Knowledge, attitudes, and practices of certified providers of medical abortion: Evidence from Bihar and Maharashtra, India

Objective: To explore Indian abortion providers' knowledge of medical abortion (MA), their personal experiences and practices of providing medical abortion, and their attitudes toward providing MA to eligible women who were poor, uneducated, and/or from rural areas. Methods: In selected districts of India's Bihar and Maharashtra states, interviews were conducted with 270 physicians who were certified as abortion providers, using a structured questionnaire. Results: The providers' knowledge of the gestational limit, the recommended doses of mifepristone and misoprostol, and other aspects of the approved protocol was far from universal. Only about two-thirds of these physicians authorized to perform MA actually performed it. Although they all counseled women about the procedure before they took mifepristone, the matters discussed were often limited to pain management and possible complications. Contraception was usually not discussed until the follow-up visit. Most providers thus missed the opportunity to provide sustained counseling to their MA patients, and did not counsel them about the need to protect themselves in the 2 weeks following the administration of mifepristone. Moreover, many providers were reluctant to offer MA to poor, uneducated, and/or rural women. Conclusions: These findings shed light on the need to raise awareness and dispel misgivings about MA among certified providers of abortion services. By placing emphasis on the method's safety and effectiveness, additional training to these would increase their confidence about offering MA to eligible women. (C) 2012 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.