title: Medical students are afraid to include abortion in their future practices: in-depth interviews in Maharastra, India.
abstract: BACKGROUND
  Unsafe abortions are estimated to cause eight per-cent of maternal mortality in India. Lack of providers, especially in rural areas, is one reason unsafe abortions take place despite decades of legal abortion. Education and training in reproductive health services has been shown to influence attitudes and increase chances that medical students will provide abortion care services in their future practice. To further explore previous findings about poor attitudes toward abortion among medical students in Maharastra, India, we conducted in-depth interviews with medical students in their final year of education.
  
  
  METHODS
  We used a qualitative design conducting in-depth interviews with twenty-three medical students in Maharastra applying a topic guide. Data was organized using thematic analysis with an inductive approach.
  
  
  RESULTS
  The participants described a fear to provide abortion in their future practice. They lacked understanding of the law and confused the legal regulation of abortion with the law governing gender biased sex selection, and concluded that abortion is illegal in Maharastra. The interviewed medical students' attitudes were supported by their experiences and perceptions from the clinical setting as well as traditions and norms in society. Medical abortion using mifepristone and misoprostol was believed to be unsafe and prohibited in Maharastra. The students perceived that nurse-midwives were knowledgeable in Sexual and Reproductive Health and many found that they could be trained to perform abortions in the future.
  
  
  CONCLUSIONS
  To increase chances that medical students in Maharastra will perform abortion care services in their future practice, it is important to strengthen their confidence and knowledge through improved medical education including value clarification and clinical training.
authors.affiliation: Division of Obstetrics and Gynecology, Department of Women's and Children's Health, Karolinska Institutet, 171 76, Stockholm, Sweden. susanne.sjostrom@ki.se.|Department of Women's and Children's Health/, International Maternal and Child Health, Uppsala University, 751 85, Uppsala, Sweden. susanne.sjostrom@ki.se.
authors.forename: Susanne
authors.initials: S
authors.lastname: Sjöström
authors.affiliation: Department of Women's and Children's Health/, International Maternal and Child Health, Uppsala University, 751 85, Uppsala, Sweden.
authors.forename: Birgitta
authors.initials: B
authors.lastname: Essén
authors.affiliation: Division of Obstetrics and Gynecology, Department of Women's and Children's Health, Karolinska Institutet, 171 76, Stockholm, Sweden.
authors.forename: Kristina
authors.initials: K
authors.lastname: Gemzell-Danielsson
authors.affiliation: Division of Obstetrics and Gynecology, Department of Women's and Children's Health, Karolinska Institutet, 171 76, Stockholm, Sweden.|Department of Women's and Children's Health/, International Maternal and Child Health, Uppsala University, 751 85, Uppsala, Sweden.|School of Health and Social Sciences, Dalarna University, 791 88, Falun, Sweden.
authors.forename: Marie
authors.initials: M
authors.lastname: Klingberg-Allvin
mesh_terms: D000028:Abortion, Induced / Q000193:education* / Q000523:psychology*; D000328:Adult; D001291:Attitude of Health Personnel; D002321:Career Choice; D003466:Cultural Characteristics; D004504:Education, Medical, Undergraduate / Q000379:methods*; D005239:Fear / Q000523:psychology*; D005260:Female; D006801:Humans; D007194:India; D007407:Interviews as Topic; D008297:Male; D018570:Risk Assessment; D013337:Students, Medical / Q000523:psychology*; D055815:Young Adult