Abortion care-seeking and reproductive rights violation in health facilities: evidence from six states of India


  • Manas Ranjan Pradhan Department of Fertility and Social Demography, International Institute for Population Sciences, Mumbai, Maharashtra, India
  • Chander Shekhar Department of Fertility and Social Demography, International Institute for Population Sciences, Mumbai, Maharashtra, India
  • Manoj Alagarajan Department of Fertility and Social Demography, International Institute for Population Sciences, Mumbai, Maharashtra, India
  • Harihar Sahoo Department of Family and Generation, International Institute for Population Sciences, Mumbai, Maharashtra, India




Abortion care, Health facilities, India, Reproductive rights


Background: Unsafe abortion continues to draw the researcher's attention due to its close association with maternal morbidity and mortality. Empirical evidence on the role of health facilities in providing safe abortion care addressing the reproductive rights of Indian women is limited.

Methods: Using data from the 2015 ‘unintended pregnancy and abortion in India’ study, the present paper aimed to understand the violation of the reproductive rights of abortion care seekers in health facilities (n=4001) in six states of India. The health facilities were sampled using a stratified random sampling strategy. Univariate and bivariate analysis was carried out using SPSS (V 25) on cleaned and weighted data.

Results: A sizeable percentage of public and private health facilities across states found seeking the consent of the husband or family members before abortion provision, compel women to adopt contraception and turn away abortion seekers, commonly citing non-medical reasons. The provision of post-abortion complications services is usually not 24/7, even at the primary health centre level, hindering access to an urgent health care need.

Conclusions: There is a need to improve access to facility-based abortion services, especially in underserved rural areas, by ensuring that all public-sector facilities have adequate equipment and supplies, including MMA drugs and trained providers. Sensitization of health care providers about the importance of ethical issues and women’s reproductive rights is urgently required to ensure safe, legal, and accessible abortion care.


United Nation. Reproductive Rights Are Human Rights. A Handbook for National Human Rights Institutions. United Nations Population Fund; 2014.

UNFPA. International Conference on Population and Development: Program of Action. United Nations Population Fund; 2004.

Ganatra B, Gerdts C, Rossier C, Johnson Jr BR, Tunçalp Ö, Assifi A, et al. Global, regional, and subregional classification of abortions by safety, 2010-14: estimates from a Bayesian hierarchical model. Lancet. 2017;390(10110):2372-81.

Sedgh G, Bearak J, Singh S, Bankole A, Popinchalk A, Ganatra B, et al. Abortion incidence between 1990 and 2014: global, regional, and subregional levels and trends. Lancet. 2016;388(10041):258-67.

Singh S, Shekhar C, Acharya R, Moore AM, Stillman M, Pradhan MR, et al. The incidence of abortion and unintended pregnancy in India, 2015. Lancet Glob Health. 2018;6(1):e111-20.

Hirve SS. Abortion law, policy and services in India: a critical review. Reprod Health Matters. 2004;12(24):114-21.

Stillman M, Frost JJ, Singh S, Moore AM, Kalyanwala S. Abortion in India: a literature review. New York: Guttmacher Institute; 2014:12-14.

Creanga AA, Roy P, Tsui AO. Characteristics of abortion service providers in two northern Indian states. Contraception. 2008;78(6):500-6.

Duggal R, Ramachandran V. The abortion assessment project- India: key findings and recommendations. Reprod Health Matters. 2004;12(24):122-9.

Grimes DA, Benson J, Singh S, Romero M, Ganatra B, Okonofua FE, et al. Unsafe abortion: the preventable pandemic. Lancet. 2006;368(9550):1908-19.

Banerjee S. Increasing access to safe abortion services in Uttarakhand: identifying medical termination of pregnancy training centers. New Delhi: IPAS India; 2007.

Kosgi S, Hegde VN, Rao S, Bhat US, Pai N. Women reproductive rights in India: prospective future. Online J Health Alli Sci. 2011;10(1):1-5.

Ipas. Improving access to comprehensive abortion care in India with focus on expanding the provider base. A policy brief. 2018.

Jejeebhoy SJ, Kalyanwala S, Mundle S, Tank J, Zavier AF, Kumar R, et al. Feasibility of expanding the medication abortion provider base in India to include ayurvedic physicians and nurses. Int Perspect Sex Reprod Health. 2012:133-42.

MoHFW, Rural Health Statistics. Ministry of Health and Family Welfare: New Delhi; 2016.

Jejeebhoy SJ, Zavier AJ, Acharya R, Kalyanwala S. Increasing access to safe abortion in rural Maharashtra: outcomes of a comprehensive abortion care model. Population council. 2011.

Navin D, Gulati S, Warvadekar J, Banerjee SK. Improving Comprehensive Abortion Care Services in Chhattisgarh through State Government- Ipas partnership- a facility baseline assessment, 2010. New Delhi, India: Ipas; 2011.

Patel L, Bennett TA, Halpern CT, Johnston HB, Suchindran CM. Support for provision of early medical abortion by mid-level providers in Bihar and Jharkhand, India. Reprod Health Matters. 2009;17(33):70-9.

Sjöström S, Essén B, Sydén F, Gemzell-Danielsson K, Klingberg-Allvin M. Medical students' attitudes and perceptions on abortion: a cross-sectional survey among medical interns in Maharastra, India. Contraception. 2014;90(1):42-6.

Ganatra B, Kalyanwala S, Elul B, Coyaji K, Tewari S. Understanding women's experiences with medical abortion: in-depth interviews with women in two Indian clinics. Glob Public Health. 2010;5(4):335-47.

Shuchita M, Shveta K, Batya E, Suresh U. Simplifying medical abortion: home administration of misoprostol. J Obstet Gynecol India. 2008;58:410-6.

Sri BS, Ravindran TK. Medical abortion: understanding perspectives of rural and marginalized women from rural South India. Int J Gynaecol Obstet. 2012;118(1):S33-9.

World Health Organization, Department of Reproductive Health and Research. Safe abortion: technical and policy guidance for health systems evidence summaries and grade tables. 2nd edn. World Health Organization; 2012.

Grimes DA, Schultz KF, Cates Jr W, Tyler CW. The Joint Program for the Study of Abortion/CDC: a preliminary report. In: Abortion in the seventies: proceedings of the Western Regional Conference on Abortion. New York, NY: National Abortion Federation; 1977:41-54.

Cates W, Grimes DA, Schulz KF. Abortion surveillance at CDC: creating public health light out of political heat. Am J Prev Med. 2000;19(1):12-7.

Islam R, Biswas SP, Halder D, Fatima K. Safety and efficacy of manual vacuum aspiration compared to dilatation and curettage in the management of early pregnancy failure. Bangladesh Med J Khulna. 2016;49(1-2):18-22.

Tunçalp Ö, Gülmezoglu AM, Souza JP. Surgical procedures for evacuating incomplete miscarriage. Cochrane Database Syst Rev. 2010(9):Cd001993.

World Health Organization, Clinical practice handbook for safe abortion. World Health Organization; 2014.

Ganatra B. Abortion research in India: What we know, and what we need to know. Women’s Reprod Health India. 2000:186-235.

Gupte M, Bandewar S, Pisal H. Women’s perspectives on the quality of general and reproductive health care: Evidence from rural Maharashtra. Improving Quality Care in India’s Family Welfare Programme. Population Council, New York; 1999:117-39.

Visaria L, Ramachandran V, Ganatra B, Kalyanwala S. Abortion in India: emerging issues from qualitative studies. Econom Polit Week. 2004:5044-52.

Ganatra B, Hirve S. Induced abortions among adolescent women in rural Maharashtra, India. Reprod Health Matters, 2002;10(19):76-85.

Barua A, Apte H. Quality of abortion care: perspectives of clients and providers in Jharkhand. Econom Polit Weekly. 2007:71-80.

Benson J, Andersen K, Brahmi D, Healy J, Mark A, Ajode A, et al. What contraception do women use after abortion? An analysis of 319,385 cases from eight countries. Glob Public Health. 2018;13(1):35-50.

Zavier A, Padmadas SS. Postabortion contraceptive use and method continuation in India. Int J Gynecol Obstet. 2012;118(1):65-70.

Pradhan MR, Ram U. Female sterilization and ethical issues: The Indian experience. Soc Change. 2009;39(3):365-87.

Ramanathan M, Mishra U, Correlates of female sterilization regret in the southern states of India. J Biosoc Sci. 2000;32(4):547-58.

Elul B, Barge S, Verma S, Kumar N, Bracken H, Sadhvani H. Unwanted pregnancy and induced abortion: data from men and women in Rajasthan, India. New Delhi: Population Council; 2004:29-30.

Banerjee SK, Andersen KL, Baird TL, Ganatra B, Batra S, Warvadekar J. Evaluation of a multi-pronged intervention to improve access to safe abortion care in two districts in Jharkhand. BMC Health Serv Res. 2014;14(1):1-2.






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