Exploring the pathways of unsafe abortion in Madhya Pradesh, India.

Nearly 40 years after enactment of the Medical Termination of Pregnancy Act of 1971, unsafe abortion continues to be a neglected women's health issue in India. This prospective study of women presenting for post-abortion care in 10 selected hospitals in Madhya Pradesh, India, aimed to understand the incidence, types and severity of post-abortion complications, probable causes of complications and consequences to women in terms of hospitalisation and incurred costs. Among 1565 women presenting for induced abortion-related services between July and November 2007, 381 women with post-abortion complications consented to participate. Data reveal a high prevalence of post-abortion complications (29%). Approximately half of women originally attempted to induce abortion at home using medication, home-made concoctions or traditional methods. Ninety percent sought care from either qualified (37%) or unqualified providers. More than half of the women were hospitalised as a result of post-abortion complications. This study suggests that supporting access to safely induced abortion services and improving community awareness on legal aspects, safe methods and approved providers are all necessary to reduce morbidity associated with unsafe abortion.