Self-managed abortion in India

While India has a relatively permissive legal framework towards abortion, facility-based care remains inaccessible or undesirable for many abortion seekers. An estimated 73% of abortions in India are self-managed using abortion medication (SMA). Since 2019, Ibis has partnered with the Family Planning Association of India (FPAI), the Rural Women’s Social Education Centre (RUWSEC), and Sanitation and Health Rights in India (SHRI) on qualitative and quantitative studies to document self-managed abortion experiences and develop a self-report tool to more accurately and appropriately measure and categorize abortion-related outcomes, including experiences with complications.

Our qualitative study with people who had self-managed abortions, their family support networks, and different cadres of abortion providers documented a range of barriers to high-quality SMA experiences. One critical barrier was that those self-managing their abortions often took the medication with either insufficient or inaccurate information about their medication regimens, what physical symptoms to expect, and how to detect warning signs of potential complications. Participants also encountered stigma from their community for having an abortion and from providers about their decision to self-manage. We documented potential opportunities for strengthening support and information-provision where those self-managing their abortions were already seeking information, specifically through family and social networks as well as community health workers.

The quantitative study pilot tested a self-report questionnaire which aimed to capture outcomes from medication abortion (MA). We also sought to better understand MA users’ expectations around bleeding, cramping, and experiences of other side effects as well as their desires and reasons for care-seeking. In this study, we report and compare the experiences of clients who sought a medication abortion from an FPAI clinic with those who sought post-abortion care from the FPAI clinic after self-managing their abortion between January 2022 – June 2022. The study found those who self-managed their abortion did not receive enough information about what to expect during the abortion process, how to prepare for and manage side effects, or how to identify potential warning signs and complications. Findings also indicate that people commonly seek care to confirm the process is complete and due to concerns about bleeding, rather than due to true medical complications.

Based on the findings from these studies, Ibis partnered with Agents of Ishq to design several resources to fill critical information gaps identified in the study and to normalize self-managed medication abortion experiences. These tools were designed to be shared digitally as well as in-person. We are continuing to work with RUWSEC and Agents of Ishq to develop and iteratively test a user-centered tool for community health workers to use when providing information and support on medication abortion and post-abortion care.

Ibis has also partnered with Vikalp Sansthan, a feminist grassroots organization supporting domestic violence survivors in India based in Rajasthan, to expand their domestic violence hotline system to include a case management system for self-managed abortion support. The phone service was updated to provide structured information on abortion, family planning, and other sexual and reproductive health topics.

Resources for community members:

Experiences self-managing an abortion using medication in India study brief in English and Tamil

Dreams, Fears and Friendship: A Story about Abortion-and Love comic in English and Hindi

Me, My M.I.L and My Abortion comic in English and Hindi

The Easy-Peasy AOI x Ibis Guide To Using Abortion Pills guide in English and Hindi

Resources for healthcare providers:

Experiences self-managing an abortion using medication in India study brief in English and Tamil