5,80,100 abortions performed in Assam every year: Report

GUWAHATI: The study on ‘Unintended Pregnancy, Abortion and Postabortion Care in Assam—2015’ conducted jointly by Indian Institute for Population Sciences, Mumbai, Population Council, New Delhi and New York-based Guttmacher Institute, highlights the importance of access to and quality of safe abortion services in the State.

The study found that an estimated 5,80,100 abortions are performed in Assam every year. These include abortions taking place both in health facilities and in other settings. The State’s abortion rate was found to be 66 terminations per 1,000 women in the reproductive age group.

An estimated 90% of the abortions occurring in health facilities in the State are surgical, while about 10% are done using Medical Methods of Abortion (MMA). 73% of all facility-based abortions take place in public facilities, and the rest in private facilities. Of all the States where the study was conducted (Bihar, Uttar Pradesh, Madhya Pradesh, Tamil Nadu, Gujarat and Assam), Assam is the only State which demonstrated better access to safe abortion services in public facilities than private facilities.

Some of the barriers that were found to continue to persist in accessing facility-based abortions are lack of trained staff , paucity of equipment and supplies, social or religious concerns and lack of registration/authorization to provide abortion.

It was found that 588 facilities in Assam provided abortion-related care as in 2015, 61% of which were in public facilities, while the rest were in private facilities. Further, the study revealed that though a majority of women in Assam live in rural areas, merely 45% of the facilities offering abortion-related services were located in these areas at the time of the study.

Nearly all (94%) of the facility-based induced abortions taking place in Assam are performed in the first trimester (i.e., the first 12 weeks of gestation). Only 6% of abortions provided in facilities occurred beyond 12 weeks. As per the study, 55% of pregnancies in Assam were unintended out of which 41 percent resulted in abortion.

Reflecting on the findings of the study, Dr. Nozer Sheriar, board member Guttmacher Institute, New York and former Secretary General, Federation of Obstetrics & Gynaecological Societies of India (FOGSI) said “ This study fills an important evidence gap and provides insights to address the large gap between abortion legality and implementation of the law to ensure access to safe, quality abortion services for all women. The Assam results prove that women do seek abortion care at public sector facilities when services are made available closer to their communities. While no woman wants to turn to an unsafe provider, there are many factors that can lead a woman to seek an abortion outside of the formal health sector. Increasing the provision of abortion services in the public sector is critical to meeting demand for abortion services for rural and lower-income women. Important steps to achieving this goal include expanding categories of approved abortion providers, including midlevel providers, and ensuring that trained staff and needed supplies are available up to the last mile.”

A majority of rural and poor women visit primary health centres (PHCs) to access health care. According to the Guttmacher study, Assam is the only State among the six States which registered 15% of all induced abortions in public facilities while Bihar, Gujarat and Uttar Pradesh fell behind at 2%, 3% and 4% respectively.

Studies have shown that unsafe abortions are the third leading cause of maternal mortality in India. About eight women die from causes related to unsafe abortion in the country every day.

As per recommendations put forth in the report, there is an impending need to improve access to facility-based abortion services, especially in underserved rural areas of Assam, by ensuring that all public facilities are adequately stocked with equipment and supplies. There is also a need to streamline the process of registering private clinics to enable them to offer safe and timely abortion services. In addition, efforts need to be streamlined towards improving the quality and availability of voluntary contraceptive services for all women, through increased investments in maternal health, and education, delaying their age at marriage and enhancing sexual and reproductive health rights (SRHR). The study also highlights the need to improve data collection on abortion going forward.