Are abortion services meeting women's needs in Madhya Pradesh, India

Although abortion has been legal in India since the 1972 Medical Termination of Pregnancy (MTP) Act, there remain many obstacles to high-quality and affordable abortion services. This study examines women's abortion experiences and the extent to which services meet women's abortion needs in Madhya Pradesh, India. Data come from a retrospective survey that examines the life course experience with abortion of a random sample of 2,448 married women (15-39). Data encompass a comprehensive set of individual, household, and service-related factors for 9,127 pregnancies. Our data show there is a sizable need for safe, accessible abortion services in Madhya Pradesh. In over half of cases (51%) in which women first attempted abortion, they initially sought the services of an unqualified provider or tried themselves to end the pregnancy. Among women who went to medical providers, in only 53% of cases did providers explain the abortion procedure; in 48% of cases, providers imposed conditions on their services in excess of legal requirements (e.g. husband's signature). Although abortions performed by medical providers were twice as likely as self-attempts to be successful (62% vs. 28%) in the first attempt, only 45% of all attempted abortions were successful. Equally alarming is that half (50%) of abortion attempts resulted in complications. Our data suggest cost and distance are important considerations in service access; women incurred greater fees and traveled farther to reach medical providers than those who went to non-medical providers. These data indicate multiple areas where services should focus attention to better serve women.