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Unintended Pregnancy and Abortion in India: Country Profile Report

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Unintended Pregnancy and Abortion in India: Country Profile Report INDIA RESEARCH REPORT MARCH 2014 Unintended Pregnancy and Abortion in India: Country Profile Report MARY PHILIP SEBASTIAN M.E. KHAN DALIYA SEBASTIAN 1 UNINTENDED PREGNANCY AND ABORTION IN INDIA: COUNTRY PROFILE REPORT WITH FOCUS ON BIHAR, MADHYA PRADESH AND ODISHA MARY PHILIP SEBASTIAN, M.E. KHAN, DALIYA SEBASTIAN The STEP UP (Strengthening Evidence for Programming on Unintended Pregnancy) Research Programme Consortium generates policy-relevant research to promote an evidence-based approach for improving access to family planning and safe abortion. STEP UP focuses its activities in five countries: Bangladesh, Ghana, India, Kenya, and Senegal. STEP UP is coordinated by the Population Council in partnership with the African Population and Health Research Center; The International Center for Diarrhoeal Disease Research –Bangladesh (icddr-b), the London School of Hygiene and Tropical Medicine; Marie Stopes International; and Partners in Population and Development. STEP UP is funded by UK aid from the UK Government. www.stepup.popcouncil.org The Population Council confronts critical health and development issues—from stopping the spread of HIV to improving reproductive health and ensuring that young people lead full and productive lives. Through biomedical, social science, and public health research in 50 countries, we work with our partners to deliver solutions that lead to more effective policies, programs, and technologies that improve lives around the world. Established in 1952 and headquartered in New York, the Council is a non-governmental, non-profit organization governed by an international board of trustees. www.popcouncil.org Suggested citation: Mary Philip Sebastian, M.E. Khan and Daliya Sebastian, 2013. “Unintended Pregnency and Aboration in India with Focus on Bihar, Madhya Pradesh and Odisha.” New Delhi, India: Population Council. © 2014 Population Council, Inc. Please address any inquiries about STEP UP to the RPC co-directors: Dr. Harriet Birungi, [email protected] Dr. Ian Askew, [email protected] Funded by TABLE OF CONTENTS ACRONYMS ................................................................................................................................................................ iii EXECUTIVE SUMMARY ............................................................................................................................................. v CHAPTER 1: INTRODUCTION ................................................................................................................................... 1 Background ...................................................................................................................................................... 1 Objectives ......................................................................................................................................................... 2 Methods ............................................................................................................................................................ 2 Data Management and Analysis ....................................................................................................................... 3 Indian Scenario ................................................................................................................................................. 4 Outcomes of unintended pregnancy ................................................................................................................. 6 CHAPTER 2: THE LEGAL, POLICY AND SOCIO-CULTURAL CONTEXT OF SEXUAL AND REPRODUCTIVE HEALTH RIGHTS IN INDIA ........................................................................................................................................ 9 Introduction ....................................................................................................................................................... 9 International Covenants / Conventions / Treaties Ratified / Acceded / Signed by India ................................... 9 Brief history of reproductive health laws and policies ..................................................................................... 10 Schemes to improve adolescent health .......................................................................................................... 14 Abortion laws and policies .............................................................................................................................. 14 Donors and international assistance ............................................................................................................... 17 Overview of policies ........................................................................................................................................ 17 CHAPTER 3: FAMILY PLANNING AND REPRODUCTIVE HEALTH INDICATORS: TRENDS AND EQUITY ANALYSIS ................................................................................................................................................................ 21 Introduction ..................................................................................................................................................... 21 History and trends of India’s national family planning program ...................................................................... 21 Use of family planning method and LAM ........................................................................................................ 22 Ever use of Contraception .............................................................................................................................. 23 Use of Limiting Methods ................................................................................................................................. 25 Current use of Contraception .......................................................................................................................... 26 Sources of contraceptives .............................................................................................................................. 30 Contraceptive Discontinuation Rate ............................................................................................................... 31 Intention to use contraceptive methods .......................................................................................................... 32 Fertility levels, trends and differentials ............................................................................................................ 32 Proximate determinants of fertility .................................................................................................................. 37 CHAPTER 4: TRENDS IN UNMET NEED FOR CONTRACEPTION AND SAFE ABORTION SERVICES .............. 42 Introduction ..................................................................................................................................................... 42 i Trends in unmet need for contraception ......................................................................................................... 42 Abortion and related outcomes ....................................................................................................................... 51 CHAPTER 5: ACCESS TO AND QUALITY OF FAMILY PLANING AND ABORTION AND POST ABORTION SERVICES ................................................................................................................................................................ 60 Introduction ..................................................................................................................................................... 60 Availability of health facilities .......................................................................................................................... 60 Exposure to media and quality of counseling on contraceptive methods and HIV ......................................... 62 M-health and E-health initiatives ..................................................................................................................... 65 What works in increasing FP access? ............................................................................................................ 66 CHAPTER 6: FINANCING AND DELIVERY MECHANISMS ..................................................................................... 73 Introduction ..................................................................................................................................................... 73 Conditional Cash Transfer Mechanisms ......................................................................................................... 73 Pay for performance Schemes ....................................................................................................................... 78 CHAPTER 7: GAPS & BARRIERS IN SERVICE PROVISION; RECOMMENDATIONS FOR A WAY FORWARD .. 81 Infrastructure, Human resource availability/ unfilled vacancies ...................................................................... 81 Training inadequacies: barrier to quality service provision ............................................................................. 82 Modifications required in monitoring and supervision ..................................................................................... 82 Community awareness of FP/SA .................................................................................................................... 82 Commodity
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