Evaluation of a behavior change communication (BCC) intervention on abortion knowledge, attitudes and practices (KAP) in Βihar and Jharkhand, India

Background: Four million unsafe abortions occur annually in India, and 13% of maternal mortality in south and central Asia is due to unsafe abortion. Despite being legal in India since 1971, many women lack knowledge of and access to safe abortion services. A BCC intervention, including wall-signs, street plays, interpersonal counseling, and communication materials, was implemented in Bihar and Jharkhand states to improve KAP around utilizing available services. We aim to evaluate the impact of this intervention.

Methods: Cross-sectional household surveys were implemented at baseline (2008) and two follow-up periods (2010 and 2011) in intervention and comparison districts in each state. Likert scale indicators to assess the impact of the intervention include availability and access, knowledge of abortion services, social support and self-efficacy within the community and family, and perception of severity of unsafe abortion. Bivariate and multivariate analyses were performed to evaluate changes in KAP post-intervention, controlling for socio-demographic characteristics.

Results: In bivariate analyses, mean scores of all but one BCC indicators increased significantly between waves two and three (p<0.01). In multivariate analyses, frequency of exposure to intervention was significantly associated with improved self-efficacy within the community and increased knowledge and access to abortion. Women in Jharkhand had significantly higher scores on self-efficacy, knowledge, and social support compared to women in Bihar.

Discussion: This BCC intervention increased knowledge and access to safe abortion services. Similar interventions along with improved service delivery of abortion and postabortion care have the potential to reduce mortality due to unsafe abortions in India.