title: Abortion providers and safety of abortion: a community-based study in a rural district of Tamil Nadu, India.
abstract: This paper reports on a community-based study in 2001-02 in a rural district of Tamil Nadu, India, among 97 women who had had recent abortions, to examine their decision-making processes, the types of facility they attended and the extent of post-abortion complications they experienced. The 36 facilities they attended, both government and private, were ranked by 18 village health nurses, acting as key informants, as regards safety and quality of care. Three categories qualified and safe, intermediate or unqualified and unsafe - were identified. Most of the providers were medically trained, and 75 of the 97 women went to facilities that were ranked as high or intermediate in quality. Government abortion services were mostly ranked intermediate in quality, and criticised by both women and village health nurses. There has been a substantial decrease in the numbers of traditional and unqualified providers. However, about 30% of the women experienced moderate to serious post-abortion complications, including women who went to facilities ranked high. We recommend that government facilities, both the district hospital and primary health centres, should improve their quality of care, that unqualified providers should be stopped from practising, and that all providers should be using the safer methods of vacuum aspiration and medical methods to reduce post-abortion complications.
authors.affiliation: Recently completed PhD, Key Centre for Women's Health in Society, University of Melbourne, Melbourne, Australia. lakshmir99@yahoo.com
authors.forename: Lakshmi
authors.initials: L
authors.lastname: Ramachandar
authors.forename: Pertti J
authors.initials: PJ
authors.lastname: Pelto
mesh_terms: D000028:Abortion, Induced / Q000009:adverse effects*; D005260:Female; D006282:Health Personnel; D006801:Humans; D007194:India; D011247:Pregnancy; D011361:Professional Competence; D011787:Quality of Health Care; D012424:Rural Population; D012449:Safety