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Traci Baird, director of the Medical Abortion Initiative at Ipas, recently traveled to the state of Jharkhand, India with the Ipas India team to observe components of a project to expand community-based access to medical abortion in the state. Medical abortion is the use of drugs, usually a combination of misoprostol and mifepristone, to end a pregnancy. The method is especially useful in rural areas where women may not have easy access to medical facilities providing surgical abortion. Ipas India works to expand access to comprehensive abortion care in India. Traci wrote to us after spending a day in the field.

We had a great day today seeing the medical abortion project in action in Jharkhand! Jarhkhand is a primarily rural state in eastern India, and women there have relatively little access to health-care providers. Ipas India is leading an effort to increase knowledge about safe abortion care, particularly medical abortion, in order to reduce the incidence of abortion-related injuries and death. 

We drove to one of the villages in the Silli area of Jharkhand where volunteers were sitting with groups of women scattered throughout the village - in the shade, a temple, someone’s house, the schoolyard - having short conversations about safe abortion. They used small flip charts to present information, encouraged and asked questions, then invited the women to play a game where they had to identify pictures that were accurate or not using green (accurate) or red (inaccurate) markers.

Women of all ages participated – nursing mothers, elders and everyone in between. Our staff estimate that 60 percent of women in the project area have participated in one of the sessions so far, and it’s still ongoing. Conversations focused on safe abortion, the option of medical abortion, the importance of identifying pregnancy early, where to go for more information and services, and contraception. The main challenge for women seeking these services is that the nearest provider is about 15 miles away, and there is no public transportation available. Villagers travel by foot or bicycle.

After observing several of these sessions, we said goodbye and left to visit a doctor providing medical abortion in a more populated part of Silli. On the road, we saw large billboards and wall signs - developed by Ipas in collaboration with a local organization - providing information on where medical abortion services are available and the importance of seeking care as early in pregnancy as possible.

The doctor in Silli provides basic health services in the community - such as childhood immunizations, prenatal care, treatment of injuries and illnesses - and since participating in Ipas training, medical abortion. Women in the area have become aware that he offers medical abortion services and they trust him already because he vaccinates their children. He said that providing medical abortion is easier than he thought it would be – that women are fairly accepting of the method, and he does 10-11 procedures each month. It is a great example of increasing access to services by engaging a trained clinician in a very basic setting.

After a roadside picnic and a flat tire, we went to another village to watch an educational street drama about abortion. The village was up an unpaved, narrow and bumpy road – apparently one that doesn’t usually get much traffic because our three cars attracted enough attention that the media arrived, thinking we must be a campaign event! They didn’t stick around long when they realized we weren’t running for office (just campaigning for safe abortion!).

Nearly the whole village – babies, children, teens, women, men, and elders watched the play with fascination. After the play the actors asked the audience questions to assess their understanding, such as “How many pills do you take?” and “Where can you go for medical abortion?” People who answered correctly received small prizes while the actors reiterated correct answers and addressed incorrect ones. The actors said people now come to them with questions about pregnancy and medical abortion, and they are able to encourage women to ask their doctors about abortion services. 

We concluded the day by discussing how to address the gaps that still remain between women who need medical abortion and providers who offer it - such as ensuring the supply of medication in a rural area like Silli. But it was clear from our day in the field that we have developed some excellent resources that will help increase access to safe abortion care for women who need it.

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For more information, contact media@ipas.org