tables: 1, Equations: 0, References: 56, Pages: 19
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                Categories
                Research Article
                Research Article

                abortion,reproductive rights,client-provider,experience,qualitative,marginalised,vulnerable,disrespect,abuse,coercion

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