Community level is where it's at! Expanding access to safe medication abortion in rural Jharkhand, India

Although medication abortion (MA) has been an option in India since 2002, use of this method has been limited to the legal private sector and informal providers. To date there has been no effort that looked holistically at the provision of MA through the rural public sector or aimed at expanding access to safe services by reaching women directly with information and social support. To address this gap, Ipas-India in collaboration with the state government of Jharkhand launched a pilot project to increase MA accessibility to women at the community level through information on safe services using multiple media and information channels including training “intermediaries” – people women go to for information. A mix of quantitative (sample size - 1,255) and qualitative (6-FGDs) research studies in two rural locales were conducted to understand the current health-care seeking behaviors and attitudes towards accessing safe abortion services, sources and channels of information when couples face an unwanted pregnancy. Initial analysis reveals low levels of understanding (18%) of the legality of abortion; 20% of abortions are reportedly attempted at home and through unsafe techniques; 51% reported post-abortion complications; untrained female health workers were found to be an important source of service provision (36%) and information (38%) on abortion services. Additionally, men play a critical role in influencing decisions on unintended pregnancy. This data analysis will inform collaborators to develop an appropriate strategy for reaching women directly with accurate information to safely access medication abortion. This presentation will describe the research results as well as the community-level interventions developed based on those results.