Controlling minds and bodies: understanding socio-cultural barriers related to induced abortion and reproductive health among married women in Rural Uttar Pradesh, India

doi:10.21203/rs.3.rs-1842500/v1

Download PDF

Research Article

Controlling minds and bodies: understanding socio-cultural barriers related to induced abortion and reproductive health among married women in Rural Uttar Pradesh, India

https://doi.org/10.21203/rs.3.rs-1842500/v1

This work is licensed under a CC BY 4.0 License

Version 1

posted

You are reading this latest preprint version

Background

In the Global South, a disproportionate magnitude of young married women, who have had unwanted and mistimed pregnancies, undergo unsafe abortion practices. This leads to a heightened burden of maternal and infant deaths in developing countries. Among other things, unsafe abortion practices are often associated with limited contraceptive method-mix with skewed focus on female sterilization, high unmet need for contraception, poor quality of sexual and reproductive health care services, low male involvement in reproductive health matters, and widespread gender inequalities against girl and women restricting their access to quality health care services. However, there is a paucity of scientific evidence related to individual and community level pathways associated with unsafe abortion practices among young married women in the context of developing countries in general, and India in particular.

Objective

The present qualitative study attempts to examine the knowledge, attitude, social norms and practices related to abortion practices that shape sexual and reproductive health status among young married women in rural Uttar Pradesh, India.

Method

Using a qualitative study design, the present study underlines the lived experiences and process of decision-making related to induced abortion and entwined family, social and healthcare-associated challenges faced by young married women in rural Uttar Pradesh, India. Focussed group discussions (FGD) and in-depth interviews (IDI) among 37 currently married women aged 18–40 years with at least one child were conducted who were residing across ten selected villages in the Jaunpur district of Uttar Pradesh, India.

Result

Evidence from the study suggests that several women opted for unsafe induced abortion to limit their family size after being unable to use contraception methods in the study villages of Uttar Pradesh, India. Unsupportive behaviour of spousal for childcare, financial hardship, lack of accessibility and affordability of contraception methods, less decision-making power and social norms and customs poses critical barriers to safe abortion practice among young married women. Findings from the study highlight a glaring dearth of access to safe, affordable and quality abortion care services that further elevate the risk of lives among young married and pregnant women in rural Uttar Pradesh.

Conclusion

This study underscored both the individual and community-level perspectives related to the decision-making of induced abortion by young women, or married couples in rural Uttar Pradesh. It highlighted various social stigma and discrimination and health-related complications faced by young married women related to unsafe induced abortions. This calls for programme managers and policymakers for increased investments into high-quality comprehensive sexual and reproductive health services, and to revitalize efforts for greater male involvement in reproductive health matters to ensure safe pregnancy and child health experiences in the Indian context.

A large number of unintended and mistimed pregnancies have contributed to high rates of inducing unsafe abortions and reproductive health issues worldwide [1]. Women’s reproductive health is related to multiple human rights, mainly recognition of the fundamental right of couples and individuals have to decide the number, spacing and timing freely of their children [2], [3]. The reproductive rights of women are concerned with the following health care services that are: (a) availability of an adequate number of healthcare facilities, (b) physically and economically accessible, (c) accessibility without discrimination, (d) quality of health care services (United Nations Human Rights, 2015). However, the unavailability of safe and affordable health care services and contraception increases the mistimed unwanted pregnancies and miscarriages that directly affect women's reproductive health. The extent, that key Sustainable Development Goals (SDGs), are to reduce maternal deaths, ensure universal access to reproductive health and the health and well being of all ages. In particular, SDG 3.7 highlights the "universal access to sexual and reproductive health care services, including family planning, education and information, and the integration of reproductive health into national strategies and programs". Furthermore, target 5.6 reiterates ensuring access to sexual and reproductive health and reproductive rights [4].

The right to safe abortion is an important component of the sexual and reproductive health of women. Women have the right to make their own decision regarding their body and their reproductive life, the right to safe sex, affordable contraception, and the right to procreate and to have a family [5], [6]. Unsafe abortion leads to maternal deaths, yet, of the 55.9 million unsafe abortions that take place each year in which 49.3 million are in developing countries [7]. According to recent studies, overall, 35 abortions occur each year per 1000 women aged 15–44 globally [8]. The medical termination of pregnancy Act 1971[9] has passed by the Indian Parliament and come into force in 1972. MPT Act 1971 addressed reducing maternal mortality and morbidity from unsafe abortion practices that were restricted under older legislation. Despite more than 50 years of liberalisation, close to eight women die due to the cause of unsafe abortion each day [10], and continue to face many social and structural barriers to access safe abortion services. A critical underlying concern is that women have the right to control their sexuality, reproduction and fertility, not the basis on which the MPT act was formulated. Preferably women fitted into specific categories in this Act, such as pregnancy resulting from rape or the agony caused by an unwanted pregnancy arising out of the failure of a contraceptive used by a married woman or her husband. While at all stages of the pregnancy health care providers and doctors carried out the decision of abortion rather than the women seeking an abortion. Researchers and policymakers have a great concern to explore the new dimensions to measure the intention of abortion by improving the measurement of pregnancy status and fertility preferences, by examining the differences due to changing individual circumstances, variations in community norms and value systems in socio-economic perspective.

The situation is getting more complicated when social norms and cultural practices influenced women's decisions to have unsafe abortions. Social norms also contribute to the social stigma when outside societal factors may also render women's perceptions and behaviour. Stigma related to abortion is defined as a “shared understanding that abortion is morally wrong and/or socially unacceptable”[11]. Social norms and stigma manifested women's perceptions, experiences, and expectations in a variety of ways that may limit access to safe abortion [12]. At the same time, multiple factors play an important role when women have to decide to induce abortion such as unsupportive behaviour of husband and mother-in-law, economic hardship, inaccessibility of safe contraception, social norms and stigma that continues to be assessed and re-examined the women’s- reproductive preferences.

Rural Uttar Pradesh provides an ideal setting for conducting this research. Uttar Pradesh is the most populous state in India, with a total population of 200 million [13]. As per the data published by National Family Health Survey (NFHS-4) 2015–2016, Uttar Pradesh is now India recorded as lagging behind the state in terms of both maternal mortality rate (around 201per 100,000 live births) and infant mortality rates (43 per 1000 live births). The rate has declined in the past years, but there is a big lacuna exists between the literature and empirical investigation of current policies. A recent report represents that 3.15 million abortions are performed in Uttar Pradesh annually with which 61 abortions per 1000 women related to reproductive age (15–49) [10]. Only 32 per cent of women are allowed to go to respective places: the market, a health facility, and areas outside the village/ community in Uttar Pradesh. Women's access to health care was impeded, which in turn would lead to poor reproductive health outcomes [14]. This paper tries to investigate, to what extent critical barriers affect reproductive health that can be overcome by improving safe abortion health care services.

In this regard, this research focuses on different barriers and challenges that women experience to access and utilize affordable contraception and safe abortion services in rural Uttar Pradesh, India. Our exploratory research using qualitative methods will allow us to compare key-informants interviews and focussed group discussion to understand the individual factors and social constraints, stigma and discrimination related to using the abortion services among currently married women in the study context. The present study addresses an important and compelling issue related to clandestine abortion practices in rural Uttar Pradesh India. There are very few studies that address both the individual (women) and community-level perspectives related to the factors that influence decision making of abortion by young women, or married couples and related complications faced by the individual women and families. In addition, the unsafe and unaffordable abortion care services further exaggerate the health risk of women’s lives in rural areas. This paper also tries to fill the gap between women who experienced abortion in the past with those who never experienced it before, and how their perceptions, lived experiences and expectation would affect their reproductive health outcomes.

Study Setting and Period

The study was conducted in ten selected villages in the Jaunpur district of Uttar Pradesh, India, worked from July 2018 to October 2019. The selection process depended based on access to Reproductive Health (RH) care services; the community health centre (CHC) has relatively good access to all villages. Population ranging from 500 to 6000 population provides heterogeneity perspectives by whether women accessed facility services when it accessible was also a consideration.

Data collection

This qualitative study was carried out with 37 women interviews who had participated in four focus group decision inset of 20 women (an average of five women in each group) and 17 in-depth interviews with key informants aged 18-40 who experienced abortion in the past and have at least one child. The open-ended questions were addressing women's reproductive health, abortion need and challenges, perception, experience and expectations regarding healthcare providers. Women who with and without a currently engaged with a steady sexual partner from among various caste, classes, religions and sex had included.

Primarily, interviews were conducted after testing the local area setting. Semi-structured interview scheduled carried out the general information about clandestine abortion, obtained from focus group discussion first-hand. Further, plan the in-depth interview with key informants at their current household location. A 90 minutes interview schedule carries forward with those women who experience abortion in the past and covers their perceptions and lived experiences related to clandestine abortion, whether it is a reproductive right of women or forced by other social factors. Findings from the focus group discussion and in-depth interview are organised according to the major themes and presented along with the integration of perspective of abortion at the Individual level, household level, community level and health care provider's level (Figure-1).

Figure 1: Perspective of Abortion based on individual, household, community and health care providers

Ethical considerations

Women's privacy and confidentiality were maintained regarding their personal information and fulfilled the research ethics requirements. Prior consent from all women was obtained orally, and they had an option to leave the study at any point.

Data processing and Analysis

The data set used for analysis contained data from 37 individual women. For the qualitative study, we used an audiotape recorder for recording the personal response of women. Simple descriptive was done to know about women's awareness, knowledge, attitude, practice and social stigma at individual and community levels. After recording, transcription was done then coded and analysed using thematic areas based on participant responses and categorised into different themes. To check internal consistency and reliability in the responses took the help of a trained enumerator for language support in a specific situation.

We conducted an in-depth interview of individual women with an average duration of 40- 90 minutes each. In contrast, the focus group discussion covered each dimension related to women's reproductive health and women empowerment with an average duration of one and half an hour. The mean average age of women was 26 years with a range of between 19-32. Twenty-one women were younger than 25 years old, whereas 14 women were lower than thirty years old and only two women above thirty years past. The highest percentage of women attained primary education (1-5) with 37.8% follow up by secondary (9-10) and junior secondary (6-8) level 27% and 18.9% respectively. Approximately 80% of the women in the sample were Hindu and the rest were Muslim. Nearly 59.4% of women had had prior abortion experience, and eight women reported having more than one abortion. An average number of children were four, and only 18.9% of women were using contraception to avoid further pregnancy. Findings from the focus group discussion and in-depth interview are presented below about knowledge, perception, attitude, expectation and social stigma about abortion.

Knowledge, attitude and access to Family Planning

Women’s knowledge, attitude and accessibility to family planning methods directly reduce the risk of unsafe abortion practices. The majority of women have known about some of the methods of family planning, but the overall use was very low. Women have some knowledge, but their attitude towards using family planning methods is highly negative. Most of the women perceived that family planning methods make them infertile and impotent. Significant concerns of women have its side-effects, disapproval by husband and mother-in-law, family size, religious reasons and accessibility and affordability of the particular methods.

Nevertheless, the role of religion is also considered one of the essential factors that influenced women for shaping attitudes about family planning methods. Generally, in the Muslim faith, sterilisation and abortion are not allowed and recognised as a sin; therefore, most Muslim women do not go for using family planning methods and abortion services whether they conceived unintentionally. One of the Muslim women said:

"My husband mostly lives in Mumbai due to work purposes, and whenever he has come, he doesn't use contraception because it is not permissible in our religion...He used to [say] children are God gifted and we have not right to refuse the God gift." (In-depth Interview, Chandwak Village, Uttar Pradesh, India, age 25)

Another woman from the same religion said:

“I already have five children, and unintentionally two months pregnant currently. [I want] to abort this child, but our religion does not give permission to do this...even [my husband] also opposed to abortion...still [my] health is not good, but I have family pressure to give birth this child.” (In-depth, Biribari Village, Uttar Pradesh, India, age 31)

However, women have partial knowledge about family planning methods that hinder them to use them in the first place and always have a fear of its side effects. Women know different family planning methods by name but without their application and significance. Such as condoms, sterilisation, pills, injectables, and IUD/ PPIUD implants have known by many of them, but accessibility and affordability are the major challenges. One woman said:

“I know some of the modern contraception methods, but I don’t know where I can opt it and who will provide”. (Focus Group, Barmalpur Village, Uttar Pradesh, India, age 25)

Another woman said:

“I know that family planning is a good method to reduce the size of the family, but its side- effects are the major problem for women’s health in general”. (Hariharpur village)

Other women from Thakur Basti:

“I have a piece of knowledge about most of the modern family planning methods such as contraception pills, injection, operations and condoms but I am living in that family where talks about these things are unacceptable”. (Focus Group, Chandwak Village, Uttar Pradesh, India, age 24)

Another woman from a lower-income family has a different attitude regarding family planning she said:

“The government initiated of family planning programme because they permanently sterilised women or men for the name of the family planning programme.And it is not acceptable by most of the women in my family and community”. (Focus group discussion, Hariharpur Village, India, age 27)

One participant from the Nishad community (fisherman community) said:

“My husband is working in another city, and I am living with my in-laws. By the time my husband comes home, we don’t have any contraception. For me, accessibility is the major problem, and I feel timid about buying a family planning method from a chemist shop”. (In-depth Interview Chandwak Village, India, age 29)

Factors influence woman/husband/ couple to opt for abortion services

There are many factors which emphasised women seeking unsafe abortion for the first instance. Most women intentionally do not want further pregnancy, but socio-cultural and economic reasons enforce them for unintended pregnancy and unsafe abortion. Women have limited autonomy to control their health decisions in rural areas of Jaunpur, Uttar Pradesh, India. A substantial number of women who participated in in-depth interviews have an opinion to opt for abortion at a first place is not wrong. Women have an abortion history in the past and supported abortion in certain conditions. One woman said:

“It is right of women to obtain an abortion or give birth to a child... [Society] will not take any responsibility neither for women health nor child upbringing.” (In-depth, Thunhi Village, Uttar Pradesh, India, age 23)

Whereas, sex-selective preferences also exist in India by using modern technology prenatal sex determined and aborted female foetuses. The law has prohibited it, but in rural society, a patriarchal mindset influences continuing abortion after prenatal sex determination. In rural villages of Jaunpur, the sex-selective abortion practice is ongoing but in a very secretive manner. During in-depth interviews, two women directly talked about their sex-selective abortions in the past. However, two indirectly confessed that they know about their foetus sex beforehand. When this information was linked with her pregnancy history, then we indeed said that women did sex-selective abortion. Four women out of 37 obtained sex-selective abortion. One of the participants knows about her sex-selective abortion and said:

“I know this was not right, but my husband’s pressure on me. He wants a boy because boys cost of parenting much cheaper than girls. He said [husband]...keep dropping girls until you get a boy.” (In-depth Interview, Faridpur Village, Uttar Pradesh, India, age 23)

Another woman stated:

“I have two girls; therefore, my husband and in-laws want the next child should be a boy. During my third pregnancy, my sister-in-law brought me to Banaras [Varanasi] for checkups then I got to know about a girl foetus in my belly. I took the prescribed medicine of the doctor and aborted my baby." (In-depth Interview, Chandwak Village, Uttar Pradesh, India, age 24)

Another more experienced participant said:

“I know there is no difference between boy and girls, but everyone wants a boy first, and ours [women] status in the family also measures by having a higher number of boys child.” (Focus Group Discussion, Hariharpur Village, Uttar Pradesh, India, age 26)

Another stated:

“I have no choice except to obtain an abortion... [My husband and I] decided to abort this child because already we have three girls child. We do not want another girl child further...” (In-depth Interview, Hariharpur Village, Uttar Pradesh, India, age 22)

However, the desire for a son in a family is one of the causes of unintended pregnancies that end with induced abortion, maternal morbidity and mortality, and poor child health outcomes. In such types of conditions, women may choose to terminate their pregnancies when expecting daughters but carry on their pregnancies when expecting sons. One woman said:

“I have already four girls, but my husband wants one boy child intentionally. He [husband] said a boy only could help in his father’s business. Therefore I aborted two girls in the womb in three subsequent years” (In-depth Interview, Faridpur Village, Uttar Pradesh, India, age 29)

Indeed, the unmet need for contraception significantly influences the reproductive intentions of women. The demographic health survey (DHS) defines unmet needs as the percentage of women who do not want to become pregnant but currently are not using contraception and want to stop or delay childbearing. The unmet need for contraception is high in rural areas where high rates of unintended pregnancy risk. One participant from the Harijan community confers that:

“I do not want further pregnancy, but my husband not allowed using any contraception during sex due to feeling of dissatisfaction.”(In-depth Interview, Thunhi Village, Uttar Pradesh, India, age 24)

Whereas another woman said:

“I live in a nuclear family with my husband and three children. Although my husband doesn’t want to use any modern contraption method and I never permit him to do sex without contraception because I do not want any child further.” (Focus Group Discussion, Barmalpur Village, Uttar Pradesh, India, age 25)

Whereas one woman said:

"I want injection [contraceptive method] to avoid further pregnancy-related complication, but the price is about 300-400 Rs. for three months...my husband's wage is only 500 Rs. per month then how we can think to invest such huge money on me when I know he [husband] has plenty of responsibility on his shoulders...although this is not the permanent and secure method of contraception.” (In-depth Interview, Madhar Village, Uttar Pradesh, India, age 24)

Furthermore, the economic status of the family is one of the significant factors that is directly linked with induced abortion, whereas inverse relation between sex-selective abortion and the economic profile of the family. One woman stated:

“It doesn't matter that next child would be a girl or a boy for me. My husband wants a son, but we can't do anything we have not that much money to test foetus sex.” (Focus Group Discussion, Ramdevpur Village, Uttar Pradesh, India, age 19)

Some women talked about the economic hardship they experienced and opted for abortion in the past. One woman said:

"I always try to convince my husband for using contraception, but my husband said he has not that much money to invest in contraception." (In-depth Interview, Kakrapar Village, Uttar Pradesh, India, age 24)

Another woman stated:

“I know contraception is the best method to avoid unintended and mistimed pregnancy, but the cost of contraception always hindered my decision.” (In-depth, Chandwak Village, Uttar Pradesh, India, age 32)

One participant from Nishad (fisher) community supports abortion in particular circumstances with her beliefs in parenting a child in a low-income family:

“We do not have that much money to provide good education to another child...[my husband] has no fixed source of income, so it will be very difficult for us for parenting a child in this meagre condition. It's better just to have an abortion [...] instead of giving birth." (In-depth Interview, Chandwak Village, Uttar Pradesh, India, age 25)

Abortion Trajectory: Role of Husband/ Mother-in-law (MIL)/ Other Peer Friends

Globally, the majority of women have a negative opinion regarding induced abortion. A general decision in focus group discussion provides different viewpoints like a woman who seeks abortion is considered an "immoral" and "irresponsible". Women perceived that it is a crime when someone intentionally murdered a child. No one has the right to permit to do this without any permission, especially their husband and in-laws. Most women feel guilty and self-judged themselves when they were seeking an abortion. One participant said:

“I do not know why people do this. [an abortion...] I am opposed to doing this... it is an illegal and immoral practice which most of the women do secretly. When something does secretly, it is considered a sin in our Indian society.”(Focus Group, Chandwak Village, Uttar Pradesh, India, age 24)

Another woman said,

“You do not have the right [to abortion][...]abortion is related to a collective decision of the family. And when everyone knows that induced abortion is a crime then why people do this [...] they should have to be careful when they do not want further children and use contraception that is easily available in the market." (Focus Group, Barmalpur Village, Uttar Pradesh, India, age 25)

However, the dominant behaviour of the husband and mother-in-law in reproductive decisions leads to abortion-related complications. Abortion leads to an end mainly of the girl’s child. One woman said, “I already have three children, two girls and one boy child but still my mother-in-law wants another boy child and told me in her words that nothing happens with one eye; at least two boys should be in the family rather than one more girl” (Focus Group Discussion, Biribari Village, Uttar Pradesh, India, age 27)

One woman said:

“I gave birth to four girls, but my husband and mother-in-law want one boy child. Therefore my mother-in-law always tries to scorn me and told me [...]If you cannot give birth to a boy, then you too have no work here [in this house]. To run our lineage, the birth of a boy is a must, not these girls.” (In-depth Interview, Madhar Village, Uttar Pradesh, India, age 25)

Another woman stated that:

"Unwillingly I was pregnant with my third child [...] I felt malaise and my in-laws family do not care about me they only wanted my baby, and he must be a boy [...] finally they got. But after that pregnancy, my menstruation periods stopped. Now two years passed away, but my menstruation periods didn’t come yet. My family never accompany me to consult with a doctor.”(In-depth Interview, Chandwak Village, Uttar Pradesh, India, age 25)

Apart from the husband & mother-in-law (MIL) other family members, neighbours and distant relatives also influence the decision of women/couples to induce abortion. One participant said:

“My two elders sisters-in-law suggested me abortion is much better than taking care of a girl child until she may get married” (In-depth Interview, Chandwak Village, India, age 32)

Another woman said:

“I rarely have a discussion with my neighbours [women] about inducing abortion practice during working in a field. We can say that no one individual women want abortion intentionally, her age, status in the family, or the number of children already she has may highly influence her abortion decision”. (Focus Group Discussion, Khalia Khas Village, India, age 28)

In addition, peer friends from the same age group of women have different perceptions regarding abortion. One woman said:

“I talk to my sister who lives in Delhi. She [women’s sister] said to me that abortion is not a crime but to induce abortion in that situation when it is necessary and it is better to use cure such as contraception rather than go for an abortion”. In-depth Interview, Faridpur Village, India, age 23)

Individual Fear, Community Norms and Cultural Practices

The spectrum of fear beliefs, and community stigma affects the individual level to the society level. Individual beliefs and cultural practices are manifestations of societal norms. In rural areas, women who do not have a son are considered as aspersion in society. A woman, who has done clandestine abortion in the past without concern with family members (in-law’s family, including the husband) is seen in a disrespected manner. Beyond describing perception, expectation and socio-cultural reasons for how community members felt about abortion services. In most cases, societal norms override individual beliefs and expectations. In addition, little/ partial knowledge about abortion services makes women scared and opt for abortion services surreptitiously. Generally, women do not know the exact source of information which knowledge is passed through. Women tended to receive information from different sources, such as stories that come from friends and relatives whom they heard from social and community gatherings. Prejudice thoughts and unclear information lead to further complications in further pregnancies. One participant said:

"Abortion is the wrong thing, and community disapprove of it generally.” (Focus Group Discussion, Thunhi Village, Uttar Pradesh, India, age 23)

While during the focus group discussion, one woman said community response retaliates against individual women's abortion-related decisions. She said:

"Society looks differentially... when they [community members] get to know when I had an abortion in the past.”(Focus Group Discussion, Hariharpur village, Uttar Pradesh, India, age 28) In contrast, another woman said:

“When I had an abortion I feel unwell, and my sister-in-law looks me in a very suspicious manner...no one help me in household chores that time I felt like I did a very heinous crime.” (In-depth Interview, Kakrapar village, Uttar Pradesh, India, age 24)

One participant shares her experience as:

“When I got to know that I am five weeks pregnant with my fourth baby... I want to discuss this news firstly with my husband, but he was in Mumbai, and he has no time to hear me then I decided to abort this baby after one week.[...] I took medicine for abortion...but I always have a fear that I did something wrong secretly.” (In-depth Interview, Biribari village, Uttar Pradesh, India, age 27)

Contrarily, one of the respondents from lower-middle-income families said:

“I did abortion. [...] I felt, I did the right thing. [...] Earlier I have fear regarding misconception of infertility, but when I took abortion under the proper guidance of gynaecologist [...] now, it changed my perspective also.”(In-depth Interview, Chandwak Village, Pradesh, India, age 30)

Individual fear and cultural beliefs manifested in women's abortion experiences. A woman who seeks abortion services has different views than those who didn't do it in the past. It means that past abortion-related experiences are incorporated into women’s perspectives. Sometimes it may be changed when an individual woman gets into contact with other social networks. One woman said:

“Prior, I have a fear with the name of the abortion [...] I did not know how other women may get ready for this, but when I choose abortion for the first time then I realise that this is not the wrong thing.” (In-depth Interview, Khaliya Khas Village, Uttar Pradesh, India, age 28)

Another woman stated:

“One of my close friends explained to me that abortion is not a bad thing and it’s not affected the health of the women too [...] even not impact on further pregnancies.” (Focus Group Discussion, Chandwak Village, Uttar Pradesh, India, age 29)

One woman said:

“I do not know when I got pregnant... after my marriage, my periods usually come after two and a half years, and suddenly I got to know that I am pregnant. [...] My mistimed and unwanted pregnancies make me stressed all the time. In the end, I have no option apart from that to opt for an abortion. My family opposed no to do it because it is wrong” (In-depth Interview, Chandwak Village, Uttar Pradesh, India, age 25)

Women's age is also a major concern of social stigma. Women above 30 and below 24 years of age are seen as suspected manner when they obtained an abortion. When newlyweds women have ever faced stigma related to their very first pregnancy. For example, one woman said:

“I never thought, I was pregnant within two months of my marriage. It was shocking news for me, and I did not want to get pregnant so soon. [...] I thought of abortion, but mother-in-law persuades me about abortion of a very first child make me infertile and cause of pregnancy-related complications in future.”(Focus Group Discussion, Faridpur Village, Uttar Pradesh, India, age 23)

In addition, the pressure of family expectations also leads to mistimed and unwanted pregnancy. One woman said:

“I have four girls, and I do not want further any child...but my mother-in-law always pressurised me. [...] I must have one son and told ‘ek aurat apne prajanan kaal khatam hone tak hi bache peda kr sakti hai’ [a woman can only give birth children until the end of her reproductive age] [...]” (In-depth Interview, Kakrapar Village, Uttar Pradesh, India, age 24)

However, another woman said:

“Currently I am 32 years old, and when I got to know that I am pregnant, made me feel so embarrassed. I have to abort this child at any cost because I know that ‘samaj wale kiya kahege mere bare mai’ [what society will talk about me]. My elder child is now 17 years old, what he will think about me that ‘ki yeh koi umar hai bacha peda karne ki’ [Is this the age to give birth to a child]. [...] No no I do not want this will happen to me. Instead, it’s better to abort this child.” (Focus Group Discussion, Chandwak Village, Uttar Pradesh, India, age 32)

It represents how women's decisions related to their reproductive health are governed by social prejudices. Sometimes the decision of abortion took by the woman herself or accompanied by her husband also, but most of the time it is influenced by other family members, neighbours and distinct relatives.

Role of Health Care Services in Abortion

Many of the women reported that they do not know about the abortion service provider in their local village. The social network with close family and friends plays an important role to consult and carry out the abortion process. One woman said:

“I usually share my health-related problems with my childhood friend who lives in my home village, she [friend] suggests to me a doctor far away from my village [in-law’s home village] for seeking an abortion service. [...] I feel uncomfortable and always being in fear of how will my community members react when they get to know about my abortion trajectory.” (In-depth Interview, Biribari Village, Uttar Pradesh, India, age 29)

Another woman from a lower-income family said:

“I live in a joint family and discuss my health-related problem with my sister-in-law. [...] I obtained abortion services from the suggested clinic by her because it is a very private topic, so I usually discussed it with only my sister-in-law.” (In-depth Interview, Chandwak Village, Uttar Pradesh, India, age 27)

It shows that trust-building among close relatives and friends very essential to obtaining abortion-related health care services. Furthermore, the husband and mother-in-law’s family mainly decided to have an abortion and where to seek health care. While many women told us that they preferably discussed abortion-related issues with only close ones because there is a very less chance to disperse information and kept secretly. One woman stated:

“I think, abortion-related issues and problems are very secretive in nature and only to discuss with a very close and trustworthy person who never disclosed to anybody.” (Focus Group Discussion, Chandwak Village, Uttar Pradesh, India, age 26)

Another woman stated:

“I do not know about much of this village because I came here after marriage. I discussed my unwanted pregnancy-related issues with my husband and elder sister-in-law only. She [sister-in-law] suggests abortion and accompanies me to seeking abortion services.” (In-depth Interview, Barmalpur Village, Uttar Pradesh, India, age 30)

Contrary to this, seven women out of thirty-seven never discussed their abortion-related discussions with their in-law's families. One woman said:

“I do not believe in anybody in my in-law’s family. I preferred to seek abortion from my mother’s home.” (In-depth Interview, Khaliya Khas Village, Uttar Pradesh, India, age 28) Another woman said:

“I always wait to go to my mother’s home during any health-related problem because there I can share anything with my mother and close friends without any kind of hesitation.” (Focus Group Discussion, Chandwak Village, Uttar Pradesh, India, age 26)

One woman said:

“If you choose abortion outside the village for the reason of confidentiality, people never get the chance to judge the women. Even if women started getting an abortion in the same village social stigma and cultural practices always hinder them badly.” (Focus Group Discussion, Chandwak Village, Uttar Pradesh, India, age 26)

While 40.5% of women seek abortion services from chemist shops followed by public and private health facilities with 29.7% and 24.3% respectively. The majority of the respondent seeks abortion medicine from chemist shop; there are many reasons which pursued them for seeking abortion through abortion pills (mifepristone and misoprostol). These pills are generally purchased by close family members and friends of women. Generally, women took the pill to seek abortion of unwanted pregnancy without consultation with the doctor due to economic hardship, negligence of family and community participation, social stigma and unmet need for contraception. One of the respondents said:

“I took one medicine that was brought by my husband from a chemist to abort my pregnancy. After my periods stopped, I felt a serious stomachache, we [me and my husband] consulted with the doctor, and after the ultrasound got to know some tissues remain inside my womb. For that my operation happened”.(In-depth Interview, Khaliya Khas Village, Uttar Pradesh, India, age 28)

Another woman from a low-income family said:

"I have to manage all the work in the absence of my husband. He lives mostly time in Mumbai and quarterly sends some amount of money. It is not enough for us to bear and care for another child. During the last visit of my husband, I got pregnant that was an unwanted pregnancy, we both do not want any further children; therefore, my neighbour brought abortion pills for me. After that, I am facing some health-related problems such as headaches, irregular periods and continuous stomachaches. Still, it’s ok for me because we cannot afford the high fees of consultation and doctor.” (In-depth Interview, Khaliya Khas Village, Uttar Pradesh, India, age 28)

One woman faced various challenges due to her unsafe abortion. She said:

"I became pregnant in the same months as my marriage, although the delivery was normal. [...] The very next month, I got my periods again and became pregnant. [...] This time, I do not want to pregnant so soon; therefore, I took medicine for abortion from the clinic and aborted the pregnancy. Within a year of my first child's delivery, I got pregnant once again. This time I could not do anything [...] after delivery of a girl child, I told my husband that uses contraception; otherwise, I will get the sterilisation done. But initially 3-4 months my husband used condoms and later stopped it. Then my periods were missed for two consecutive months I tested and found I again got pregnant this time I retook medicine and aborted. I have faced many health-related problems since then my periods got disturbed, constant backache, continuously white discharge and pain in my lower belly. My husband refused to pay for my treatment. I feel weak, malaise and not able to do household chores properly." (In-depth Interview, Ramdevpur Village, Uttar Pradesh, India, age 27)

In contrast, doctors' and staff's behaviour in both public and private health centres hindered women who want to seek health care. The abusive tone and awkward words of medical staff develop a negative feelings in women. One woman expressed her negative experiences and said:

“It was my first pregnancy in the community health facility centre (CHC). [...] I was in a panic and bore so much pain that time because going to deliver a baby within the next couple of hours. Still, the doctor spoke very violently and said very frightful words to women who go for delivery. [...] It was such a horrible experience for me, and I decided never to go again to that place.” (Focus Group Discussion, Chandwak Village, Uttar Pradesh, India, age 26)

Another woman stated:

“It has happened at both the public and private health centre that medical staff talk in a very rudeness manner with their patients mostly women who come for seeking pregnancy and abortion-related services. The poor women have to bear all these nonsense not just she liked, but his family not affords the cost of private clinics.” (Focus Group Discussion, Chandwak Village, Uttar Pradesh, India, age 30)

One woman said:

“I sought abortion service in a private hospital with my sister-in-law. [...]Doctor asked so many personal questioned that embarrassed me to answer in the front of my sister-in-law.” (In-depth Interview, Madhar Village, Uttar Pradesh, India, age 25)

One woman said:

“I sought for abortion service in a private clinic, but there women staff continuously gossiping about my husband relation and past delivers. [...] It hurts me a lot, and I never go there again.” (Focus Group Discussion, Ramdevpur Village, Uttar Pradesh, India, age 29)

In addition, many social norms against abortion impede women to alter their decision. The medical staffs of both the public and private health facilities try to impose their decisions on women because they are also highly influenced by the social and cultural norms of rural settings. One woman said:

“I fully prepared for sought abortion service and the medical staff said it is wrong and for that, I will have to bear so much pain. I left from there and quit the plan of abortion.” (Focus Group Discussion, Kakrapar Village, Uttar Pradesh, India, age 24)

Another woman said, “After the second pregnancy, I want some time to get again pregnant. [...] Therefore, I consult with the doctor about abortion. [...] But after abortion produces, they [providers] inserted copper-T without my counsel, they lied to me.” (In-depth Interview, Thunhi Village, Uttar Pradesh, India, age 24)

Whereas on the contrary, one woman said, “I thought negative before obtaining abortion services. [...] The treatment procedure was good, and the doctor counselled me before the procedure and gave me one day time to discuss it with family and friends. After treatment doctor suggested contraceptives too." (Focus Group Discussion, Ramdevpur Village, Uttar Pradesh, India, age 29)

One woman who belongs to a low-income family stated:

“I do not want another child. Therefore, my husband and I decided for seeking an abortion. [...] We obtained abortion from a community health centre located at Biribari village. I still remembered that horrifying day; doctors faced complications during my abortion procedure and then immediately they suggested shifting me to Danganj health centre. [...] I will always be thankful to public health facility doctors for their treatment and care.” (In-depth Interview, Chandwak Village, Uttar Pradesh, India, age 29) Many positive experiences never come in front of people, but negative experiences counterpart people's perceptions and expectations.

Besides, several women reported guidance provided by providers instructed them to use the contraception such as condoms, injections and copper-T with details conversations about their pros and cons. In some of the cases, providers ask questions when women have already a child and want no baby within the next one or two years, so why they are not using any contraception method. Many women agreed with the provider’s discussion and engaged in high conservation with providers to get more detailed information. One provider shared her experience:

“She [provider] said I had already four children. During the birth of my fourth child, the doctor suggested the use of contraception, and after the proper counselling doctor inserted copper-T. [...] now I feel comfortable. (In-depth Interview, Faridpur Village, Uttar Pradesh, India, age 29)

The majority of women reported a lack of infrastructure and long queues as other major reasons for women do not give proper attention to their reproductive health; mainly, in a private clinic. While pre-abortion and post-abortion facilities also hindered women from seeking services in public and private healthcare centres. One of the women said:

“I took abortion service from the public ‘community health centre’ but due to the unavailability of a senior doctor, the trainer did my abortion procedure without proper counselling and injected wrongly. [...] Due to their lack of practice, I suffered from a severe health problem, and it took six months to recover. (In-depth Interview, Chandwak Village, Uttar Pradesh, India, age 24)

Another woman who had faced a negative experience in public health centre said:

“After the abortion, they [providers] sterilised me without consulted and counsel. [...] My husband and in-laws always taunt me for my sterilisation.” (Focus Group Discussion, Hariharpur Village, Uttar Pradesh, India, age 30)

The majority of women in this study emphasised to use of abortion medicine from the chemist and also recommends others. Unawareness about contraceptive methods, unfavourable follow-up treatments, misconception about facility providers, fear of judgement and social stigma played a very crucial role while women seek abortion services from different facility centres.

The present qualitative study attempts to examine the knowledge, attitude, social norms and practices that related to abortion practices that shape sexual and reproductive health status among young married women in rural Uttar Pradesh, India. The dynamics of reproductive health outcome represents a multi-layered context in the field of population health studies. The present study has focused on rural women of Uttar Pradesh, as they continually being impeded to access reproductive health services mainly, safe abortion services compared with their urban counterparts. The study sampled comprised of currently married women between 18–40 years of age group. The proportion to access safe and affordable abortion continues to be a challenge for women when it turns into severe to critical and ended with maternal deaths. Few studies examine both individual women and community-level perspectives that can lead to women’s perceptions, experiences and expectations while community and peer friends' decisions influence induce unsafe abortions. The current study also illustrated some noteworthy differences in opinion among young women to induce abortion and tried to critically understand the relationship between the reproductive health of women and abortion trajectories. The main focus of the study was to analyse the difference in responses due to changing individual circumstances, variations in community norms and cultural practices that affect the decision making of abortion in a rural setting. This study found women have a negative impression of abortion in rural areas in India [15]–[17] women feel guilt and self-judged while thinking to obtain an abortion. The decision of abortion is under the control of domestic authorities, mainly husbands and in-laws, rather than allowing individual women to exercise their reproductive rights [18]. The finding of this study illustrates the struggle of women in rural villages related to poor reproductive health, poverty, lack of autonomy and unsafe abortion practice. This qualitative data also help to analyse implication for programming and policy.

Findings highlight responses based on data collected from in-depth interviews and focus group discussions. For example, at one moment women said abortion is an immoral and illegal practice, and husband and family permission should require before obtaining it. At another moment, abortion should be a reproductive right of women. In the focus groups, women were highly influenced by prejudice set by society about abortion and tended to be 'morally and socially correct' [19]. However, in-depth interview responses affirmed seeking abortion and favour having an abortion as a reproductive right.

The number of abortions performed depends upon unintended pregnancies which are directly associated with the unmet need for contraception [20]. However, access to affordable contraception is considered a matter of great concern for poor women [21], [22]. As the desire for a son increases the number of unintended pregnancies also increased and resulted in unsafe abortions [23], [24]. One of the most reassuring aspects of the findings is the status of women being decided by having a son and this desire for a son has not stopped with having only one son but more the number the better the status of women in both family and society. Indeed, husbands and in-laws continuously persuaded women for having more sons rather than daughters in the family. Data revealed the desire for a son was the prominent cause of sex-selective abortion that is mainly conducted in a secretive manner in rural areas. Women's illiteracy, low standard of living, a higher number of son preferences and sex-selective abortion are positively associated with inducing abortion and post-abortion related complications [25]–[27]. Whereas, reproductive health complications increase the financial burden on the family and led to poverty risk [28]. However, the gap was not so wide between the rich and poor to seek abortion services but to deal with abortion-related consequences, the primary concern of this research. Studies show that the socio-economic status of the family assessed the linkages with the following indicators such as the utilisation of and access to safe abortion services, post-abortion complications and maternal mortality and morbidity [29]–[31].

The findings from this research also highlight the social norms and stigma, which positively contributed to a low expectation among women seeking abortion services. However, women's age and marital status were amplified by community judgement, therefore, women gave greater importance to clandestine abortion while choosing abortion services and contributed to access to lower quality healthcare [32]. Besides, this study also clearly brings out that most women have fear and felt stigmatised when they shared their abortion trajectories with their peers and friends who reside within same the in-laws family. This study also illustrated that women social circles comprised of few women friends and mainly belonged to their maternal place.

This study also highlights the role of abortion service providers because most of the women preferred to obtain services from an outer periphery of the village rather than take turns from a nearby clinic or chemist. After all, women have not only fear speaking with the known person in the reception but are mistrusted, denied care, mistreated and reported to law enforcement always resulting in social stigma encountered by young women seeking abortion [11], [12]. Notably, most of the women preferred to obtain abortion services from chemist shops [33] rather than utilised services from public and private clinic facilities centres. The mistreated behaviours of the medical staff and providers were the leading cause for not seeking assistance from the public and private facility centres. Many women induce abortion at home using medication from a chemist shop and without any formal visit to a doctor’s consultation which resulted in serious abortion complications [34], [35]. The low level of awareness about medical procedures among most health care providers leads to unsafe abortion among young married women [19], [31], [36]. The negative experiences about abortion services providers not only enforce women to seek services from informal grounds but also emphasised them to take their reproductive health issues for granted.

Limitations of the Study

The present study adds to the literature on comparative analysis between individual women and community-level perspectives by dealing with abortion-related constraints, challenges and perceptions based on focus group discussion with personal knowledge, attitude and expectation of their past abortion trajectories through in-depth interviews. Three significant limitations need to help conduct future research. First, the sample of interviews in this study comprised focus group discussions and in-depth interviews with women. At the same time, abortion service providers' comments can help to enrich the result of future research such as primary health workers, doctors, staff and chemist shop owners. Second, the limited sample size is a challenge to trace the response from broader perspectives. Third, the husband and mother-in-law responses related to decision making of abortion play an essential role in the pursuit of women's reproductive decisions; therefore, incorporation of husband and mother-in-law responses helps to design future training and service delivery programmes.

It was observed that a woman's knowledge, attitude, experience, and access to family planning methods directly affect abortion-related decisions, especially when a woman never experienced abortion in the past. The role of the husband, mother-in-law (MIL), other family members, neighbours and other distant relatives were important agents of abortion-related decisions. Social norms, stigma and cultural practices negatively affect women's reproductive health; hence efforts should continue to provide women and child health-related awareness using different modes of communication such as television, radio, banners and campaigns. For both women and child health care, the role of health workers is very crucial as it is observed that women highly rely on them for primary health care services. Most of the marginalized lower-class women were highly vulnerable to access abortion-related services; hence public policies and interventions should focus on these targeted populations first. To sum up, we suggested that both public and private facility centres should also be engaged to provide proper counselling care for their abortion and contraception services. Providers should focus on participant responses that would be kept confidential to ensure to build the trust between women and abortion service providers.

CHC: Community Health Centre

DHS: Demographic health survey

FGD: Focus Group Discussion

MIL: mother-in-law

RH: Reproductive Health

SDG: Sustainable Development Goal

Ethics approval and consent to participate

The ethical approval for the primary data collection as part of a doctoral dissertation was obtained from the Board of Research Studies, Faculty of Social Sciences, University of Delhi, India. All methods were performed in accordance with relevant guidelines and regulations. The participants gave both oral and written informed consent to participate.

Consent for publication: Not applicable

Availability of data and materials

The transcripts of this qualitative research that support the finding of this research are not available in public domain due to the data privacy and consent issue of participants. However, supplementary data may be provided from the corresponding author through reasonable request.

Competing interests:Not applicable

Funding: No direct financial support or funding was obtained to conduct this study.

Authors' contributions: PT, PKP and KB conceptualized and designed the study. PT collected and analysed the data. PT wrote the first draft of the manuscript. PT, PKP and KB contributed to reviewing and editing of the manuscript and read and approved the final version of the manuscript for submission.

Acknowledgements: We would like to thank the Department of Geography, Delhi School of Economics, University of Delhi for approving the study and providing the opportunity to conduct the study. Authors also extends deep regards to all the study participants for their valuable time and information for the study.

M. Yazdkhasti, A. Pourreza, A. Pirak, and F. Abdi, “Unintended Pregnancy and Its Adverse Social and Economic Consequences on Health System: A Narrative Review Article,” Iran. J. Public Health, vol. 44, no. 1, pp. 12–21, Jan. 2015, Accessed: May 31, 2020. [Online]. Available: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4449999/
S. Kosgi, V. Hegde N, S. Rao, S. B. Undaru, and N. B. Pai, “Women reproductive rights in India: prospective future,” Online J. Health Allied Sci., vol. 10, no. 1, p. 7, 2011.
Z. Sathar, C. Callum, and Jejeebhoy, “Gender, region, religion and reproductive behavior in India and Pakistan,” ResearchGate, 2001. https://www.researchgate.net/publication/239915125_Gender_region_religion_and_reproductive_behavior_in_India_and_Pakistan (accessed Feb. 14, 2019).
W. Rosa, Ed., “Transforming Our World: The 2030 Agenda for Sustainable Development,” in A New Era in Global Health, New York, NY: Springer Publishing Company, 2017. doi: 10.1891/9780826190123.ap02.
D. S. Sharma, “Reproductive Rights and Women’s Health: a New Prospective,” Int. J. Humanit. Soc. Sci. Invent., vol. 4, no. 4, p. 6, 2015.
United Nations, Abortion policies and reproductive health around the world. UN, 2014. doi: 10.18356/3fc03b26-en.
G. Sedgh et al., “Abortion incidence between 1990 and 2014: global, regional, and subregional levels and trends,” The Lancet, vol. 388, no. 10041, pp. 258–267, Jul. 2016, doi: 10.1016/S0140-6736(16)30380-4.
S. Singh, L. Remez, G. Sedgh, L. Kwok, and T. Onda, “Abortion Worldwide 2017: Uneven Progress and Unequal Access,” Guttmacher Institute, New York, 2018. Accessed: May 31, 2020. [Online]. Available: https://www.guttmacher.org/sites/default/files/report_pdf/abortion-worldwide-2017.pdf
“MTP ACT, 1971 | Ministry of Health and Family Welfare | GOI.” https://main.mohfw.gov.in/acts-rules-and-standards-health-sector/acts/mtp-act-1971 (accessed May 30, 2020).
S. Singh et al., “Abortion and Unintended Pregnancy in Six Indian States: Findings and Implications for Policies and Programs,” N. Y. Guttmacher Inst., p. 32, 2018, [Online]. Available: https://doi.org/10.1363/2018.30009
K. Cockrill, B. Heroldum, U. Upadhyay, B. Sarah, K. Blanchard, and D. Grossman, “Addressing Abortion Stigma Through Service Delivery,” White Pap. Retrieved Sea Change Program Ibis Reprod. Health ANSIRH INROADS, p. 29, 2013, doi: 10.1016/S0968- 8080(08)31396–2.
S. Makleff et al., “Exploring stigma and social norms in women’s abortion experiences and their expectations of care,” Sex. Reprod. Health Matters, vol. 27, no. 3, pp. 50–64, Nov. 2019, doi: 10.1080/26410397.2019.1661753.
P. Achyut et al., “Impact evaluation of the Urban Health Initiative in urban Uttar Pradesh, India,” Contraception, vol. 93, no. 6, pp. 519–525, Jun. 2016, doi: 10.1016/j.contraception.2016.02.031.
M. J. Mafuyai, A. Emmanuel, S. M. Gimba, A. B. Barry, and A. Obadiah, “Perception and Practice of Family Planning among Rural Women in North Central Nigeria,” Cont. J Med. Res., vol. 8, no. 1, pp. 14–19, 2014, doi: https://doi.org/10.5707/cjmedres.2014.8.1.14.19.
S. K. Banerjee, K. L. Andersen, R. M. Buchanan, and J. Warvadekar, “Woman-centered research on access to safe abortion services and implications for behavioral change communication interventions: a cross-sectional study of women in Bihar and Jharkhand, India,” BMC Public Health, vol. 12, no. 1, p. 175, Dec. 2012, doi: 10.1186/1471-2458-12-175.
B. Ganatra and S. K. Banerjee, “Expanding Community-Based Access to Medical Abortion in Jharkhand: A pre-intervention baseline survey in selected two blocks of Ranchi and Khunti districts.,” Ipas India, 2010, [Online]. Available: https://www.academia.edu/14028247
R. Duggal and V. Ramachandran, “The Abortion Assessment Project—India: Key Findings and Recommendations,” Reprod. Health Matters, vol. 12, no. sup24, pp. 122–129, Jan. 2004, doi: 10.1016/S0968-8080(04)24009-5.
M. Paul, B. Essén, S. Sariola, S. Iyengar, S. Soni, and M. Klingberg Allvin, “Negotiating Collective and Individual Agency: A Qualitative Study of Young Women’s Reproductive Health in Rural India,” Qual. Health Res., vol. 27, no. 3, pp. 311–324, Feb. 2017, doi: 10.1177/1049732315613038.
M. Gupte, S. Bandewar, and H. Pisal, “Abortion needs of women in India: A case study of rural Maharashtra,” Reprod. Health Matters, vol. 5, no. 9, pp. 77–86, 1997, doi: 10.1016/S0968-8080(97)90008-2.
K. Ranjana and Y. Awdhesh, “Role of Gender in Contraceptive Use among Currently Married Women in Uttar Pradesh and Bihar,” p. 12, 2012.
A. Thomas and E. Monea, “The High Cost of Unintended Pregnancy,” CCF Brief 45, p. 6, 2011.
T. K. S. Ravindran and U. S. Mishra, “Unmet need for reproductive health in India,” Reprod. Health Matters, vol. 9, no. 18, pp. 105–113, Jan. 2001, doi: 10.1016/S0968-8080(01)90097-7.
P. Potdar, A. Barua, S. Dalvie, and A. Pawar, “‘If a woman has even one daughter, I refuse to perform the abortion’: Sex determination and safe abortion in India,” Reprod. Health Matters, vol. 23, no. 45, pp. 114–125, Jan. 2015, doi: 10.1016/j.rhm.2015.06.003.
S. M. George, “Sex Selection/Determination in India: Contemporary Developments,” Reprod. Health Matters, vol. 10, no. 19, pp. 190–192, Jan. 2002, doi: 10.1016/S0968-8080(02)00034-4.
R. Yokoe, R. Rowe, S. S. Choudhury, A. Rani, F. Zahir, and M. Nair, “Unsafe abortion and abortion-related death among 1.8 million women in India,” BMJ Glob. Health, vol. 4, no. 3, May 2019, doi: 10.1136/bmjgh-2019-001491.
S. Pallikadavath and R. W. Stones, “Maternal and social factors associated with abortion in India: a population-based study,” Int. Fam. Plan. Perspect., vol. 32, no. 3, pp. 120–125, Sep. 2006, Accessed: Jun. 29, 2020. [Online]. Available: http://search.ebscohost.com/login.aspx?direct=true&db=cmedm&AN=17015241&site=eds-live&scope=site
A. Kaddour, R. Hafez, and H. Zurayk, “Women’s Perceptions of Reproductive Health in Three Communities around Beirut, Lebanon,” Reprod. Health Matters, vol. 13, no. 25, pp. 34–42, Jan. 2005, doi: 10.1016/S0968-8080(05)25170-4.
R. Prakash, A. Singh, P. K. Pathak, and S. Parasuraman, “Early marriage, poor reproductive health status of mother and child well-being in India,” J. Fam. Plann. Reprod. Health Care, vol. 37, no. 3, pp. 136–145, Jul. 2011, doi: 10.1136/jfprhc-2011-0080.
S. K. Banerjee, R. Kumar, J. Warvadekar, V. Manning, and K. L. Andersen, “An exploration of the socio-economic profile of women and costs of receiving abortion services at public health facilities of Madhya Pradesh, India,” BMC Health Serv. Res., vol. 17, no. 1, p. 223, Mar. 2017, doi: 10.1186/s12913-017-2159-6.
L. Sanneving, N. Trygg, D. Saxena, D. Mavalankar, and S. Thomsen, “Inequity in India: the case of maternal and reproductive health,” Glob. Health Action, vol. 6, no. 1, p. 19145, Dec. 2013, doi: 10.3402/gha.v6i0.19145.
A. Tamang and J. Tamang, “Availability and Acceptability of Medical Abortion in Nepal: Health Care Providers’ Perspectives,” Reprod. Health Matters, vol. 13, no. 26, pp. 110–119, Jan. 2005, doi: 10.1016/S0968-8080(05)26194-3.
S. J. Jejeebhoy, S. Kalyanwala, A. J. F. Zavier, R. Kumar, and N. Jha, “Experience seeking abortion among unmarried young women in Bihar and Jharkhand, India: delays and disadvantages,” Reprod. Health Matters, vol. 18, no. 35, pp. 163–174, Jan. 2010, doi: 10.1016/S0968-8080(10)35504-2.
B. Ganatra, V. Manning, and S. P. Pallipamulla, “Availability of Medical Abortion Pills and the Role of Chemists: A Study from Bihar and Jharkhand, India,” Reprod. Health Matters, vol. 13, no. 26, pp. 65–74, Jan. 2005, doi: 10.1016/S0968-8080(05)26215-8.
C. Ellertson, B. Elul, and B. Winikoff, “Can women use medical abortion without medical supervision?,” Reprod. Health Matters, vol. 5, no. 9, pp. 149–161, Jan. 1997, doi: 10.1016/S0968-8080(97)90019-7.
L. Ramachandar and P. J. Pelto, “Medical Abortion in Rural Tamil Nadu, South India: A Quiet Transformation,” Reprod. Health Matters, vol. 13, no. 26, pp. 54–64, Jan. 2005, doi: 10.1016/S0968-8080(05)26195-5.
L. M. Calhoun et al., “Provider imposed restrictions to clients’ access to family planning in urban Uttar Pradesh, India: a mixed methods study,” BMC Health Serv. Res., vol. 13, no. 1, Dec. 2013, doi: 10.1186/1472-6963-13-532.

No competing interests reported.

Download PDF

Version 1

posted

You are reading this latest preprint version

Controlling minds and bodies: understanding socio-cultural barriers related to induced abortion and reproductive health among married women in Rural Uttar Pradesh, India

Status:

Version 1

Abstract

Background

Objective

Method

Result

Conclusion

Figures

Background

Methods

Results

Discussion

Limitations of the Study

Conclusions

Abbreviations

Declarations

References

Additional Declarations

Status:

Version 1