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In 2015, the World Health Organization (WHO) published a guideline on the role of health workers in providing safe abortion and postabortion contraception, with evidence-based recommendations on the range of providers who can perform interventions to provide safe abortion, postabortion care, and postabortion contraception. The WHO guideline is global in nature and must be contextualized to individual country settings. The present paper compares the scenario in India, including the legal and policy frameworks, with the WHO guidelines. It provides legal and policy recommendations that are needed to improve access to comprehensive abortion care in India, with a focus on expanding the provider base. The process used to develop these recommendations was a combination of empirical evidence gathering and multistakeholder consultations. An outcome of this exercise was a policy brief entitled "Improving access to comprehensive abortion care in India with focus on expanding provider base," which is used as an advocacy tool. [ABSTRACT FROM AUTHOR]

Objective: To test an infographic two-pager on medication abortions (MA) aimed to improve pharmacists counseling in India.Methods: A quantitative baseline survey was conducted among 283 pharmacists in three districts around Lucknow, Uttar Pradesh in January 2018. The intervention (infographic) was given to 117 of these pharmacists a few weeks later and a follow-up survey was conducted 3 months later with 281 pharmacists. In addition, mystery clients were sent to 115 of the pharmacists.Results: A statistically significant improvement in knowledge post-intervention was found, compared to pre-, for almost all quality items measured. Difference-in-difference estimators showed a difference in knowledge among indicators related to misoprostol in particular. However, mystery client reports showed few differences in pharmacist behaviors between intervention and control pharmacists.Conclusion: This simple, paper-based intervention, which required no training, showed a significant improvement in pharmacists' knowledge and was welcomed by the providers. Translating knowledge into behavior change, however, seems more difficult to impact. Adapting this simple intervention to motivate providers to change behaviors could improve the quality of care provided by pharmacists in India. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To investigate the patterns and determinants of postabortion contraceptive use and the rates of method continuation in India. Methods: Population-level retrospective calendar data on 5135 married women who had their last abortion during the 60months preceding the survey were drawn from 2005–2006 Indian National Family Health Surveys. Multinomial logistic regression was used to model the factors associated with postabortion method choices. Method discontinuation rates were estimated using proportional hazard models. Results: Overall, 70.4% of women reported not using any method following abortion, and the levels varied considerably across states. Significant differences were observed in the type of method adopted by women living in large cities, small towns, and rural areas. Poor and socially excluded women were less likely to use any method after abortion, particularly modern reversible methods. Method discontinuation rates were considerably higher among socially disadvantaged groups. Conclusion: Postabortion contraceptive adoption is exceptionally low in India. Reproductive health interventions should urgently consider implementing comprehensive postabortion care policies, integrating family planning with sexual and reproductive healthcare services, and in particular targeting women from disadvantaged communities. [Copyright &y& Elsevier]

Abstract: Objective: This study was carried out to explore whether the rates of postabortion adoption of a contraceptive method, and continuation of contraception over 6months, differ among women undergoing medical abortion (MA) or surgical abortion by manual vacuum aspiration (MVA). Methods: The study was conducted in Bihar and Jharkhand, 2 of the least-developed states of India. The analysis focused on 679 married women who were followed up 6months after they underwent MA (n=308) or MVA (n=371) at clinics run by Janani, a nonprofit organization. Results: The rates of adoption and continuation of contraception were similar in the 2 groups, although with some notable distinctions in the timing of adoption of contraception and the method of contraception adopted. While the women who underwent MA were significantly less likely to adopt contraception in the month following abortion (58% vs 86%), this difference had narrowed considerably by the end of the second month (82% vs 91%); and by the end of the sixth month (89% vs 94%), respectively. There were no significant differences between the MA and the MVA groups with respect to the continuation of reversible contraception. Conclusions: The findings indicate that, in a setting that offers comprehensive counseling and a range of contraceptive methods, and where adoption of contraception is voluntary, a large majority of women will adopt and continue to use a method of contraception after an abortion even in these less developed parts of India. [Copyright &y& Elsevier]