As we all know that unsafe and illegal abortions contribute significant numbers in the Maternal Mortality rate (MMR). Policies and strategies made by the Indian government constantly focused to enhance and provide the access of care as well as availabilities of services related to comprehensive abortion care in every setting, whether it is Public or Private sector.
The following provides a full overview of the policies under NPP (National Population Policy) 2000 and Reproductive and Child Health-II (RCH II) as per the Medical termination of Pregnancy (MTP) Act 2021 which implemented at the root level through National Health Mission (NHM).
National Population Policy (2000)
The National Population Policy was launched in the 2000 with the aim to addressing the unmet need of contraception, poor health care infrastructure, and incompetent health care personnel to provide care/services for basic reproductive and child health (RCH). In this view NPP 2000 planned to sensitize the given areas with the long term goal to expand the availability of safe abortion care.
- To enhance the community/ground level education. In this must be educate the women’s, head of the family and adolescents regarding availability of safe abortion services and the consequence’s of unsafe and illegal abortions.
- To ensure safe and legal abortion more attractive by providing the quality services. In this, need to increase the geographical area, make sure the affordability, maintaining confidentiality and providing the complete abortion care by including the post-abortion counselling and follow-up sessions.
- To ensure updated and effective health care technologies which is very easy and safe. for examples- Manual vacuum aspiration is not completely depends on anesthesia, promote non-surgical techniques.
- To promote private sectors and NGOs by doing the collaboration with them to enhance the quality of care and increase the coverage of safe abortion services.
- Ensure easy registration process.
- Ensure the availability of additional training centers.
- Strengthen the services at PHC, CHC, DH/DWH and Specialty hospitals.
Major Initiatives taken by RCH-II and NHM
The major initiatives taken by RCH-II and National health mission falls under these three categories:
- To establishing the CAC service delivery- In this several steps has been taken
- Implementation of CAC Guidelines
- Ensure the availability funds to provide the services including the equipment and drugs.
- Capacity building of health care personnel’s.
- Medical staff, ANM and ASHAs must be trained to maintain confidentiality while providing the counselling and promote the importance of post abortion care and contraception.
- In the Essential drug list must be add the MMA drugs.
- Through district level inspection committees (DLCs) ensure the certification of private sector facilities and NGOs.
- Need to monitor the CAC services quarterly by using the assessment tool and ensure the availability of ‘Nischay’, pregnancy detection kit at ground level health care facilities.
- Generating the Awareness with the help of IEC/BCC– In this need to focus on
- Plan and execute the workshop on CAC at state level for every state and district level officers.
- Develop the standard IEC/BCC content at central level and further distribute to all the state for printing, implementations and fallow-up.
- Ensure the sufficient funds in yearly Budget.
- Capacity building of health care workers.
- Approach under RMNCHA+N– In this need to focus on
- Early detection of pregnancy.
- Early Registration of Pregnancy.
- Family planning counselling and services.
- Safe abortion care services.
- Ensuring the Facility preparedness
- strengthen the quality of capacity building activities by providing them teaching materials, mannequins, skill lab, modules/guidelines and teaching aids.
- Ensure the Maternal Death Review (MDR). Analysis of each cases will helps to fill the gaps in the delivery of services.
Comprehensive Abortion Care: A Women Centered Approach
The Government of India released the first CAC Training and Service Delivery Guidelines in 2010 with the intention of changing the way abortion care is provided, from merely a medical procedure to a Woman Centered Comprehensive Abortion Care approach. This entails offering safe and authorized abortion services while accounting for the various aspects that affect a woman’s need for her bodily and emotional health, her unique situation, and her capacity to get abortion services. The subsequent Guidelines versions in 2018 and 2023 reflected the ongoing initiatives.
Elements of Women centered CAC
Conclusion
Abortion risks can be avoided. Still, it accounts for a sizable portion (8%) of maternal fatalities in India. In India, a number of social, policy, economic, and physical reasons restrict women’s access to and use of abortion services, even though it is legal in some states. The NPP and RCH II/NHM policies of the Indian government place a strong emphasis on CAC interventions. The national maternal health policies priorities the availability of skilled providers, high-quality services at facilities, and convenient access near communities in order to enhance women’s access to services. The three main components of a woman-centered CAC are respectable choice, access, and quality.