CEHAT followed up its study of women's perspective on abortion by conducting a study of the abortion care facilities and providers in two districts of Maharashtra. Simultaneously, this project also initiated our advocacy on abortion at the state level. The study covered the registered as well as non-registered, and the government as well as private abortion care facilities in nine tehsils of two districts. The survey involved the study of physical and medical standards, interviews with the providers, observation of the provider-client interaction, exit interviews of the clients and so on. It was found that -
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Of the 159 abortion care facilities identified by us in these nine tehsils, the ratio of registered to non-registered facility was 1:2.8. Only about one quarter of the government health care facilities in this area provided abortion care. About two thirds of the abortion care facilities were urban based.
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Little more than a quarter of the abortion care facilities were equipped, fully and completely, with essential anaesthetic and resuscitation equipment. About two thirds of them were having all surgical instruments required for the MTP procedures and about 60 per cent stocked all the life saving drugs. Many of them did not have the service of anaesthetist available. Only about 43 per cent of the abortion service providers were qualified as per the Act. Non-allopaths constituted about 28 per cent.
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The content and texture of woman-provider communication were found to be unsatisfactory. Counselling was either poor or completely absent. Not many providers felt necessary to tell women about the "dos and don'ts" of post-operative care.
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There is increasing commercialisation of abortion care. There is high use of irrational drugs and unwanted abortion procedures. We also found rampant sex selective abortion practices.
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The study captured the unwarranted role of abortion service providers as 'gate keepers'. This role is a consequence of over-medicalisation of abortion care. Commercial interests of the medical fraternity, stronghold of patriarchal value system, stigma attached to the act of abortion, tendency to moralise, denial of women's sexuality and reproductive rights, etc., have an impact on the providers' role as gate keepers, often against the interests of women.
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The study also revealed the range of problems that heads of health care facilities face while seeking MTP registration. Lack of access to information, ill-equipped government staff at the concerned offices, apathy on part of the medical fraternity and hospital administrators about medical legislation and regulatory mechanism and unsatisfactory response of the state administrators, contribute to the existence of a large number of non-registered abortion care facilities.
This study found the quality of abortion services available to women substandard. The poor implementation of the law and rules for the quality by the government and low compliance with the legislation by the medical profession, were chiefly responsible for this state of affairs. We feel that improvement in the quality of abortion care should be a part of the strategy for general improvement in the health care delivery system.
Supported by: the Ford Foundation, New Delhi Research Team:Sunita Bandewar, Madhuri Sumant, Hemlata Pisal,Mugdha Lele and Shelley Saha
