A.J. Francis Zavier

Can nurses perform manual vacuum aspiration (MVA) as safely and effectively as physicians? Evidence from India.

BACKGROUND Although legal, access to safe abortion remains limited in India. Given positive experiences of task-shifting from other developing countries, there is a need to explore the feasibility of expanding the manual vacuum aspiration (MVA) provider base to include nurses in India. STUDY DESIGN A prospective, two-sided equivalence study was undertaken in five facilities of a non-government organisation in Bihar and Jharkhand to explore whether efficacy and safety rates associated with MVA provided by newly trained nurses were equivalent to those provided by physicians. Eight hundred and ninety-seven consenting women with gestation ages of ≤ 10 weeks were recruited. RESULTS Nurses were as skilled as physicians in assessing gestation age and completed abortion status, performing MVA and obtaining patient compliance. Overall failure and complication rates were low and equivalent between the two provider types, and both provider types were equally acceptable to women who underwent the procedure (98%). CONCLUSION Findings of the study make a compelling case for amending existing laws to expand the MVA provider base in order to increase access to safe abortion in India.

Abortion experiences of unmarried young women in India: evidence from a facility-based study in Bihar and Jharkhand.

CONTEXT Little is known about the experiences of unmarried young women in India who seek to terminate an unintended pregnancy. METHODS A survey was conducted among 549 unmarried women aged 15-24 who had obtained an abortion in 2007-2008 at one of 16 clinics run by the nongovernmental organization Janani in the states of Bihar and Jharkhand. Differences in background characteristics, and in obstacles to obtaining an abortion, between those who had an abortion in the first trimester and those who did so in the second trimester were compared, and logistic regression analysis identified associations between these factors and obtaining a second-trimester abortion. RESULTS Eighty-three percent of women realized they were pregnant within the first two months of their pregnancy, and 91% within the first trimester. Eighty-four percent decided before the end of the first trimester to have an abortion, but only 75% obtained one in this period. One in six participants said that pregnancy had resulted from a nonconsensual sexual encounter, and such reports were more frequent among those who obtained a second-trimester abortion. Women who were older or who had more schooling had a decreased likelihood of having a second-trimester abortion (odds ratios, 0.9 each), whereas those who lived in rural areas, those who did not receive full support from their partners and those who reported a forced encounter had an increased likelihood of having a late abortion (2.3-4.1). CONCLUSIONS Sex education programs that highlight the importance of recognizing a pregnancy early in gestation, and of obtaining an early abortion if a pregnancy is unwanted, are needed for unmarried young women and men.

Adoption and continuation of contraception following medical or surgical abortion in Bihar and Jharkhand, India

This study was carried out to explore whether the rates of postabortion adoption of a contraceptive method, and continuation of contraception over 6 months, differ among women undergoing medical abortion (MA) or surgical abortion by manual vacuum aspiration (MVA).

Demand for contraception to delay first pregnancy among young married women in India.

In India, evidence is sparse regarding the demand for contraception to delay first pregnancy among married young people. Using data drawn from a study conducted in six Indian states among 9,572 women aged 15-24 who were married for five or fewer years, we explore the scope of this demand, the extent to which it has been satisfied, and, using logistic regression analyses, the factors correlated with contraceptive use to delay first pregnancy among those reporting demand. Findings confirm considerable demand for contraception to postpone first pregnancy (51 percent). Of those with demand, only 10 percent had practiced contraception. Contraception was more likely to have been practiced by educated women, those aware of family planning methods before they were married, those exposed to quality sexuality education, and those who participated in marriage-related decision making. Women who reported feeling pressure to prove their fertility were less likely to have practiced contraception.

Postabortion contraceptive use and method continuation in India

To investigate the patterns and determinants of postabortion contraceptive use and the rates of method continuation in India.

How conditional cash transfers to promote institutional delivery can also influence postpartum contraception: Evidence from Rajasthan, India

To examine the association between the receipt of benefits from a conditional cash transfer (CCT) scheme—Janani Suraksha Yojana (JSY)—and postpartum contraceptive use in Rajasthan, India.

Experiences of unmarried young abortion-seekers in Bihar and Jharkhand, India

While several studies have documented the prevalence of unprotected pre-marital sex among young people in India, little work has explored one of its likely consequences, unintended pregnancy and abortion. This paper examines the experiences of 26 unmarried young abortion-seekers (aged 15–24) interviewed in depth as part of a larger study of unmarried abortion-seekers at clinics run by an NGO in Bihar and Jharkhand. Findings reveal that recognition of the unintended pregnancy was delayed for many and many who suspected so further delayed acknowledging it. Once recognised, most confided in the partner and, for the most part, partners were supportive; a significant minority, including those who had experienced forced sex, did not have partner support and delayed the abortion until the second trimester of pregnancy. Family support was absent in most cases; where provided, it was largely to protect the family reputation. Finally, unsuccessful attempts to terminate the pregnancy were made by several young women, often with the help of partners or family member. Findings call for programmes for young women and men, their potential partners, parents and families and the health system that will collectively enable unmarried young women to obtain safe abortions in a supportive environment.

Non-consensual sex within pre-marital relationships: experiences of young women in India

In India, little is known about the prevalence of non-consensual sex within pre-marital relationships and factors correlated with such experience, although a sizeable proportion of young people engage in pre-marital relationships. Drawing on qualitative and quantitative data from a representative study of youth in six Indian states, this paper examines the extent to which young women who had had pre-marital sex had experienced non-consensual sex, that is, sex by persuasion or force, and factors associated with it. Analysis is restricted to 821 young women who reported pre-marital sex. Of those who had had pre-marital sex, 33% reported that they were either persuaded (14%) or forced (19%) to engage in sex. Young women residing in urban areas and in communities reportedly characterised by physical fights among youth were more likely than their respective counterparts to have experienced sex by persuasion. Young women who had delayed sexual initiation and those who displayed self-efficacy were less likely than others to experience forced sex. Young women who had experienced geographic mobility in adolescence and who had witnessed parental violence were more likely than others to report forced sex. Finally, those in southern states were less likely than their northern counterparts to experience forced sex.