Supporting self-managed abortion care in “practice not premise”: Provider perspectives, roles, and referral pathways in India
Presenter Biography
Laura Jacobson is a PhD candidate in health system and policy and her research focuses on abortion quality of care, medication abortion self-use, and health system accountability. In addition, Laura supports abortion research activities as a consultant with Ibis Reproductive Health and the World Health Organization.
Institution
OHSU
Program/Major
Health Systems and policy
Degree
PhD
Presentation Type
Poster
Start Date
4-4-2024 1:00 PM
Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.
Keywords
Abortion, self-managed abortion, pharmacy, referrals, quality of care
Abstract
Objective: Describe provider perspectives and roles in self-managed abortion (SMA) in India and identify referral pathways to facility- and self-managed abortion care.
Methods: We conducted a qualitative study of 33 semi-structured interviews with a range of providers (medical, community health, and pharmacy) in India. We conducted a thematic analysis and identified referral pathways including the type of provider, the abortion care modality (in-facility or SMA), and the reason.
Results: Referrals to facility-managed abortion care were common. Providers' perception of SMA safety coupled with liability concerns resulted in discouraging clients from seeking SMA. Nonetheless, participants acknowledged three areas where providers played a role in SMA: providing information, dispensing medication, and providing support. SMA referrals pathways occurred bidirectionally between pharmacy workers and local providers. Some community health workers provided referrals to pharmacies, but more often only provided information and support.
Conclusion: Despite provider concerns, support and referrals for SMA do occur in India. Understanding the dynamics of provider perspectives, roles, and referral pathways can inform improvements to comprehensive reproductive health policies and programs in order to promote client-centered abortion care—including SMA—and address provider concerns. There is a need for synergies between the formal health sector and SMA support networks.
Supporting self-managed abortion care in “practice not premise”: Provider perspectives, roles, and referral pathways in India
Objective: Describe provider perspectives and roles in self-managed abortion (SMA) in India and identify referral pathways to facility- and self-managed abortion care.
Methods: We conducted a qualitative study of 33 semi-structured interviews with a range of providers (medical, community health, and pharmacy) in India. We conducted a thematic analysis and identified referral pathways including the type of provider, the abortion care modality (in-facility or SMA), and the reason.
Results: Referrals to facility-managed abortion care were common. Providers' perception of SMA safety coupled with liability concerns resulted in discouraging clients from seeking SMA. Nonetheless, participants acknowledged three areas where providers played a role in SMA: providing information, dispensing medication, and providing support. SMA referrals pathways occurred bidirectionally between pharmacy workers and local providers. Some community health workers provided referrals to pharmacies, but more often only provided information and support.
Conclusion: Despite provider concerns, support and referrals for SMA do occur in India. Understanding the dynamics of provider perspectives, roles, and referral pathways can inform improvements to comprehensive reproductive health policies and programs in order to promote client-centered abortion care—including SMA—and address provider concerns. There is a need for synergies between the formal health sector and SMA support networks.