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Objectives
Despite abortion being legal in India since 1971, the rate of abortion complications
remains high. This high rate of complications has been attributed, at least in part,
to abortions occurring outside of the legal facility-based system. We assessed the
association between self-managed abortion and abortion complications among women in
India.
Methods
This is a cross-sectional analysis among women in India who participated in the National
Family Health Survey (NFHS-4) of 2015–2016. We used two multivariable binomial logistic
regression models to assess the association between self-managed abortion and abortion-related
complications (with and without gestational age as a covariate).
Results
Of the 1,027 pregnancies that ended in abortion, 332 (32%) were reported as self-managed.
After adjusting for age, parity, having a living son, caste, intimate partner violence,
education and income, self-managed abortion was associated with fewer abortion-related
complications than clinician-managed abortions (adjusted OR (aOR), 0.53; 95% CI, 0.31–0.92).
The trend remained but the difference was no longer statistically significant after
further adjusting for gestational age at the time of abortion (aOR, 0.63; 95% CI,
0.36–1.10).
Conclusions
After we adjusted for gestational age, self-managed and clinician-managed abortion
in India had similar complication rates. Women who self-manage abortion likely use
safe methods, such as misoprostol with or without mifepristone, and face fewer barriers
in accessing care resulting in abortion access at an earlier gestational age, which
decreases risk of complications. These findings highlight the importance of self-managed
abortion as an affordable, safe and private option.
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Copyright
© 2022 Published by Elsevier Inc.
