More Infographic Resources #Abort The Stigma
Woman-centered Comprehensive Abortion Care (CAC) includes high quality counselling and post abortion contraception as essential components of care. The methods being used to provide abortions need to be as per current standards. Recommended methods include – manual vacuum aspiration (MVA), electric vacuum aspiration (EVA), medical methods of abortion (MMA) and Dilation and Evacuation (D&E).
Obsolete and unsafe methods such as Dilation and Curettage (D&C) need to be phased out completely. It is not enough to only ensure provision of abortion services but equally important to ensure that all critical components of care are being provided and the right to privacy and confidentiality is being maintained. Obtaining voluntary consent of the woman at all stages of service provision need to be a non-negotiable component of CAC.
The main challenge remains with implementation of these guidelines. Acute provider shortage and inadequate infrastructure limit the ability of public health facilities to ensure delivery of comprehensive abortion care (CAC)
The Government of India, has developed the ‘Training and Service Delivery Guidelines for Comprehensive Abortion Care’ in 2010. http://ow.ly/cp6c30fmWCd
There are several barriers to the provision of comprehensive abortion care (CAC). Provider shortage is perhaps one of the most significant barriers. World over, including in South Asian countries like Nepal, there has been a considerable and evidence based shift to include an expanded pool of skilled providers – midwives, nurses and paramedics – in the delivery of abortion services. This has happened in two ways.
For some methods of abortion provision, particularly during the first trimester, there has been ‘Task shifting.’ Task shifting involves moving, where appropriate, the delivery of a service e.g. medical abortion, to a less specialized health worker. For more advanced stages of abortion where surgical methods of abortion is being used ‘Task sharing’ is being introduced to “optimize” health workers’ skills to provide some elements of care to support the specialists.
The Medical Termination of Pregnancy Act, 1971 is a provider-centric law. It does not accord women the right to abortions on request. A number of conditions guide its implementation. However, there are important provisions with regard to consent and confidentiality that can ensure women are able to obtain an abortion on their own terms. For example, the law allows persons above 18 years to provide consent and does not require spousal or guardian consent. Similarly, confidentiality is mandated. These are important provisions that those seeking abortions need to be aware of. However, there is very low knowledge about the law amongst abortion seekers. Providers themselves lack knowledge about the law and/or impose their own values in the abortion decisions that women make. One example of this is to ask married women to seek spousal consent prior to providing an abortion.
The Indian abortion law requires certification of facilities and providers to provide abortion services. The 2002 Amendment of the law resulted in some important gains. Registration of facilities was decentralised to the district level to enable speedier registration of facilities and providers. The Amendments also separated the facility level requirements for the provision of medical abortion, first trimester and second trimester abortions. This on paper, is meant to ensure registration of higher number of facilities that provide medical and first trimester abortions due to the simplified requirements. In reality this has not been the case. The district level mechanism that is meant to provide certification, often remains non-functional.
There are a number of grounds for which women can seek abortions up to 20 weeks including contraceptive failure. In the past year, there have been a spotlight on women seeking late term abortions beyond the legal limit of 20 weeks on account of fetal abnormality and in some instances rape and incest where there has been a delay in seeking medical care. This has renewed the debate on the need to increase the gestation limit to seek abortions to 24 weeks from the current limit of 20 weeks.
Provision of abortion services largely remain in the private sector with much fewer services available in the public sector. The private sector includes a wide range of informal providers that provide abortion services, despite not having the skills nor the training to do so. This contributes to the high rate of unsafe abortions.
One of the main barriers is the lack of awareness and information about the availability of services. Very few facilities – in the public or private sector – display the availability of services on their premises. Lack of availability in the public sector is due to shortage of providers, lack of trained providers and shortage of equipment. Even where there are trained providers they are often overburdened with institutional delivery and are therefore unable to provide abortion services. Provision of abortion services remains a low priority in the public sector. #AbortTheStigma #IResistWePersist #Sept28