Like a mother-daughter relationship: community health intermediaries' knowledge of and attitudes to abortion in Karnataka, India

Nandagiri, Rishita ORCID: 0000-0003-4424-769X (2019) Like a mother-daughter relationship: community health intermediaries' knowledge of and attitudes to abortion in Karnataka, India. Social Science & Medicine, 239. ISSN 0277-9536

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Abstract

Community Health Intermediaries (CHIs)- ANMs, ASHAs, and pharmacists- are key to realising task-sharing efforts to increase abortion access in LMICs, but their knowledge of and attitudes to abortion remains underexplored. Evidence on abortion task-sharing has focused primarily on CHIs' technical and clinical abilities, overlooking social contexts and norms that influence attitudes and behaviours. This mixed-methods study describes the abortion knowledge, attitudes, and roles of three cadres of CHIs in rural districts of Karnataka, India. Quantitative data on CHIs' abortion attitudes (n = 118) were collected using the Stigmatising Attitudes, Behaviours, and Actions Scale (SABAS), followed by in-depth interviews (n = 21) with a subset of the population over eight months in 2017. Findings show that CHIs, present at multiple points in women's abortion trajectories, serve as barriers or facilitate access to abortion care. Their abortion attitudes reflect social contexts and environments, drawing on social norms surrounding fertility, woman- and mother-hood. They demonstrate poor knowledge of abortion laws, conflating them with sex-selection laws. CHIs also reflect poor knowledge of abortion methods. They report little to no training on abortion. CHIs contend with entrenched social and structural inequalities in carrying out their tasks, affecting the kind and quality of care they are able to provide. Understanding CHIs' experiences, knowledge and attitudes can advance abortion care-provision, support task-sharing efforts, and potentially improve the quality of women's abortion-seeking experiences.

Item Type:	Article
Additional Information:	© 2019 Elsevier Ltd
Divisions:	Social Policy
Subjects:	R Medicine > RG Gynecology and obstetrics H Social Sciences > HV Social pathology. Social and public welfare. Criminology H Social Sciences > HQ The family. Marriage. Woman
Date Deposited:	20 Apr 2020 15:09
Last Modified:	12 Dec 2024 02:07
URI:	http://eprints.lse.ac.uk/id/eprint/104095

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