Unintended Pregnancy, Abortion and Postabortion Care in Assam: 2015 Study Findings
This report, focused on Assam, is part of a larger study titled Unintended Pregnancy and Abortion in India (UPAI), which was conducted to provide much-needed information on the incidence of induced abortion and pregnancy, as well as access to and quality of safe abortion services. The report first provides detailed findings on facility-based abortion and postabortion services in the state; it then draws on these and other data to formulate estimates of the incidence of abortion and unintended pregnancy.
Incidence and Settings of Abortion
An estimated 580,100 abortions occurred in Assam in 2015. These include safe and unsafe abortions, and those taking place both in health facilities and in other settings. The state’s abortion rate was 66 terminations per 1,000 women of reproductive age. Regarding the settings of these procedures:
- The large majority of abortions (74%, or 427,800) took place in nonfacility settings using medical methods of abortion.
- Only 21% of abortions (122,300) occurred in health facilities.
- Approximately 5% (29,900) were performed outside of health facilities using other methods.
Facility Distribution and Accessibility
An estimated 588 facilities in Assam provided abortion-related care (induced abortion, postabortion care or both types of services) in 2015; 61% were public and 39% were private. Public facilities provided the majority of all facility-based terminations (73%). However, access remains a challenge as 80% of primary health centres reported offering no abortion-related care.
Geographic Disparities
Although more than eight in 10 women of reproductive age in Assam live in rural areas, only 45% of facilities that provide any abortion-related services were located in rural areas. Furthermore, all private facilities were located in urban areas, and only 18% of public hospitals that provide abortion-related services—the facilities best equipped to handle severe complications—were located in rural areas.
Gestational Age and Clinical Methods
The vast majority (94%) of health facility abortions took place in the first trimester of pregnancy (up to 12 weeks’ gestation), and 65% occurred at less than 8 weeks’ gestation. Most were performed surgically using manual or electric vacuum aspiration (57%) or either dilatation and evacuation or dilatation and curettage (30%).
Unintended Pregnancy and Fertility Regulation
More than half (55%) of pregnancies occurring in Assam in 2015 were unintended. Three-fourths (74%) of these unintended pregnancies ended in an abortion, making unintended pregnancy an important indicator of women’s ability to regulate their fertility.
Key Statistics Summary (Assam, 2015)
| Category | Value |
|---|---|
| Estimated total abortions | 580,100 |
| Abortion rate (per 1,000 women) | 66 |
| Unintended pregnancies | 55% |
| Nonfacility abortions (Medical Methods) | 74% |
| Public facility share of terminations | 73% |
Context and Challenges
Although abortion is legal in India, evidence on how many abortions occur and under what circumstances they are performed is limited. Official incidence statistics come from the Family Welfare Yearbook published by the Ministry of Health and Family Welfare (MoHFW), Government of India; these statistics underestimate abortion incidence because coverage of facility-based services is incomplete and many abortions take place outside of a facility setting. Until now, the country has lacked a large-scale study of abortion service provision in both public and private health facilities that documents the care provided and its quality.