Increasing Access to Comprehensive abortion care in India

This project to increase access to comprehensive abortion care (CAC) in India was developed by the Consortium for Safe Abortions in India, which includes Action Research and Training for Health (ARTH); the Center for Enquiry into Health and Allied Themes (CEHAT); the Federation of Obstetric and Gynecological Societies of India (FOGSI); FPA India (Family Planning Association of India); the International Unit of Maternal Child Health, Uppsala University (IMCH-Uppsala University); Ipas; Population Council; and the Society of Midwives, India (SoMI).

The goal of the project was to increase access to legal, safe, and comprehensive abortion services, including postabortion family planning services, in the public health system with a focus on the rural poor. The Swedish International Development Cooperation Agency and the David and Lucile Packard Foundation co-funded the original three-year project, 2006-2008, which was extended for another year through December 2009 and now after a no cost extension through 2010.

FOGSI’s role in the project began in 27th July 2004 through the MTP Committee when Nozer Sheriar and Jaydeep Tank attended the concept meeting for the project held in New Delhi. Following this a concept note was developed and the Consortium for Safe Abortions in India was formed. It was decided that the consortium as a group would develop the proposal. This was followed by a Logical Framework analysis workshop spread over two days on the 26th to 28th of July 2005 which was attended by Jaydeep Tank. Further meetings were held in Sweden in Uppsala at the IMCH and the University, and in Stockholm at various locations like the Sida office, Karolinska institute, the Swedish Parliament, etc.

The proposal was finalized and submitted in 2005 and approval for the project came from Sida and the Packard Foundation in 2005 – 06.

This was followed by a work plan meeting held on 17th and 18th of April 2006 in New Delhi where work plans were evolved. Following this Scope of Work and budget rationalization was performed through a series of meetings and correspondence.

After an internal review where the proposal was sent to the FOGSI office and legal clearance from FOGSI’s side was obtained from Hariani and Co. FOGSI signed the agreement in 2007.

As was decided at the managing committee meeting in September 2007 a core committee for the project was formed which includes:

President FOGSI, Vice President in charge of MTP Committee FOGSI , Secretary General FOGSI, Deputy Secretary FOGSI, and Treasurer FOGSI and the Project Convenors Nozer Sheriar and Jaydeep Tank.

Given the nature of our organization FOGSI is involved in almost all the activities of the project.

A project management committee (PMC) of representatives from each Consortium-member organization was set up as the coordinating and decision-making body for the Consortium and was responsible for directing the project’s broad operations.

Project Brief

The overall goal of the four-year (January 2006 – December 2009 , $1.6 million project was to increase access to legal, safe, and comprehensive abortion services, including postabortion family planning services, in the public health system, focusing on the rural poor.

The objectives of the project were:

To develop and implement a district-level model for delivery of safe abortion services through the public health system, which includes increasing both the availability of and demand for services

To expand the provider base for providing manual vacuum aspiration (MVA) and medical abortion (MA)

To assist two state governments on systemic, resource, administrative, and legal issues to increase access to safe and legal abortion in the public and private sectors

To advocate with the national government and two state governments for changes to policies, laws, rules, regulations, and practices to increase access to safe abortion services in the public and private sectors

To achieve the above objectives, the project focused on four identified result areas:

Result Area 1: An effective district-level model for CAC, including postabortion family planning services developed and implemented in the public health system for improving supply and demand of safe and legal abortion services in the two districts.
Result Area 2: Pilot models developed and implemented for expanding provider base and technology choices for safe abortion services in the public health system.
Result Area 3: Effective implementation of MTP rules & regulations in two states resulting in increased access to safe and legal abortion services.
Result Area 4: Recommendations based on studies made to national and state governments that enables policy, legal and implementation changes.

The Consortium implemented project activities under Result Areas 1 through 3 in Rajasthan and Maharashtra, piloting district-level models in one district in each state – Aurangabad in Maharashtra, and Tonk in Rajasthan – and working to facilitate effective implementation of existing laws and policies. Result Area 4 had a national reach.

The project achieved several major accomplishments, including:

Piloting a model for CAC service delivery in two selected districts – Aurangabad (Maharashtra) and Tonk (Rajasthan) – that:
Achieved ownership by the state governments of the district level model to ensure availability of safe abortion services at facilities where they were not available prior to the intervention.
Trained a pool of CAC-trained doctors and nursing staff regularly offering CAC services
Increased awareness among women about the legality and availability of safe abortion services at public health facilities
Increased the number of safe abortions over a period of three years, as demonstrated by an increase in abortion caseloads at public-sector health facilities
Conducting an operations research study to demonstrate provision of safe medical abortion services by midlevel providers, including Bachelor of Medicine and Bachelor of Surgery (MBBS) and Bachelor of Ayurvedic Medicine and Surgery (BAMS) doctors and nurses
Conducting a situational analysis of the available resources for medical termination of pregnancy (MTP) in the states of Rajasthan and Maharashtra that highlighted poor reporting standards of MTP cases, mostly because government officials were not aware of the reporting requirements
Advocating among the nursing cadre to keep abortion on their agenda, which was supported by the Federation of Obstetric and Gynaecological Societies of India (FOGSI) issuing a statement supporting the role of midwives in abortion care
Increasing awareness of the national MTP Act among district-level officials through advocacy workshops, which helped increase the number of sites approved to offer legal abortion services in the private sector in the two intervention states

However, because of delays in winning approvals from the state governments of Rajasthan and in launching some activities, the Consortium has not completed two activities. The Packard Foundation has granted the Consortium a five-month no-cost extension period through May 2010 to complete these two activities as well as three others. The principal partners and the no-cost extension activities are:

FPAI to complete behavior change communication (BCC) activities in Tonk (Rajasthan)
Population Council to complete the operations research study
ARTH to train district coordinators of the Pre-Conception and Pre-Natal Diagnostic Techniques (PCPNDT) Act who will be responsible for reporting MTP data using a Management Information System
Documentation of project outcomes:
- Completion of the end line research and facility survey in Aurangabad and Jalna districts in Maharashtra by Population Council
- Follow-up of the situational analysis study by ARTH
- Digital archiving of the outputs of the Consortium project by Ipas