“Everything turned out well”: Women’s perspectives on medical abortion

Dr. Bela GanatraSr. Research & Policy Advisor

Expanding Access to Medical Abortion: Building on Two Decades of Experience; Lisbon, Portugal; March 2-4, 2010

Women who have not used MA

Women’s groups

Whose perspectives?

Clinical trials –choice; acceptability; satisfaction.

Few studies with in-depth interviews

Women’s groups• Do not always see it as promoting

autonomy or choice• E.g. in India

oConcern about promoting lack of responsibility of health systems; women not having access to care for complications;

oConcern over bleeding when many women anemic

oConcern over tablets being used to promote population control

Women’s needs ..context is everything

LOW HIGHMedical safety ConfidentialityEffectiveness Cost; Pain control Minimal

disruptionInformation quick

outcome

LEGAL, SOCIAL & ECONOMIC VULNERABILITY

Costs increase, providers restrict use in low literacy women, women seek care later

Self medication; Unsafe providers, alternative drugs

Abortion with ‘medicines’ not new

• “Relative” cost • Perceptions on effectiveness,

safety• Strong tablets (like anti-

cancer like drugs); ‘foreign tablets’; greater fear of incomplete abortion;

• chewable tablets less effective than those swallowed

• Expectation that multiple hospital visits should not be required.

contracept

ion

Herbs/home remedies

Tablets /injection

s –chemist/l

ocal provider

Hospital

/surgery

Ganatra, Manning et al 2005; Ongoing Ipas pilot in Bihar/ Jharkhand ; India

Clinic experience:• Data from a qualitative study in two urban

Indian clinics • Choice:

o Often negative ( avoid pain, avoid surgery; avoid anesthesia);

o Sometimes positive (feels natural, allows more privacy, cost)

o Provider influence high –expectation that provider makes the choice

• Underlying nuances reflect reality of their life and real meaning to ‘choice’

Ipas/ Pop Council study: Ganatra, Kalyanwala et al 2009

What determined the MA experience?

Provider driven expectations

Good counselling v/s anxiety inducing

dependence

Ipas/ Pop Council study: Ganatra, Kalyanwala et al 2009

• ‘The doctor called us and gave us care and medicine. We liked this a lot. The doctor asked me whether I had a lot of pain. At any other place maybe you wouldn't get so much care but here the doctor gave really good care’

• ‘He supported me. He insisted that I eat on time and suggested that we ask the doctor about weakness and for a prescription for [pain] medication’

• ‘He told me to go to my mother’s place for 15 days. He was quite understanding’

Ipas/ Pop Council study: Ganatra, Kalyanwala et al 2009

Outcome

• I thought, I hoped I am not in those 10 percent (of failure cases). I was just praying to God all these days that I hope I am in that 90 percent”.

• “The toilet is public toilet on the ground floor. Family members are often there. There are no lights in the toilet. I brought a candle when I went to the toilet but checking (the expulsion) is difficult”.

Ipas/ Pop Council study: Ganatra, Kalyanwala et al 2009

• Madam told me to wait until 4:30 pm for my abortion to take place. I didn't have my abortion by 4:30 pm so I went home. The next day I had bleeding and the day after, it came out. I kept it. I kept it in a carry bag. . .on a pad inside the carry bag. It was whitish and pinkish in color. Two days later, I went back to the hospital and showed it. Only then I knew.

• “I was told something red would come out but only a white knot came out of this size. Did I abort? I don’t know? ”

Lessons learned

• Balance between too much and too little information; • Decrease anxiety by ensuring that information about

normal variations is conveyed and understood• Ensure that information and communications materials

allow for individual context• Even in the clinic setting provider control can be reduced• Role of the ‘provider’ or service as “support” is

important in overcoming isolation / stigma etc. • More options of methods and of options within the

method (routes, home based; follow up options the better) more likely to meet needs

“Everything has turned out well. What else matters? I will definitely use this

method again”. • Power dynamics, gender inequalities,

lack of autonomy and choice get mirrored in the way MA is perceived / used as well

• Technology or pills (even MA!!) are not the magic bullet …it’s the empowerment that is

Visit us online atwww.ipas.org/medicalabortion

or write tomedicalabortion@ipas.org