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Case Studies from the Villages of Bokaro District, Jharkhand

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Case Studies from the Villages of Bokaro District, Jharkhand ABORTION OPTIONS FOR RURAL WOMEN : CASE STUDIES FROM THE VILLAGES OF BOKARO DISTRICT, JHARKHAND Lindsay Barnes Abortion Assessment Project - India TABLE OF CONTENTS ○○○○○○○○○○ PREFACE ○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○ v ○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○ ABSTRACT○○○○ vii ○○○○○○○○○○○○○ GLOSSARY OF TERMS AND ACRONYMS ○○○○○○○○○○○○○ viii ○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○ I. BACKGROUND ○○○○○○○○○○ 1 II. METHODOLOGY ○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○ 2 ○○○○○○○○○○○○○○○○○○○○○○○ III. SELECTION METHOD ○○○○○○○○○○○○ 2 ○○○○○○○○○○○○○○○○○○○○○○○○○○○ IV. PROFILE OF THE WOMEN○○○○○○ 4 V. PREVENTING UNWANTED PREGNANCIES: ○○○○○○○○○○○○○○○○○○○○ ○○○○○○ WOMEN’S EXPERIENCE OF CONTRACEPTION ○○○○○○○○○○○ 5 ○○○○○○○○○○○○○○○○ A. CONTRACEPTION USE PRIOR TO ABORTION ○○○○○○○○ B. CONTRACEPTION USE FOLLOWING ABORTION ○○○○○○○○○○○○○○○○○○○○○○○ ○○○○ VI. THE ABORTION OPTIONS AVAILABLE: ○○○○○○○○○○○○○○○○○○ ○○○○○○○○○○○○○○○○ SERVICE PROVIDERS AND TECHNIQUES ○○○○○ 7 ○○○○○○○ A. QUALIFIED MEDICAL PRACTITIONERS (PRIVATE/GOVERNMENT○○○○○○○○○○○) B. UNQUALIFIED MEDICAL PRACTITIONERS ○○○○○○○○○○○○○○○○○○○○○○○○○○ ○○○○○○○○○○○○○○○○○○○○○ C. FEMALE HERBAL PRACTITIONERS ○○○○○○○○○ ○○○○○○○○○ VII. DEALING WITH UNWANTED PREGNANCIES : ○○○○○○○○○ ○○○○○○○○○○○○ RURAL WOMEN’S EXPERIENCES OF ABORTION ○○○○ 10 ○○○○○○○○○○○○○○ A. DECISION-MAKING AND ABORTION ○○○○○○○○○○○○○○○ B. THE ABORTION EXPERIENCE ○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○ ○○○○○○○○○○○○○○ C. COST AND ABORTION CARE ○○○○○○○○○○○○○○○○○○ ○○○○○○○○○○ D. ACCESSIBILITY AND ABORTION ○○○○○○○○○○○○○○○○○○○○○ E. I MPACT ON WOMEN’S HEALTH ○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○ ○○○○○○○ VIII. CASES OF ABORTION-RELATED DEATHS ○○○○○○○○○○○○○○ ○○○○○○○○○○○○○○○○○ NOT INCLUDED IN THIS STUDY ○○○○○○○○○○○ 14 ○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○ IX. DISCUSSION ○○○○○○○○○○ 15 ○○○○○○○○○○ X. APPENDIX ○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○ ○○○○○○○○○○○○○○○○○ 1. APPENDIX1 ABORTION ASSESSMENT SCHEDULE ○○○○○ 17 PREFACE Abortions have been around forever. But stand the abortion and related issues at different points of time in history it has from the women’s perspective. received attention for differing reasons, some IV. Household studies to estimate incidence in support of it, but often against it. Abortion of abortion in two states in India. is primarily a health concern of women but V. Dissemination of information and litera- it is increasingly being governed by patriar- ture widely and development of an advo- chal interests which more often than not cacy strategy curb the freedom of women to seek abortion as a right. This five pronged approach will, hope- fully, capture the complex situation as it is In present times with the entire focus obtained on the ground and also give policy of women’s health being on her reproduction, makers, administrators and medical profes- infact preventing or terminating it, abortion sionals’ valuable insights into abortion care practice becomes a critical issue. Given the and what are the areas for public policy in- official perspective of understanding abortion terventions and advocacy. within the context of contraception, it is im- portant to review abortion and abortion prac- The present publication is the second in tice in India. the AAP-I series of working papers. Lindsay Barnes has conducted a survey in Bokaro The Abortion Assessment Project India district in newly created Jharkhand state (AAP-I) has evolved precisely with this con- and presented first hand information on safe cern and a wide range of studies are being and legal abortion services scenario in the undertaken by a number of institutions and area. researchers across the length and breadth We thanks Sunanda Bhattacharjea for of the country. The project has five compo- assisting in the language editing of this pub- nents: lication and Mr. Ravindra Thipse, Ms. Muriel I. Overview paper on policy related issues, Carvalho and Margaret Rodrigues for timely series of working papers based on exist- publication of this entire series. ing data / research and workshops to pool This working paper series has been sup- existing knowledge and information in ported from project grants from Rockefeller order to feed into this project. Foundation, USA and The Ford Foundation, II. Multicentric facility survey in six states New Delhi. We acknowledge this support focusing on the numerous dimensions gratefully. of provision of abortion services in the We look forward to comments and feed- public and private sectors back which may be sent to [email protected] III. Eight qualitative studies on specific is- Information on this project can be obtained sues to compliment the multicentric by writing to us or accessing it from the studies. These would attempt to under- website www.cehat.org Ravi Duggal 22nd September 2003 Coordinator, CEHAT ABSTRACT This study aimed to document poor, ru- ten accessed different methods of abortion, ral women’s experience of abortion in a back- which added to cost and risk. ward part of the Bokaro district in The crucial role of the unqualified rural Jharkhand. Twenty five women who had ex- medical practitioners was noted: as provid- perienced abortions during the previous two ers of abortion services, and as agents for years were selected, and interviewed utiliz- service providers. These private, unqualified ing a semi-structured questionnaire. A small practitioners were found to have a negative number of service providers were also inter- impact on women’s health, and gain finan- viewed. cially from the promotion of abortion. None All the women were married, and most had provided contraceptive counseling, had accessed abortions after reaching their warned women of the dangers of repeated optimum family size. The average age of the abortion or the risks of infection. women was 31.2 years. Only two women in None of the women in the study had the study were literate, and were mostly availed government services for abortion tribal, Muslim, backward and scheduled care, or for the management of abortion-re- caste. lated complications. Apart from the four The study highlighted the total lack of women who accessed abortions from the hos- accessible, affordable and safe abortion ser- pital of Bokaro Steel Plant (since they agreed vices. Only three to undergo the compulsory sterilization) all women experienced a complication-free, women had accessed illegal abortion ser- safe abortion from a single, qualified service vices. The study shows that in a system provider. Fifteen women had to access care dominated by private practitioners, abortion from more than one provider, since the com- care becomes a lucrative source of profit, and plications that arose could not, normally, be women’s overall health and well-being is a managed by the same provider. Women of- low priority. vii GLOSSARY OF TERMS AND ACRONYMS BGH Bokaro General Hospital D&C Dilation and Curettage D&E Dilation and Evacuation DGO Diploma in Gynaecology & Obstetrics FHP Female Herbal Practitioner IUD Intrauterine Device MMS Mahila Mandal Samiti MMWSHG Mahila Mandal Women’s Self Help Groups MTP Medical termination of Pregnancy OCPs Oral Contraceptive Pills RCH Reproductive & Child Health RMP Rural Medical Practitioner viii ABORTION OPTIONS FOR RURAL WOMEN : CASE STUDIES FROM VILLAGES OF BOKARO DISTRICT, JHARKHAND The aim of this study is to document Hospital (BGH) are provided free of cost. poor, rural women’s experience of abor- However, the bureaucratic obstacles to get tion in a backward part of the Bokaro admission, the number of visits needed, the district in Jharkhand. We hope to explore amount of time involved, have all served to what women do when faced with an un- deter many women from accessing this fa- wanted pregnancy, and what obstacles they cility. Besides, during the busy ‘family plan- face in accessing safe and accessible ning campaign season’, from November to abortion. March, this service is in practice withdrawn. Women with unwanted pregnancies are I. BACKGROUND refused admission. Although the medical termination of The government health centres in the pregnancy (MTP) has been legalised for al- district do not provide regular birth spacing most 30 years and abortion care is suppos- services, delivery care, let alone abortion edly provided for in the Government’s ‘Re- services. The government’s referral hospi- productive and Child Health’ (RCH) program, tal does not have the facilities to perform a safe and legal abortion remains inacces- major surgery that may be needed during sible for the vast majority of rural women in obstetric emergencies or as a result of abor- Jharkhand. Poor, village women continue tion complications (such as perforation of to risk their lives and health in seeking the uterus, which may necessitate a hys- termination of an unwanted pregnancy. The terectomy). The Civil Surgeon informed us collapse of the government’s health system, that no government doctor in the district is the non-availability of birth spacing meth- qualified to provide abortion services. ods in spite of the priority given to the pro- motion of family planning, has further ex- Faced with an unwanted pregnancy, poor acerbated this problem. village women have the following ‘options’: Bokaro district, in the newly created l To continue with the pregnancy Jharkhand State, is typical of the sort of l Agree to undergo a tubectomy and try to development that is taking place. Although get admission into Bokaro General Hos- the state has a well-equipped hospital, it is pital available only for the employees of the steel plant. Safe and legal abortion services are l Access (illegal) abortion from a quali- available in the hospital,
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