Abortion Rate, Care and Cost: A Community Based Study

Abortion Assessment Project – India (AAP-I) studies conducted on various aspects of abortion in 18 states of the country. The main objective of the survey was to study pregnancy outcome analytically with a focus on abortions in Maharashtra. CEHAT has undertaken a state level sample household survey to arrive at abortion incidence rates and to examine the nature and extent of abortion related morbidity in Maharashtra and its management.A state representative sample of 5712 ever-married women aged 15-54 from 5405 households from all districts of the state were interviewed. The study also endeavours to examine women's choice of abortion provider, to understand the expenditure patterns on abortion care and reasons for seeking abortion in the light of their socio-cultural milieu.

Rates of Pregnancy Loss
For 1996-2000 period, the rate of induced abortion was found to be 45.4 per 1000 reported pregnancy outcomes and the ratio per 1000 live birth was 50.7. Induced abortions ere on the rise in Maharashtra with the rate having doubled for the period 1996-2000 than for the period 1976-95. The incidence of induced abortion was more than three times higher in urban areas than rural areas and is much higher in Mumbai. The mean number of induced abortions is 16 times higher among women from high standard of living than women from low standard of living. While reported sex-selective abortion was only four per cent of the total pregnancies terminated between 1976 and 1995, it more than tripled to about 12 per cent for the period 1996-2000. The rate of reported sex determination test per 100 live births increased from 0.2 in 1976- 1980 to 2.4 in 1996-2000. Many abortions, both induced and spontaneous, in rural areas resulted in excessive bleeding. Problems due to vaginal discharge and pains and aches were almost twice higher among induced abortions from rural areas than urban areas. In case of spontaneous abortion, problems due to vaginal discharge were four times higher in rural areas than urban areas.

Issues of Access and Care
Both the mean and median distances of the private facilities accessed were lower than those for public facilities in rural as well as urban settings. The services of the private sector were sought for 62.3 per cent of the spontaneous abortions and 79.3 per cent of induced abortions. The public sector services were used for 15.6 and 17.9 per cent respectively for spontaneous and induced abortions. Consent was taken from spouse or relative in an overwhelming 87 per cent of induced abortion. Both public and private providers largely seek such consent before undertaking the abortion.

Cost of Abortion Services
The average out-of-pocket cost per abortion was Rs. 1415.40, being Rs. 1746.50 for induced abortions and Rs. 1113.70 for spontaneous abortions. The average cost per abortion to Mumbai women is much higher at Rs. 2760 per abortion than other areas. Otherwise there were only marginal ruralurban differentials in out-of-pocket expenditures on abortion. For induced abortion, between public and private sector the overall cost variation was over eleven times, but for medical care costs like hospital cost it was much higher in the private sector by as much as 20 times. Medicine costs were higher in the private sector by over nine times. In the public sector the main cost component for induced abortions was travel.

Supported by: Ford Foundation, New Delhi and Rockefeller Foundation, New York. Research Team:Ravi Duggal, Sunita Bandewar, Shelley Saha, Manasee Mishra, Bhagyashree Khaire, Sugandha More, Madhuri Sumant, Priti Bhogale, other 30 field researchers.