Potential role of midlevel health care providers in medication abortion provision in Bihar and Jharkhand, India

Current abortion policies in India exclude non-physicians from being trained to provide abortions. Even though abortion is legal in India, women often resort to unsafe methods as access to safe abortion providers is difficult. Studies conducted worldwide show that medication abortion offers a safe and effective alternative to surgical abortion. Medication abortion using a regimen of mifepristone & misoprostol was legalized in India in 2002 and provides an opportunity to expand women's service options for safe abortions. In recent years, the WHO and other international bodies have supported expanding the role of midlevel health care providers (MPs) in abortion provision. Limited research exists exploring whether MPs would be interested in providing medication abortion services and whether physicians would be supportive. No published studies have explored this in India. Understanding the potential role of MPs in medication abortion provision in India is necessary in a context where legal providers are difficult to access and rates of maternal mortality due to unsafe abortion are high. Surveys of health facilities and their staff were conducted May-August 2004 in Bihar & Jharkhand states to collect information related to family planning services. A multistage cluster sample design was applied to obtain a sample of 1,341 facilities and 2,455 staff. Statistical models are estimated using multivariate logistic regression to explore the relationship between individual provider characteristics and health facility characteristics and the medication abortion related knowledge, attitudes and provision intentions of MPs. Physicians and MP attitudes towards MPs providing abortions will also be described.