Nandagiri, Rishita 
ORCID: 0000-0003-4424-769X
(2018)
"They know everything": community health workers' attitudes to and influence on abortion access in India.
In: British Society for Population Studies annual conference, 2018-09-10 - 2018-09-12, Winchester, United Kingdom, GBR.
Abstract
Safe abortion access is impeded by multiple barriers, including legal status of abortion, availability of trained providers, and degree of abortion knowledge. Even where abortion is legally available, it may remain inaccessible due to lack of accurate abortion information and knowledge, lack of trained providers, especially in rural areas, and limiting provision of services to physicians or specialists. The paucity of trained/available providers may lead to delays in access to care or abortions taking place under unsafe conditions. Task‐sharing/task‐shifting enables lay and mid‐level healthcare professionals such as nurses, midwives, pharmacists, and community health workers (CHWs) in healthcare service provision. In India, female CHWs and pharmacists act as the key interface between public health systems and rural communities. Equipped with pregnancy testing kits, they are present for women’s first acknowledgement or confirmation of pregnancy. As trusted confidants and sources of information, women turn to CHWs for advice and support in their abortion decision‐making. Yet, their attitudes to abortion, and current and potential roles in abortion access remain underexplored. A nested mixed‐methods (questionnaires=112, in‐depth interviews=21) study design was utilised to collect data over eight months in rural villages in two districts in Karnataka, India. Preliminary findings suggest that CHWs display some stigmatising attitudes and lack knowledge of current laws; and influence abortion trajectories by providing advice or withholding information. Their roles and attitudes are shaped by and function within social, political, and cultural contexts. Task‐sharing efforts must account for social, political, and cultural relations that inform CHWs negotiations, subversions, & service provision.
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