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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.
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).
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).
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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