New Delhi: Maternal mortality, which primarily impacts developing countries, reflects the health divide between rich and poor. Reducing maternal deaths requires strengthening maternal health services, including comprehensive abortion care (CAC), by ensuring the presence of qualified staff and increasing the use of public sector facilities by women. The State of Madhya Pradesh is one among six states with significantly higher Maternal Mortality Ratio (MMR) than the national average (221 compared to 167 deaths per 100,000 live births). Madhya Pradesh is one of India’s largest states with a population of 73.34 Million people and about three-fourths of them living in rural areas.
In 2006, the state government of Madhya Pradesh with technical support from Ipas Development Foundation (IDF) began a concerted effort to ensure access to CAC services at all levels of public health facilities, including primary, secondary and tertiary level facilities. Key IDF interventions include working closely with the State Government to train doctors, orient nursing staff, liaison with state and district officials for facilitating the availability of essential equipment and drugs, as well as establishing site signage (poster or wall sign) on the availability of CAC services. The primary goal of this ongoing intervention is to ensure access to free of cost, safe and early CAC services for women, especially poor women.
An in-depth study undertaken by IDF recently published in The BMC Health Services Research (BioMed Central) journal explored the socio-economic profile of women accessing CAC services at different levels of public health facilities in rural and urban Madhya Pradesh. This study specifically examines 1) if public sector facilities are offering CAC services to women, 2) socio- economic profile of women varied by type of public sector facilities, and 3) if women incurred any out-of-pocket cost (indirect) to access services in terms of transportation, food, clinical examination, and medicines.
A total of 1036 women presenting to 19 randomly selected facilities for induced abortion and post-abortion care, provided informed consent, were interviewed between May and December 2014. Seventy-two percent (n = 742) of respondents were interviewed at selected primary level health facilities (primary and community health centers) and 28% were interviewed at secondary level hospitals (including sub-district and district hospitals).