A Remote Analysis of Self-Managed Abortion in India

This summer, I planned to do a retrospective analysis on self-managed abortion in India. Self-managed abortion occurs when a person performs their own abortion without clinical supervision. It is sometimes also referred to as self-induced abortion or even DIY abortion. Various methods of abortion fall within this quite broad categorization, including herbal remedies, blunt force, and more and more commonly – the unsupervised use of a combination of pharmaceutical drugs, such as mifepristone and misoprostol. Just like the methods used, the reasons that lead a person to self-manage an abortion vary greatly. Contrary to popular belief, abortion rates by country do not correlate to whether or not abortion is legal in the country. However, abortions generally become safer as legal avenues for abortion are created. So, one reason leading people to self-manage is a lack of legal abortion services. In India however, abortion has been broadly legalized since 1971. So the question remains, why are a quarter of abortions reported as self-managed in India?

I began my project by postulating that the distance to a clinic offering legal abortion would correlate to the relative rate of self-managed abortion. That is, if a woman lives far from any clinics, she would be unable to access legal abortion care and resort to self-managing. However, it became abundantly clear that we didn’t have sufficient data to determine this. As is often the case in a retrospective analysis, where one does not design the survey but then analyzes the

data collected in a way that was not initially intended, we were limited by the questions posed and information collected. So, I had to figure out a way to pivot the analysis while maintaining the leading question – why are a quarter of abortions reported as self-managed in India?

To change the leading hypothesis, I needed more cultural and clinical background on the region. I have never been to India, and though I planned to be there this summer, COVID-19 had other ideas. But even had I been in India this summer, I would not have enough insight on the lives of women across India to make a new informed hypothesis. So, I depended on my team of mentors, including Dr. Abhishek Singh, at the International Institute for Population Sciences (IIPS) in Mumbai, India, and Drs. Sarah Averbach, Anita Raj and Lotus McDougal at UCSD. Following their clinical, cultural and analytical insight, I decided to look at whether previously experienced intimate partner violence increases the likelihood of self-managing an abortion. In addition, given the range of methods used for self-managed abortion, I wanted to look at whether self-managed abortions have higher complication rates than clinically managed abortions.

Following a steep learning curve of statistics, I designed the analysis. Through our partnership with IIPS in Mumbai, the analysis was primarily done by Dr. Singh’s team, with special thanks to Dr. Ajit Kumar Yadav. Communicating effectively about the desired analysis was non-trivial, especially that it all had to occur online. Despite my general aversion to coding, I found that sending coding scripts back and forth was an invaluable way to understand one another clearly. Additionally, keeping an open avenue for questions improved our collaboration. As of this week, the main data analysis has been complete. It seems that some forms of intimate partner violence do increase the odds of self-managing an abortion in India. But it also poses many other questions. Why does it seem that self-managed abortions have lower complication rates than non self-managed? What methods do women use to self-manage abortions in India?

As I write this, I am now working to transcribe the analysis to writing. It is important to me that the work we did is accessible and does not simply remain a leading hypothesis.

Written and drawn by Sophie Goemans

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