GUWAHATI, Aug 20 - A study on unintended pregnancy, abortion and post-abortion care in Assam, conducted jointly by Indian Institute for Population Sciences, Mumbai, Population Council, New Delhi, and the New York-based Guttmacher Institute, has found that an estimated 5,80,100 abortions are performed in Assam every year.
These include abortions taking place both in health facilities and in other settings. The State’s abortion rate was found to be 66 terminations per 1,000 women in the reproductive age group.
The 2015 study highlights the importance of access to and quality of safe abortion services in the State.
“An estimated 90 per cent of the abortions occurring in health facilities in the State are surgical, while about 10 per cent are done using Medical Methods of Abortion (MMA),” it said.
The study found that 73 per cent of all facility-based abortions take place in public facilities, and the rest in private facilities.
“Of all the states where the study was conducted (Bihar, Uttar Pradesh, Madhya Pradesh, Tamil Nadu, Gujarat and Assam), Assam is the only state which demonstrated better access to safe abortion services in public facilities than private facilities. Some of the barriers that were found to persist in accessing facility-based abortions are lack of trained staff, paucity of equipment and supplies, social or religious concerns, and lack of registration/authorisation to provide abortion,” it said.
It was found that 588 facilities in Assam provided abortion-related care as on 2015, and out of them 61 per cent were public facilities, while the rest were private facilities.
Further, the study revealed that though a majority of women in Assam live in rural areas, merely 45 per cent of the facilities offering abortion-related services were located in these areas at the time of the study.
“Nearly all (94 per cent) of the facility-based induced abortions taking place in Assam are performed in the first trimester (i.e., the first 12 weeks of gestation). Only 6 per cent of abortions provided in facilities occurred beyond 12 weeks,” it said.
As per the study, 55 per cent of pregnancies in Assam were unintended, out of which 41 percent resulted in abortion.
Reflecting on the findings of the study, Dr Nozer Sheriar, board member of Guttmacher Institute, New York, and former Secretary General of the Federation of Obstetrics & Gynaecological Societies of India (FOGSI) said that the study fills an important evidence gap and provides insight to address the large gap between abortion legality and implementation of the law to ensure access to safe, quality abortion services for all women.
“The Assam results prove that women do seek abortion care at public sector facilities when services are made available closer to their communities. While no woman wants to turn to an unsafe provider, there are many factors that can lead a woman to seek an abortion outside of the formal health sector. Increasing the provision of abortion services in the public sector is critical to meeting demand for abortion services for rural and lower-income women. Important steps to achieving this goal include expanding categories of approved abortion providers, including mid-level providers, and ensuring that trained staff and needed supplies are available up to the last mile,” said Dr Sheriar.
A majority of rural and poor women visit primary health centres (PHCs) to access health care.
According to the study, Assam is the only state among the six states which registered 15 per cent of all induced abortions in public facilities while Bihar, Gujarat and Uttar Pradesh fell behind at 2 per cent, 3 per cent and 4 per cent respectively.
“Studies have shown that unsafe abortions are the third leading cause of maternal mortality in India. About eight women die from causes related to unsafe abortion in the country every day,” it said.
As per recommendations put forth in the report, there is an impending need to improve access to facility-based abortion services, especially in under-served rural areas of Assam, by ensuring that all public facilities are adequately stocked with equipment and supplies.
“There is also a need to streamline the process of registering private clinics to enable them to offer safe and timely abortion services. In addition, efforts need to be streamlined towards improving the quality and availability of voluntary contraceptive services for all women, through increased investments in maternal health and education, delaying their age at marriage and enhancing sexual and reproductive health rights. The study also highlights the need to improve data collection on abortion going forward,” it said.