Aborto

Maternal and Social Factors Associated with Abortion In India: A Population-Based Study
By Saseendran Pallikadavath and R. William Stones
CONTEXT: A cultural preference for sons may be a factor driving recourse to abortion in India, as women carrying fe-

male fetuses may decide to terminate their pregnancies. To assess this hypothesis, more information on the incidence of abortion, and onmaternal and social correlates of the procedure, is needed.
METHODS: Birth order–specific abortion ratios were calculated using the birth histories of 90,303 ever-married

Saseendran Pallikadavath is senior research fellow, Centre for AIDS Research, and R. William Stones is director, Centre for AIDS Research, and senior lecturer, Department of Obstetrics and Gynecology—both at the University ofSouthampton, United Kingdom.

women aged 15–49 who participated in India’s 1998–1999 National Family Health Survey. For the first four births, the association between abortion and various maternal and social variables, including the sex of the respondent’s last child, was assessed using logistic regression.
RESULTS: The overall abortion ratio was 17.0 per 1,000 pregnancies. The ratio increasedfrom 5.3 per 1,000 pregnancies for first-order births to 25.8 per 1,000 pregnancies for third-order births and then declined. The strongest predictor of abortion was maternal education: Women with at least a primary education were more likely than those with no education to have had an abortion (odds ratios, 1.9–6.7). Rural residence was associated with a reduced likelihood of abortion (0.6). Therewas no association between the sex of a woman’s previous child and the odds that she subsequently had an abortion. CONCLUSION: At the national level, it is likely that unintended pregnancy, rather than the sex of the previous child, un-

derlies demand for abortion in India. Rising educational attainment among women may lead to an increase in the demand for abortion. International Family PlanningPerspectives, 2006, 32(3):120–125

Under the 1971 Medical Termination of Pregnancy Act, a woman in India can legally obtain an abortion if her pregnancy carries the risk of grave physical injury, endangers her mental health, is the result of contraceptive failure (in a married woman) or rape, or is likely to produce a child with physical or mental abnormalities.1 Legal abortions may be obtainedthrough more than 11,000 approved clinics.2 Estimates of the number of abortions performed annually in India vary considerably, from 0.6 million to 6.7 million.3 The former is an official figure, whereas the latter is an estimate derived from a field study; the difference could be an indication of the extent of illegal abortion. Although abortion has been legal in India for more than three decades,access to safe services remains limited for most women. For example, it has been estimated that nearly 90% of abortions in India are performed under potentially unsafe conditions in unapproved facilities, by providers ranging from qualified doctors to those without any training or qualifications.4 Women use these providers because there is a dearth of medical provision in most rural areas and becausemany women are unaware of or unable to travel to the safe facilities that do exist. There are no definitive studies linking maternal deaths to unsafe abortions in rural settings, but official statistics from 1998 suggest that about 9% of maternal deaths in rural India are due to complications of abortion.5 This figure, however, does not take into

consideration the very large differences inmaternal mortality between the country’s northern and southern states, or the difficulty of identifying deaths that occur early in pregnancy, before women have come to the attention of maternal health services. The Medical Termination of Pregnancy Act was amended in 2002 and 2003 to improve women’s access to safe abortion, in part by giving village committees (Panchayats) more input regarding health...