Abortion Providers and Safety of Abortion: A Community-Based Study in a Rural District of Tamil Nadu, India

• Published in: Reproductive health matters 2004-11, Vol.12 (24), p.138-146
• Main Authors: Ramachandar, Lakshmi, Pelto, Pertti J
• Format: Article
• Language: English
• Subjects: Abortion; abortion complications; abortion law and policy; abortion services; Abortion, Induced - adverse effects; Asia; Female; Health care quality; Health Personnel; Health services; Humans; India; Legislation; Medical equipment; Nurses; Obstetric labor complications; Pregnancy; Pregnancy complications; Professional Competence; providers; quality of care; Quality of Health Care; Reproductive health; Rural Population; Safety; Women's health; Womens health; Womens health services
• ISSN: 0968-8080; 1460-9576
• DOI: 10.1016/S0968-8080(04)24015-0

This paper reports on a community-based study in 2001–02 in a rural district of Tamil Nadu, India, among 97 women who had had recent abortions, to examine their decision-making processes, the types of facility they attended and the extent of post-abortion complications they experienced. The 36 facilities they attended, both government and private, were ranked by 18 village health nurses, acting as key informants, as regards safety and quality of care. Three categories – qualified and safe, intermediate or unqualified and unsafe – were identified. Most of the providers were medically trained, and 75 of the 97 women went to facilities that were ranked as high or intermediate in quality. Government abortion services were mostly ranked intermediate in quality, and criticised by both women and village health nurses. There has been a substantial decrease in the numbers of traditional and unqualified providers. However, about 30% of the women experienced moderate to serious post-abortion complications, including women who went to facilities ranked high. We recommend that government facilities, both the district hospital and primary health centres, should improve their quality of care, that unqualified providers should be stopped from practising, and that all providers should be using the safer methods of vacuum aspiration and medical methods to reduce post-abortion complications. Une étude communautaire réalisée dans un district rural du Tamil Nadu, Inde, auprès de 97 femmes ayant récemment avorté a examiné leurs processus de décision, les types d'installations fréquentées et les complications après l'avortement. Les 36 centres, publics et privés, utilisés par les femmes étaient gérés par 18 infirmières de village qui servaient d'informatrices clés pour la sécurité et la qualité des soins. Trois catégories – soins qualifiés et sûrs, intermédiaires ou non qualifiés et non sûrs – ont été identifiées. La plupart des prestataires avaient suivi une formation médicale et 75 des 97 femmes s'étaient rendues dans des centres de qualité élevée ou intermédiaire. Les services publics d'avortement étaient généralement de qualité intermédiaire, et critiqués par les femmes et les infirmières de village. Le nombre de prestataires traditionnels et non qualifiés avait nettement diminué. Néanmoins, près de 30% des femmes avaient souffert de complications modérées à graves après l'avortement, même celles qui étaient allées dans des centres bien classés. Nous recommandons que les cen