Induced abortion in villages of Ballabgarh HDSS: rates, trends, causes and determinants

Background: Induced abortion has been legal in India on a broad range of medical and social grounds since 1980s. Often, induced abortion is resorted to as a means for contraception, and has a potential to be misused for sex selective feticide. We assessed the rates, trends, causes and determinants of induced abortions from 2008-12 in a rural community of northern India. Methods: Present study is a secondary data analysis of pregnancy outcomes at Ballabgarh Health and Demographic Surveillance System from 2008-12. The data was retrieved from the Health and Management Information System maintained at Ballabgarh. Cause of abortion was self-reported by the women who underwent abortion. Results: Of the 11,102 pregnancies, 1,226 (11 %) culminated as abortions of which 425 (3.8 %) were induced abortions. Spontaneous abortion rate (7.2 %) was twice that of induced abortion rate (3.8 %). Both abortion rates had an increasing trend during the course of the study period. Self-reported reasons for opting for induced abortions were bleeding per vaginum (23 %), unwanted pregnancy (16 %), and unviable fetus diagnosed by ultrasonography (11 %). Eight percent of the induced abortions were due to the female sex of the fetus. About 11 % of the abortions were performed beyond 20 weeks of gestation which was the upper legal permissible gestational age for performing induced abortions in India. About 10 % of the abortions were performed by unqualified practitioners. Caste, wealth index, birth order and size of the village population were the factors that were significantly associated with induced abortion. Conclusions: Though the abortion rate was low, the proportionate contribution of induced abortion was more than what could be expected. Unsafe and sex selective abortion, though illegal, was prevalent. Upper caste and higher socio-economic status families were more likely to opt for induced abortion.