Policy change to improve access to safe abortion care in federal Nepal.

In Nepal's constitution, safe abortion care is recognized as an essential component of a comprehensive approach to fulfill individuals' sexual and reproductive health and rights. In the current context of transition to a three-level governance (federal, provincial, and local), there are opportunities to accelerate decentralization and devolution of decision-making power, increase access to and coverage of safe abortion services, and improve health outcomes. This article documents the processes and results of the policy change undertaken by the Ministry of Health and Population in collaboration with development partners to decentralize the approval process of safe abortion sites and providers with the objective to increase access to and coverage of safe abortion services.

Provision of medical methods of abortion in facilities in India in 2015: A six state comparison.

Medical methods of abortion, MMA, has been legal in India since 2002. Guidelines stipulate that it should be administered by a provider or acquired via prescription. 1.

The incidence of abortion and unintended pregnancy in India, 2015.

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.

Physicians' and non-physicians' views about provision of medical abortion by nurses and AYUSH physicians in Maharashtra and Bihar, India.

There is only limited evidence on whether certified and uncertified health care providers in India support reforming the Medical Termination of Pregnancy (MTP) Act to expand the abortion provider base to allow trained nurses and AYUSH physicians (who are trained in Indian systems of medicine) to provide medical abortion. To explore their views, we conducted a survey of 1,200 physicians and other health care providers in Maharashtra and Bihar states and in-depth interviews with 34 of them who had used medical abortion in their practices. Findings indicate that obstetrician-gynaecologists and other allopathic physicians were less supportive than non-physicians of nurses and AYUSH physicians providing early medical abortion.

Feasibility of expanding the medication abortion provider base in India to include ayurvedic physicians and nurses.

Context: The availability of trained abortion providers is limited in India. Allowing ayurvedic physicians and nurses to perform medication abortions may improve women's access to the procedure, but it is unclear whether these clinicians can provide these services safely and effectively.

Methods: Allopathic physicians, ayurvedic physicians and nurses (10 of each), none of whom had experience in abortion provision, were trained to perform medication abortions.

Unsuccessful prior attempts to terminate pregnancy among women seeking first trimester abortion at registered facilities in Bihar and Jharkhand, India.

Many abortion seekers in India attempt to induce abortion on their own, by accessing oral medication/preparations from a chemist without a prescription or from an unauthorized provider, and present at registered facilities if these attempts fail. However, little is known about those whose efforts fail or the ways in which programmes and policies may address the needs of such women. This paper explores the experiences of women whose efforts failed, including their socio-demographic profile, the preparations they used, and the extent to which they experienced serious complications, delayed seeking care from an authorized provider, or delayed abortion until the second trimester of pregnancy.

Adoption and continuation of contraception following medical or surgical abortion in Bihar and Jharkhand, India.

Objective: This study was carried out to explore whether the rates of postabortion adoption of a contraceptive method, and continuation of contraception over 6 months, differ among women undergoing medical abortion (MA) or surgical abortion by manual vacuum aspiration (MVA).

Methods: The study was conducted in Bihar and Jharkhand, 2 of the least-developed states of India. The analysis focused on 679 married women who were followed up 6 months after they underwent MA (n=308) or MVA (n=371) at clinics run by Janani, a nonprofit organization.

Knowledge, attitudes, and practices of certified providers of medical abortion: evidence from Bihar and Maharashtra, India.

Objective: To explore Indian abortion providers' knowledge of medical abortion (MA), their personal experiences and practices of providing medical abortion, and their attitudes toward providing MA to eligible women who were poor, uneducated, and/or from rural areas.

Methods: In selected districts of India's Bihar and Maharashtra states, interviews were conducted with 270 physicians who were certified as abortion providers, using a structured questionnaire.

Results: The providers' knowledge of the gestational limit, the recommended doses of mifepristone and misoprostol, and other aspects of the approved protocol was far from universal.

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

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.

Can nurses perform manual vacuum aspiration (MVA) as safely and effectively as physicians? Evidence from India.

Background: Although legal, access to safe abortion remains limited in India. Given positive experiences of task-shifting from other developing countries, there is a need to explore the feasibility of expanding the manual vacuum aspiration (MVA) provider base to include nurses in India.

Study Design: A prospective, two-sided equivalence study was undertaken in five facilities of a non-government organisation in Bihar and Jharkhand to explore whether efficacy and safety rates associated with MVA provided by newly trained nurses were equivalent to those provided by physicians.

Experiences of unmarried young abortion-seekers in Bihar and Jharkhand, India.

While several studies have documented the prevalence of unprotected pre-marital sex among young people in India, little work has explored one of its likely consequences, unintended pregnancy and abortion. This paper examines the experiences of 26 unmarried young abortion-seekers (aged 15-24) interviewed in depth as part of a larger study of unmarried abortion-seekers at clinics run by an NGO in Bihar and Jharkhand. Findings reveal that recognition of the unintended pregnancy was delayed for many and many who suspected so further delayed acknowledging it.

Abortion experiences of unmarried young women in India: evidence from a facility-based study in Bihar and Jharkhand.

Context: Little is known about the experiences of unmarried young women in India who seek to terminate an unintended pregnancy.

Methods: A survey was conducted among 549 unmarried women aged 15-24 who had obtained an abortion in 2007-2008 at one of 16 clinics run by the nongovernmental organization Janani in the states of Bihar and Jharkhand. Differences in background characteristics, and in obstacles to obtaining an abortion, between those who had an abortion in the first trimester and those who did so in the second trimester were compared, and logistic regression analysis identified associations between these factors and obtaining a second-trimester abortion.

Experience seeking abortion among unmarried young women in Bihar and Jharkhand, India: delays and disadvantages.

Studies suggest that the experiences of unmarried young women seeking abortion in India differ from those of their married counterparts, but the evidence is limited. Research was undertaken among nulliparous young women aged 15-24 who had abortions at the clinics of a leading NGO in Bihar and Jharkhand. Over a 14-month period in 2007-08, 246 married and 549 unmarried young abortion seekers were surveyed and 26 who were unmarried were interviewed in depth.

Understanding women's experiences with medical abortion: In-depth interviews with women in two Indian clinics.

We explored women's perspectives on using medical abortion, including their reasons for selecting the method, their experiences with it and their thoughts regarding demedicalisation of part or all of the process. Sixty-three women from two urban clinics in India were interviewed within four weeks of abortion completion using a semi-structured in-depth interview guide. While women appreciated the non-invasiveness of medical abortion, other factors influencing method selection were family support and distance from the facility.

Desire for motherhood: exploring HIV-positive women's desires, intentions and decision-making in attaining motherhood.

With access to prevention of parent-to-child transmission (PPTCT) and antiretroviral therapy (ARV), people living with HIV/AIDS are better able to consider childbearing and parenthood. However, there is limited understanding of the reproductive healthcare needs and the impact of infection on the fertility desires of women living with HIV/AIDS. Research on the relationship between fertility and HIV/AIDS has been largely clinical, focusing on the ability of women living with HIV/AIDS (WLHA) to conceive or their pregnancy outcomes.

Increasing access to safe abortion services in rural India: experiences with medical abortion in a primary health center.

Introduction: To increase access to safe abortion in rural India, the feasibility and acceptability of mifepristone-misoprostol abortion was assessed in a typical government run primary health center (PHC) in Nagpur district, Maharashtra State, that does not offer surgical abortion services and must refer off-site for emergency and backup services.

Materials And Methods: Consenting pregnant women (n=149) with View Article and Find Full Text PDF