Where do rural women obtain postabortion care? The case of Uttar Pradesh, India.

CONTEXT Although Indian law permits abortion for a broad range of social and medical indications, millions of unsafe and illegal abortions and countless subsequent complications occur annually. Nonetheless, in the central Indian state of Uttar Pradesh, few women with abortion complications are reported to seek care at registered private and public health facilities. Information is needed about where rural women seek care for abortion complications and about the quality of care they receive. METHODS Qualitative data were collected in 1999 in four villages in rural Uttar Pradesh. The study team conducted community mapping exercises, focus group discussions with female and male community members, and in-depth interviews with women of reproductive age and with postabortion care providers. RESULTS Postabortion care is widely available in the villages studied, largely from untrained or inappropriately trained providers. Because village-level providers are the front line of care for many women, abortion complications may be exacerbated rather than alleviated, appropriate care delayed and the cost of treatment increased. Village-level postabortion care does not include family planning and contraceptive counseling services or links to reproductive and other health services. CONCLUSIONS : Existing village-level postabortion care services are inadequate. There is an urgent need to increase women's access to higher-quality postabortion care. This can be done by simultaneously engaging village-level providers in the formal system of postabortion care service delivery, as appropriate, and addressing the prevailing social and cultural mores that discourage women with abortion complications from seeking higher-level care.