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Availability, Utilisation and Health Providers' Attitudes Towards Safe Abortion Services in Public Health Facilities of South

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Availability, Utilisation and Health Providers' Attitudes Towards Safe Abortion Services in Public Health Facilities of South AVAILABILITY, UTILISATION AND HEALTH PROVIDERS’ ATTITUDES TOWARDS SAFE ABORTION SERVICES IN PUBLIC HEALTH FACILITIES OF SOUTH 24 PARGANAS, WEST BENGAL DR. SOUVIK PYNE Dissertation submitted in partial fulfillment of the requirement for the award of the degree of Master of Public Health ACHUTHA MENON CENTRE FOR HEALTH SCIENCE STUDIES SREE CHITRA TIRUNAL INSTITUTE FOR MEDICAL SCIENCES & TECHNOLOGY Thiruvananthapuram, Kerala. India – 695011 October 2015 AVAILABILITY, UTILISATION AND HEALTH PROVIDERS’ ATTITUDES TOWARDS SAFE ABORTION SERVICES IN PUBLIC HEALTH FACILITIES OF SOUTH 24 PARGANAS, WEST BENGAL DR. SOUVIK PYNE Dissertation submitted in partial fulfillment of the requirement for the award of Master of Public Health ACHUTHA MENON CENTRE FOR HEALTH SCIENCE STUDIES SREE CHITRA TIRUNAL INSTITUTE FOR MEDICAL SCIENCES & TECHNOLOGY Thiruvananthapuram, Kerala. India – 695011 October 2015 Dedicated to my beloved parents, Late Bijay Pyne and Smt. Manika Pyne. Acknowledgements Foremost, I would like to express my sincere gratitude to my guide Prof. (Dr.) T.K. Sundari Ravindran, Professor, Achutha Menon Centre for Health Science Studies (AMCHSS) for her constant support, motivation, patience, supervision and immense knowledge. Her guidance helped me in all the time from conceptualising the research to writing the dissertation. It is a great privilege to work under such an inspiration and I am really short of words to express my thankfulness for her. I am grateful to Dr. Mala Ramanathan, Dr. P. Sankara Sarma, Dr. Ravi Prasad Varma, Ms. Jissa VT for helping me in my dissertation and Dr. K.R. Thankappan, Dr. V Raman Kutty, Dr. Biju Soman, Dr. Kannan Srinivasan, Dr. Manju R Nair for their valuable comments to improve my dissertation. I am indebted to Dr. B Subha Sri (Rural Women’s Social Education Centre), Dr. Suchitra Dalvie (Asia Safe Abortion Partnership), Dr. Sarika Chaturvedi (Karolinska Institutet, Sweden), Mr. Sushanta K Banerjee (Ipas) for their precious inputs during the course of my dissertation. I thank Mr. Swapan Chattopadhyay (Ex-District Magistrate, South Dinajpur district, West Bengal) for his immense help in personally forwarding my study permission application to the Department of Health & Family Welfare, Government of West Bengal and facilitating in procuring the permission for my study. I also thank Mr. Debasis Bose (Additional Secretary, Department of Health & Family Welfare) for personally sending my permission letter and Dr. Biswaranjan Satpati (Director of Health Services & EO Secretary, Department of Health & Family Welfare) for granting me the permission to conduct the study. I am grateful to all the officials and staffs of the Department of Health & Family Welfare, Government of West Bengal who lend their co-operation by taking part in my study and/or facilitating it amidst their busy working schedule all through my data collection. I am thankful to my seniors Mr. Sanjeev Kumar Singh (MPH 2011) and Mr. Kirti Sundar Sahu (MPH 2013) for guiding my journey to this institution and throughout it. I extend my special thanks to other members of the adored Illuminati group (Dr. Aakshi Kalra, Mr. Bevin Vinay Kumar, Mr. Peeyush) for their unending support, for the stimulating discussions, for the critical coping strategies in difficult times, for the sleepless nights we were working together before deadlines, and for all the fun we have had in the last two years. I also thank Ms. Minu Abraham, Dr. Sanjay Babasaheb Bandgar, Ms. Pritty Titus, Dr. Tijo George, Dr. Shreeporna Bhattacharya for their timely help whenever needed and other colleagues for their encouragement. I thank my friend Dr. Santanu Mukherjee for taking time out for doing many of my Bengali translations of my study tools. I am grateful to my dear friends Dr. Shubha Choudhury and Ms. Rinu PK for being with me always and keeping my morale afloat. I take this opportunity to acknowledge the blessings, love and care showered by God, my father and my mother upon me in everything I did, without which I could have never completed this work. DECLARATION I hereby declare that this dissertation titled “Availability, utilisation and health providers’ attitudes towards safe abortion services in public health facilities of South 24 Parganas, West Bengal” is the bonafide record of my original field research. It has not been submitted to any other university or institution for the award of any degree or diploma. Information derived from the published or unpublished work of others has been duly acknowledged in the text. DR. SOUVIK PYNE Achutha Menon Centre for Health Science Studies Sree Chitra Tirunal Institute for Medical Sciences & Technology Thiruvananthapuram, Kerala, India – 695011 October 2015 CERTIFICATE Certified that the dissertation entitled “Availability, utilisation and health providers’ attitudes towards safe abortion services in public health facilities of South 24 Parganas, West Bengal” is a record of the original research work undertaken by Dr. Souvik Pyne in partial fulfillment of the requirements for the award of the degree of ‘Master of Public Health’ under my guidance and supervision. Dr. T.K. SUNDARI RAVINDRAN Professor Achutha Menon Centre for Health Science Studies Sree Chitra Tirunal Institute for Medical Sciences & Technology Thiruvananthapuram, Kerala, India – 695011 October 2015 Contents Sections Topics Page no. Abstract 1 Introduction 1.1. The international mandate for safe abortion services...................... 1 1.2. The need for safe abortion services................................................. 4 2 Literature review 2.1. Global scenario................................................................................ 6 2.1.1. Brief background.......................................................................... 6 2.1.2. Availability and access................................................................. 9 2.1.3. Utilisation..................................................................................... 12 2.1.4. Health providers’ attitude............................................................. 13 2.2. Indian scenario................................................................................ 15 2.2.1. Brief background.......................................................................... 15 2.2.2. Availability and access................................................................. 19 2.2.3. Utilisation..................................................................................... 26 2.2.4. Health providers’ attitude............................................................. 28 2.3. Need for the study........................................................................... 30 3 Methodology 3.1. Objectives........................................................................................ 31 3.2. Study design.................................................................................... 31 3.3. Study setting.................................................................................... 31 3.4. Sample size and sample selection procedures................................. 32 3.5. Operational definitions.................................................................... 35 3.6. Data collection techniques............................................................... 36 3.7. Data collection................................................................................. 37 3.8. Data storage..................................................................................... 38 3.9. Data analysis.................................................................................... 38 3.10. Ethical considerations...................................................................... 39 3.11. Dissemination of results.................................................................. 39 4 Results 4.1. Availability and utilisation of MTP services................................... 40 4.1.1. Results from facility survey......................................................... 40 4.1.2. District level records.................................................................... 53 4.2. Health providers’ attitude................................................................ 53 4.2.1. Characteristics of health providers............................................... 53 4.2.2. Attitude towards safe abortion..................................................... 55 4.2.3. Factors influencing attitude towards safe abortion....................... 56 4.3. Results from in-depth interviews.................................................... 58 4.3.1. Factors affecting provider choices in general............................... 59 4.3.2. Factors affecting availability and utilisation of MTP services..... 63 Sections Topics Page no. 5 Discussion and conclusion 5.1. Discussion........................................................................................ 79 5.2. Strengths of the study...................................................................... 85 5.3. Limitations of the study................................................................... 86 5.4. Conclusion....................................................................................... 87 5.5. Policy recommendations................................................................. 88 5.6. Further research............................................................................... 89 References Annexes Annexure I: Tables of utilisation records and factors affecting attitude towards safe abortion Annexure II: Informed consent forms
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