Can community health workers play a greater role in increasing access to medical abortion services? A qualitative study

BMC Women's Health

Research Article

Sharad D. Iyengar¹  Pallavi Gupta¹  Kirti Iyengar²  Heidi Bart Johnston³  Bela Ganatra⁴ 

[1] Action Research & Training for Health (ARTH), Satyam, Ramgiri, Badgaon, 313011, Udaipur, Rajasthan, India;Action Research & Training for Health (ARTH), Satyam, Ramgiri, Badgaon, 313011, Udaipur, Rajasthan, India;Department of Women’s and Children’s Health, Karolinska Institutet, WHO collaborating Centre, Karolinska University Hospital, SE-17176, Stockholm, Sweden;Swiss Tropical and Public Health Institute, P.O. Box 4002, Socinstrasse 57, Basel, Switzerland;UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, 20 Avenue Appia, 1211, Geneva-27, Switzerland;

关键词: India;    Medical abortion;    Community health workers;    Post-a bortion complication;    Sterilisation;   

DOI  :  10.1186/s12905-017-0391-1

 received in 2016-07-25, accepted in 2017-05-11,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundDespite being legally available in India since 1971, barriers to safe and legal abortion remain, and unsafe and/or illegal abortion continues to be a problem. Community health workers have been involved in improving access to health information and care for maternal and child health in resource poor settings, but their role in facilitating accurate information about and access to safe abortion has been relatively unexplored. A qualitative study was conducted in Rajasthan, India to study acceptability, perspectives and preferences of women and community health workers, regarding the involvement of community health workers in medical abortion referrals.MethodsIn-depth interviews were conducted with 24 women seeking early medical abortion at legal abortion facilities or presenting at these facilities for a follow-up assessment after medical abortion. Ten community health workers who were trained to assess eligibility for early medical abortion and/or to assess whether women needed a follow-up visit after early medical abortion were also interviewed. The transcripts were coded using ATLAS-ti 7 (version 7.1.4) in the local language and reports were generated for all the codes, emerging themes were identified and the findings were analysed.ResultsCommunity health workers (CHWs) were willing to play a role in assessing eligibility for medical abortion and in identifying women who are in need of follow-up care after early medical abortion, when provided with appropriate training, regular supplies and job aids. Women however had apprehensions about contacting CHWs in relation to abortions. Important barriers that prevented women from seeking information and assistance from community health workers were fear of breach of confidentiality and a perception that they would be pressurised to undergo sterilisation.ConclusionsOur findings support a potential for greater role of CHWs in making safe abortion information and services accessible to women, while highlighting the need to address women’s concerns about approaching CHWs in case of unwanted pregnancy. Further intervention research would be needed to shed light on the effectiveness of role of CHWs in facilitating access to safe abortion and to outline specific components in a programme setting.Trial registrationNot applicable.

【 授权许可】

CC BY   
© The Author(s). 2017