Knowledge, attitude and practices of abortion and PPIUCD in Indian women

Abstract

Background: According to the first national study of the incidence of abortion and unintended pregnancy in India, an estimated 15.6 million abortions were performed in the country. The current study was done to determine awareness among Indian women regarding abortions and its legalities as well as post partum intra uterine device. Aims and Objective: To know the status of knowledge, awareness and practices of abortion services and PPIUCD in women Materials and Methods: A study was done between January to December 2019 among 9359 women who attended the outpatient department of obstetrics and gynaecology and family planning department at Muzaffarnagar medical college, which is a tertiary care institute at important district of Uttar Pradesh, Muzaffarnagar by using predesigned, pretested questionnaire. The patients were then assessed based on demographic factors like age, literacy, socioeconomic scale and occupation. They were asked about their personal experience and their awareness about legal status of abortion in India, eligible provider and site. Results: Among 9359 women enrolled, 6084 (65%) were in the age group of 20-30 years and majority 3002(32.1%) belonged to lower middle class; 5616 (60%) were illiterate. Only 2340(25%) knew about the legalities of abortion and 1498(16%) about eligible provider. In 4264(67%) cases, MTP were self prescribed, out of which and 764(12%) developed major life threatening complication and saved and 40% chronic morbidity.4475 (70%) not adopted any post abortal contraceptive method. Conclusion: The current study found that almost 75% of the women were unaware of legal status of abortion in India and 67% women have self prescribed MTP. Post abortal contraception counselling and adoption need attention as only 30% adopted any regular method. There is free availability of MTP KIT at counter. Hence, the urgent need of the hour is to reduce unintended pregnancies, by promoting PPIUCD, creating more awareness about availability of safe and legal abortion practices in India among public and health workers with emphasis for post abortion contraceptive counselling. Introduction According to the first national study of the incidence of abortion and unintended pregnancy in India, an estimated 15.6 million abortions were performed in the country. It also found that 81% of abortions were achieved using medical abortion that was obtained either from a health facility or another source. Fourteen percent of abortions were performed surgically in health facilities, and the remaining 5% of abortions were performed outside of health facilities using other, typically unsafe, methods [1]. This paper synthesizes recent evidence on abortion scenario in India, explores factors why women seek abortions. It highlights factors, notably unmet needs for contraception, lack of awareness of legality of abortion services, limited access to safe services, poor quality of services, leading women to seek services from untrained providers or self-procurement of medical abortion kits without the knowledge of proper consumption or the potential complications. Thus by creating awareness about abortions and improving post abortal counselling we can surely help tackle this problem to some extent. Levels of unsafe abortion are very high in India, especially given that abortion is legal for broad range of indications, and available in public and private health sector. In India, around 10000-12000 women die each year as a consequence of unsafe abortion while many women suffer from long term morbidity with abortion-related complications [2]. Estimates for contribution of unsafe abortions to maternal death in India vary from 8-20% [3, 4] Recent data suggest that 3-9% of all