A study on abortion care services in different tiers of rural health care in Malda district of West Bengal, India

Abstract

Objective: To assess comprehensive abortion care (CAC) services uptake and barriers to it in selected representative units of the three tier health care in the district of Malda in West Bengal, India.

Methods: We conducted community-based, concurrent, parallel mixed methods study. Quantitative assessment of knowledge of primary health care workers on CAC and appropriate infrastructure assessment was done. Qualitative methods were used to identify themes affecting uptake of quality care among stakeholders.

Results: A total of 48 staff nurses and 133 auxiliary nurses and midwives were included in the study. About half of nurses (of total 48) who were second tier health care provider and two thirds (of total 133) of first tier health care provider had incorrect knowledge about legality of abortion. Only 40% mothers seeking abortion were accompanied to subcentre by primary health care worker. At the third tier health care site, physicians insisted on necessity of refresher training. Suboptimal uptake of available CAC services was due to lack of enabling environment. Lack of updated training across health care workers was observed.

Conclusions: Health care providers at the community level were unaware of facilities available for mothers seeking abortion. Higher level health care providers were unsure of specific knowledge about legal permissibility and sterilization of apparatus for abortion. At the highest level, more training on medical methods of abortion was required. The problems identified are amenable to correction, and some administrative and service-related provision on appropriate measures may lead to immediate success.

Keywords

Abortion care uptake / Tiers of service primary health care / Perception / Service uptake

Conflict of interest statement

The authors declare no conflicts of interest to disclose.

Funding

This study was funded by National Health Mission, Government of West Bengal [HFW-35099/37/2018-SFWB SEC(DHS)(HFW)/4441, dated 23 August 2018].

Authors’ contributions

Concept and design were performed by Debjani Sengupta and Pramit Ghosh; data collection was carried out by Debjani Sengupta; data handling was done by Debjani Sengupta; analysis was made by Pramit Ghosh; manuscript preparation was performed by Debjani Sengupta and Pramit Ghosh.

Publisher’s Note

The Publisher of the Journal remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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