Gender Gaps in Research on Abortion in India - CommonHealth

midwife, and six from non-allopathic doctors.
Concern for secrecy may override that for safety. Women <strong>in</strong> rural West Bengal who had suffered
complications follow<strong>in</strong>g an unsafe abortion stated that they had gone to untra<strong>in</strong>ed providers <strong>in</strong> order to
ma<strong>in</strong>ta<strong>in</strong> the secrecy and anonymity (76).
What are women's reasons for choice of a particular abortion provider? In Maharashtra (10), the ma<strong>in</strong>
reasons were that the provider was a specialist, stated by 81% of the women, followed by 61% who
chose a provider because s/he was 'good-natured, listens and expla<strong>in</strong>s'. Similar reasons were cited by
abortion users <strong>in</strong> Varanasi (55), but cost was the most important consideration above all else. Those
who could afford went to a private cl<strong>in</strong>ic such as the Parivar Seva Sanstha, and those who did not have
the money went to the traditional dai who used unsafe methods and charged a low fee. In Chandigarh
(70), the choice was based on recommendations by a physician or the local auxiliary nurse midwife
(ANM) <strong>in</strong> about a third of the women, and the quality of care and cost were each stated as a reason only
by 12.5%. Among adolescents seek<strong>in</strong>g abortion <strong>in</strong> Haryana, 86% identified cost and confidentiality as
the most important factors govern<strong>in</strong>g choice of abortion provider (50).
<strong>Research</strong> gaps
Draw<strong>in</strong>g on the 'three delays' model <strong>in</strong> seek<strong>in</strong>g obstetric care, there appear to be four major
delays <strong>in</strong> term<strong>in</strong>at<strong>in</strong>g an unwanted pregnancy successfully. The first delay occurs <strong>in</strong> recognis<strong>in</strong>g the
symptoms of pregnancy; the second, <strong>in</strong> decid<strong>in</strong>g to term<strong>in</strong>ate the pregnancy; the third, <strong>in</strong> mak<strong>in</strong>g contact
with an abortion provider; and the fourth, <strong>in</strong> hav<strong>in</strong>g the pregnancy term<strong>in</strong>ated successfully. As seen
above, <strong>in</strong>formation on one or the other delay is available from many studies. However, there is no
s<strong>in</strong>gle study that traces the pathway to <strong>in</strong>duced abortion <strong>in</strong> a large enough group of women of
vary<strong>in</strong>g characteristics.
We also do not know how each delay is <strong>in</strong>fluenced by gender-factors such as lack of awareness of one
's body, shame and embarrassment related to an unwanted pregnancy, lack of decision-mak<strong>in</strong>g power,
the need to f<strong>in</strong>d an escort or the money to go to an abortion facility, fear or be<strong>in</strong>g reprimanded
by the provider, and be<strong>in</strong>g passed on from one provider to another because of provider-perceptions on
appropriate female sexual and reproductive behaviour. The comb<strong>in</strong>ation of poverty and gender
factors may exacerbate each delay for low-<strong>in</strong>come women. Cost of abortion services as a reason for
delay <strong>in</strong> seek<strong>in</strong>g <strong>in</strong>duced abortion has not been explored adequately <strong>in</strong> studies exam<strong>in</strong><strong>in</strong>g delay
<strong>in</strong> care-seek<strong>in</strong>g.
Studies show that women prefer to use private rather than public sector health facilities for hav<strong>in</strong>g an
<strong>in</strong>duced abortion. The attitude of personnel <strong>in</strong> public sector health facilities is mentioned as a reason <strong>in</strong>
some of the studies. A prospective comparison of women's abortion experiences <strong>in</strong> public and private
sector health facilities may yield better <strong>in</strong>sights <strong>in</strong>to the range of reasons for preferr<strong>in</strong>g one over the
other, and also the differences <strong>in</strong> profile of the women who use abortion services <strong>in</strong> the public and
private sector, and those who use the services of traditional providers.
Abortion and contraceptive use 12
Data on knowledge of reversible and permanent methods of contraception <strong>in</strong> India show high
levels of knowledge of both, although sterilisation is by far the best-known method to all groups of
women. Also, use of sterilisation has risen consistently over the past few decades and fertility
levels have decl<strong>in</strong>ed <strong>in</strong> all states of India, more rapidly <strong>in</strong> some than <strong>in</strong> others. Despite the clear
motivation to regulate fertility, Indian women often do not use contraception, especially for
12. The follow<strong>in</strong>g studies fall under this section: Reference numbers 3, 10, 63, 70, 71, 72
13