LOVE

Document Sample
LOVE Powered By Docstoc
					                    INDUCED ABORTIONS IN ANDHRA PRADESH-
               A study in Krishna and Guntur districts of Andhra Pradesh.

                                              Dr.M.M.Krishna Reddy *
1. INTRODUCTION:
                 Ever since the introduction of the legalization of abortions through the
Medical Termination of Pregnancy (MTP) Act in 1972 in India, there is a constant rise in
the reported cases of induced abortions or MTPs in the country. The data extracted from
the yearbook 1991-92 of government of India clearly reveals that “ from 1978 to 1990 the
causes due to abortions relating to childbirth and pregnancy of women ranges from 5
percent to 13.7 percent in India. As on the year 1990, 11.8 percent of the pregnant women
died due to the causes relating to abortions in the country. So, the important reason for
the maternal deaths of pregnant women is due to abortions of one type or the other.”
According to the Centre for Operations Research and Training (CORT, 1994) report on
the topic of induced abortions in India, it explains that the number of approved
institutions providing MTP facilities has increased from 1877 in 1976 to 7121 in 1991.
The number of MTP cases from a mere 25 reported in the year 1972-73 has gone up to
632526 in 1991-92. It is also estimated that private medical practitioners conduct an
approximately 5-6 million abortions every year in India. A majority of the cases are done
in rural areas having inadequate health facilities and hence done in an unhygienic and
unscientific way. All such abortions are conducted in unrecognized clinics and are
considered as illegal and hence not reported in any statistics. These illegal abortions
carried out by untrained village practitioners have been the major determinant of
continued high levels of maternal morbidity and mortality in India. According to an
estimate roughly some 12 percent of the maternal deaths are due to septic abortions. It is
surprising that even after nearly 30 years of legalization of MTPs, its availability in the
rural areas is very limited and even in the Community Health Centres (CHCs), Primary
Health Centres (PHCs) registered for providing MTPservices, and no information is
available on its utilization and its efficient functioning. So, facilities for the conduct of
safe abortions are a must in urban and more particularly in the rural areas of the country.
The necessity for such abortion facilities in the government health centres and hospitals is
crucial not only from family planning perspective, but more importantly as a measure to
ensure safe abortion to Indian women if she desires to terminate pregnancy.

                  The Centre for Operations Research and Training (CORT) conducted a
study on the situational analysis of MTP facilities in Gujarat State in India. The
following information gives a brief idea about the same study. The study covers 88
public and 55 private clinics registered for providing MTP services. Besides, 36 exit
interviews of MTP acceptors were also conducted to assess the quality of services
provided by the clinics and their satisfaction with the services received by them. The
study shows that out of the 83 registered public clinics only 37 (45percent) are currently
providing MTP services, 25(30 percent) had provided the services earlier bur are not
providing it at present, whereas the remaining 21 (25 percent) has never provided the
MTP services. The main reason for not providing MTP services was non-availability of
-----------------------------------------------------------------------------------------------------------
*Research Investigator,Population Research Centre,A.U.Walrair-530003,A.P. India.
                                      :2:

trained doctors. In a number of clinics, both manpower and equipment‟s were not
available. While most of the doctors (94 to 97 percent) in the CHCs and urban private
clinics were conducting MTP, less than half (42 to 48 percent) of the doctors in the PHCs
and the rural private clinics were conducting MTP. Even among the clinics currently
providing the MTP services, all the equipment‟s required to carry out the procedure
efficiently were not available. The study shows that out of the 37 public clinics currently
providing the MTP, as high as 16 clinics (43 percent) were not adequately equipped to
perform even one type of MTP procedure efficiently. The CHCs are relatively better
equipped in the rural and semi-urban areas. In terms of the availability of services, they
are closely followed by the urban private clinics. Exit interviews of the MTP acceptors
show that more care and check ups are done in the public clinics as compared to the
private clinics. The cost of the abortion expenses is also found to be cheaper in public
clinics in contrast to the private clinics. The information collected from the eight
institutes involved in MTP training in Gujarat shows that generally quality of MTP
training is very poor. In training, each doctor or trainee is expected to do 25 MTPs, but
they conduct only 4-5 MTP cases only. Hence even after training many doctors lack
confidence and do hesitate to provide MTP services. Some times due to the pressure of
the family planning activities, doctors are not sent for MTP training and the training‟s for
MTPs are not encouraged as it is a neglected area in the hospital services. According to
the service statistics in Gujarat State, the number of MTPs declined inspite of the increase
in the number of approved MTP centres. Under reporting of MTPs might be a reason for
such contradictory trends as a large number of MTPs are conducted in private clinics that
do not report regularly to the government.

                 THE NFHS-AP (1992) findings on induced abortions in A.P. reveals
that - In any survey, it is more difficult to collect retrospective information on
pregnancies than on live births, particularly on pregnancies spontaneously aborted within
the first few months after conception. The total number of pregnancies and the percentage
of all pregnancies that end in spontaneous abortions are almost certainly underestimated
and should not be subject to very rigorous interpretations. Respondents may suppress
reports on induced abortions or induced abortions may be reported as spontaneous
abortions. This may be due to the problems from both the respondent women due to their
poverty and illiteracy and the investigators personnel drawbacks in extracting this
information from the respondents. Therefore the actual incidence of induced abortions
may be much higher due to the underreporting of induced abortions. In NFHS, the still
births and live births are more accurately reported than abortions because of extensive
probing that occurred when the birth histories are collected. And hence the
underreporting is observed to be more with regard to both spontaneous and induced
abortions especially in the rural areas of A.P. The NFHS findings also reveals that the
induced abortions is higher in the case of urban women (1.7%) in contrast to the rural
women (0.5%) in Andhra Pradesh state. The younger women in the urban areas in the age
groups of 15-19 and 20-24 years are having 17.1 and 1.3 percent of induced abortions
respectively. However, the younger women in the rural areas in the age groups of 15-19
                                      :3:

years and 20-24 years are having 0.8 and 1.1 percent of induced abortions respectively. In
total 0.8 percent of the women in A.P. are undergoing induced abortions in which the
women in the age groups of 15-19, 20-24 and 35-39 are having 3.5, 1.2 and 1.0 percent
respectively. The higher proportions of spontaneous abortions observed in rural and
urban areas of A.P. may have some percentage of induced abortions due to the wrong
reporting of some of the induced abortions as spontaneous abortions by the women due to
some social and psychological problems in revealing the truth on this aspect.

           In the present article the performance of abortions and the facilities available
to conduct the abortions at the levels of Community Health Centres (CHCs) and the
Primary Health Centres (PHCs) are considered in both Krishna and Guntur districts of
Andhra Pradesh state to understand the need assessment to induced abortions in these
areas. The data collection work is done during the months of August and September
1999. But the demand for the induced abortions from the point of view of the village
rural women and the peripheral health staff working in the villages needs to be added to
understand the need for abortions in different districts of Andhra Pradesh better and to
have a holistic understanding of the topic under study. So, the present article concentrates
on these two important areas of CHCs and PHCs of the two districts specified towards
understanding the demand for induced abortions in Andhra Pradesh State.

2. METHODOLOGY & RESULTS AND DISCUSSION:


             The methodology, results and discussion are included in the
two separate items of the studies undertaken by the researcher in both
Krishna and Guntur Districts of Andhra Pradesh, India on the topic
specified above.
                                  :4:
I.    Facilities available at PHCs to conduct MTPs in Krishna
      and Guntur districts of Andhra Pradesh


Methodology & Results and Discussions:
                In order to know the various facilities available at PHCs
in the two districts of Krishna and Guntur to conduct MTPs, a few PHCs
are selected at random to extract or to collect the needed information
from the PHCs in both the districts.     The following are the names of
PHCs in the two districts selected for the purpose of the study. They are:
(1) Totlavalluru (2) Manda Valle (3) Bapulapadu (4) Ibrahimpatnam (5)
Kankipadu (6) Digavalli (7) Mudinepalle (8) Telladevarapalle (9) China
Pandrika (10) Movva (11) Choutapalle (12) G.Konduru (13) Veerulapadu
(14) Reddigudem and (15) Unguturu in Krishna district and (1)
Nizamapatnam (2) P.V.Palem (3) Dhulipudi (4) Kavuru (5) Pandrapadu (6)
Bollapalle (7) Pidinguralla (8) Rampicherla (9) Dachepalle (10) Muppalla
(11) Rajupalem (12) Ganapavaram and (13) Mandapadu in Guntur
district of Andhra Pradesh.
              Among all the selected 28 PHCs in both Krishna and
Guntur districts of Andhra Pradesh, the data on abortions particulars
have been collected by interviewing a majority of the medical officers of
the concerned PHCs (10 each in Krishna and Guntur districts out of 20
PHCs). In the event of the non-availability of the medical officer in the
PHCs, M.P.H.E.O.s (4 in Krishna and 3 in Guntur districts out of 7
PHCs) have been contacted to extract the needed information on
abortions. In one PHC, a paramedical staff available at the time of the
interview is contacted to collect the information on the abortion
particulars. So, the medical officers, the M.P.H.E.Os and the paramedical
staff of the concerned PHCs are the respondents considered for the
purpose of the study. It has been noticed that most of the PHCs (24 out
of 28) selected are relatively big PHCs having more
                                   :5:
than 16 villages under their coverage. Only 4 PHCs are having the
coverage of less than 16 villages. The village coverage of the big PHCs
(12 each) is almost same in both Krishna and Guntur districts of Andhra
Pradesh. Regarding the coverage of the population of the PHCs are
concerned, most of the PHCs (21 out of 28) are having more than 30 000
population in both the districts (12 PHCs in Krishna and 9 in Guntur
districts).    Only 7 PHCs (3 in Krishna and 4 in Guntur districts) are
covering the population size of less than 30 000.
Table – 1: Distribution of PHCs on the basis of the number of deliveries
           Conducted during the last one year in Krishna and Guntur
           Districts of Andhra Pradesh.

S.NO.     Total number of Krishna             Guntur         Total
          deliveries in the District          District
          last one year

 1.        < 100                    5               1            6

 2.            101+                 4               11          15

 3.        not recorded/Nil/        6                1            7
           No response

 4.           Total                15               13          28



        Table – 1 explains that the number of deliveries conducted in PHCs
in the last one year period are comparatively less in Krishna district (4
out of 15 having more than 100 deliveries) in contrast to Guntur (11 out
of 13 having more than 100 deliveries) where there are more deliveries in
PHCs. But, 5 out of 15 PHCs in Krishna district and 1 out of 13 PHCs in
Guntur district are having less than 100 deliveries during the last one-
year period. However, the not recorded/Nil/no response PHCs are
observed to be more in Krishna district (6 out of 15) compared to the
Guntur district (1 out of 13).
                                  :6:

Table – 2: Distribution of PHC according to the Clients visit for
             abortions in Krishna and Guntur districts of Andhra Pradesh.
S.No. Visit     to   PHC    for   Krishna      Guntur        Total
       abortion                    District    District


1.     Yes                              2         3            5


2.     No                            13           10          23


3.     Total                         15          13           28


              In the above table – 2, the clients to undergo MTPs
(abortions) at PHCs are very few in number (5 out of 28) in both Krishna
(2 out of 15) and Guntur (3 out of 13) districts of Andhra Pradesh. This
observation shows clearly the poor demand for MTPs (abortions) to the
PHCs in the two districts studied here. The further analysis of the clients
visiting the 5 PHCs to undergo MTPs (abortions) reveals that one PHC in
each district are conducting less than 25 MTPs in the last one year,
whereas 2 PHCs in Guntur district are conducting more than 25 MTPs in
the same one year period.


             When a question is asked to know the person conducting
MTPs in the PHCs in the two districts, 4 out of 5 PHCs revealed that the
concern medical officers conduct the MTPs in the PHCs only. The
remaining one PHC responded others / not applicable as a response.
Since the medical officer is a well-trained person in conducting MTPs in
PHCs, he alone is authorized to do the abortions in the PHCs.        Among
the 4 PHCs in the two districts, only one PHC in Krishna district alone
recorded the age and education particulars of the
                                     :7:
MTP cases conducted in their PHC. All the MTP cases fall in the age‟s 20-
30 years and are illiterate women.
               Regarding the availability of the facilities in the PHCs to
conduct MTPs are concerned, only 6 PHCs of 3 each in Krishna and
Guntur districts are having all the required facilities to conduct MTPs at
the PHC level. A majority of the PHCs (22 out of 28) both in Krishna (12
out of 15 PHCs) and Guntur (10 out of 13 PHCs) districts are not having
the needed facilities to conduct MTPs at the PHCs. So, lack of sufficient
facilities at the PHCs to conduct MTPs may be an important for the poor
conduct of MTPs at the PHC level.
               The distribution of the PHCs according to the number of
MTPs referred to the referral hospitals in both the districts reveals that a
majority of the PHCs (11 out of 12) in Krishna and Guntur (6 out of 10)
districts are referring the MTP cases to the nearby community health
centres, district and area hospitals also. So, the referral hospitals need to
be better equipped with all the required facilities to conduct MTPs
properly.
Table – 3: Distribution of the PHCs according to the number of MTPs
             referred from them to the referral hospitals in the last one
             year in Krishna and Guntur district of Andhra Pradesh.

S.No. No. referral MTPs from      Krishna      Guntur        Total
      PHCs                        District     District
1.     Nil                            5            2           7


2.     < 10 cases                     5            2           7


3.     11- 50 cases                   2            6           8


4.     Total                         12           10           22
                                 :8:
         Table – 3 reveals that only 7 PHCs are referring less than 10
MTP cases in the last one year to the referral hospitals in the two
districts in Andhra pradesh. Most of them under this category belong to
Krishna district (5 out of 12 PHCs) in contrast to Guntur district (2 out of
10 PHCs). Some 8 PHCs are referring 11- 50 MTP cases to the nearest
referral hospitals in the last one-year period. A majority of these PHCs
belong to Guntur district (6 out of 10) in contrast to Krishna district (2
out of 12). But surprisingly 7 PHCs out of 22 are not referring any of the
MTP cases to the referral hospitals and a majority of them belong to
Krishna district (5 out of 15) in contrast to Guntur district (2 out of 10).
Since 15 out of 22 PHCs are referring MTP cases to the nearest referral
hospitals, the referral hospitals must be well equipped to perform safe
abortions to the rural women.
Table – 4: Distribution of the age particulars of the referral MTP
            cases from PHCs in Krishna and Guntur districts of
            Andhra Pradesh.

S.No. Age of the referral         Krishna      Guntur        Total
      MTP cases from PHCs         District     District

1.     Nil / No response             5            6           11

2.     < 20 years                    1           16           17

2.     21-30 years                   1           17           18

4.     Total                         7           39           46



      Table - 4 explain the age particulars of the referral MTP cases as
furnished by certain PHCs in both the districts. The data reveals that
most of them are in the age group of less than 30 years.             An equal
proportion of the MTP cases are found in the age groups of < 20 years (
                                 :9:
51 percent) and 21-30 years (49 percent) respectively. But much of the
data (around 94 percent) on age of the referral MTP cases are found to be
from Guntur district (33 out of 35) in contract to Krishna district (2 out
of 35 i.e. 6 percent). The finding reveals that most of the women referred
for MTP are young women who includes both unmarried and married
equally.

Table – 5: Distribution of the educational particulars of referred MTP
            cases from PHCs in Krishna and Guntur districts of Andhra
            Pradesh.

S.No. Education of referral       Krishna      Guntur        Total
      MTP cases from PHCs         District     District
1.    Illiterates                     -          22           22

2.     Primary                         -          6            6

3.     Secondary and above             2          5            7

4.     Nil/No response                 5          6           11

5.     Total                           7         39           46


      Table - 5 reveals that most of the referral MTP cases (63 percent)
from PHCs of both the districts are illiterates (22 out of 35). But a few of
the referral MTP cases are being primary (6 out of 35 i.e. 17 percent) and
secondary education (7 out of 35 i.e. 20 percent). However, most of the
referral MTP cases from PHCs are recorded in Guntur district (33 out of
35 i.e. 94 percent) in contrast to Krishna district 2 out of 35 i.e. 6
percent). So, the findings reveal that a majority of the referral MTP cases
are illiterate women but some of them are having primary and secondary
education also.
                                 : 10 :

Table – 6: The medical officers and others opinion on other sources
            Where the clients go for abortions in both Krishna and
            Guntur districts of Andhra Pradesh.


S.No. Availability of other       Krishna      Guntur        Total
      sources                     District     District

1.       Yes                         13           7           20

2.       No                           2           6            8

3.       Total                       15          13           28



        In table – 6 when the respondents are drawn their attention to a
question on other sources where the clients will undergo MTPs apart
from PHCs, the responses revealed that a majority of the MTP cases (20
out of 28) are going to other places to undergo abortions in both the
districts. The visit to other sources for the sake of abortions is found to
be more in Krishna district (13 out of 15) in contrast to the Guntur
district (7 out of 16). This finding clearly explains that the other sources
of services are found to be an important factor apart from PHC services
to accept abortions (MTPs) in the rural parts of the two districts studied
here.    So the clients who are going for abortions are utilizing other
hospitals or services in higher proportions in contrast to the rural health
services such as PHCs. The quacks in the rural areas including the RMPs
might be attracting these MTP clients towards their sources in
significantly higher proportion in contrast to the government health
services such as PHCs.
                                  : 11 :

Table – 7: The medical officers and others opinion about the other
             Sources regarding MTPs in Krishna and Guntur districts
             of Andhra Pradesh.

S.No. Opinion in MTP                Krishna     Guntur        Total
      facilities in other           District    District
      sources

1.     Facilities and
       treatment are good at           7           6            13
       private hospitals

2.     Very poor/No facilities
       at government health            3           2            5
       centres

3.     Other reasons poor              3           1            4
       staff, carelessness etc.

4.     No response                         -       6            6

5.     Total                           13          15           28

      Table – 7 reveals that the important reason for seeking other
sources to undergo MTPs is found to be “the better facilities and
treatment available at the private hospitals in the rural areas” in both the
districts of Andhra Pradesh. The second important reason being “the
poor and no sufficient facilities to undergo MTP at government health
centres such as PHCs”. No response is observed to be more in Guntur
district (6 out of 15) on this question. The findings clearly project that
the better facilities and treatment available at private health centres are
able to attract more MTP cases towards their side.         The poor and no
facilities and treatment to conduct MTPs at PHCs is influencing the MTP
clients to visit private hospitals including the RMPs and quacks.         The
provision of better facilities and services at PHCs will help to a significant
extent to prevent the MTP cases visiting private hospitals for MTP
services there.
                                 : 12 :

Table – 8: The medical officers and others opinion on the approximate
            Demand for abortions in one year in PHCs in Krishna
            and Guntur districts of Andhra Pradesh.

S.No. Demand for MTP               Krishna      Guntur      Total
                                   District     District

1.     < 25                           7            9         16

2.     26 +                           6            3         9

3.     No response/demand             2            1         3

4.     Total                         15           13         28

      Table – 8 brings to forward the demand for MTPs in one year in the
PHC area as per the respondents opinion.            Most of the PHCs are
expressing the demand for MTPs in their respective localities. The
demand varies from 1-100 cases in the PHC areas. But half of the PHCs
(16 out of 28) are expressing demand strength of less than 25 MTP cases
in a year. But some PHCs are found to have higher demand of more
than 26 MTP cases in a year and in few rare PHCs the demand is around
100 MTP cases in a year. The findings revealed here explains clearly that
the higher demand for MTPs in the rural areas to PHCs is a positive
indication to strengthen the required MTP facilities at PHCs for the
benefit of MTP clients in the rural parts of the state.
Table – 9: Medical officers and others opinion on the need for
            Establishing abortion Clinic in the PHC area in
            Krishna and Guntur districts of Andhra Pradesh.

S.No. Need for MTP clinic          Krishna      Guntur      Total
                                   District     District

1.     Yes                           11            4         15

2.     No                             4            9         13

3.     Total                         15           13         28
                                : 13 :

      Table – 9 reveals that a majority of the PHCs are expressing the
need to establish abortion clinic in the PHCs in Krishna district (11 out
of 15) in contrast to Guntur (4 out of 13) where a few of the PHCs are
informing the need. But surprisingly in Guntur district, a majority of the
PHCs (9 out of 13) is informing that there is no need for establishing MTP
clinic in PHCs. But in both the districts, slightly higher proportion of the
PHCs (15 out of 28) are expressing the intention of the need to start
abortion clinics in their centres. This finding clearly reveals the necessity
of establishing MTP clinics at the PHCs depending upon the demand to it
in the same PHCs.


            Table – 10 brings out the suggestions of the respondents for
promoting safe abortions at PHC level in the study areas. It has been
suggested that trained and qualified doctor/staff should conduct MTP in
the Hospitals/PHCs.     All the PHCs must be provided with good MTP
theatre with all required equipment‟s and facilities.       And preferably
qualified and trained lady doctors must be allowed to conduct MTPs at
PHCs. Avoiding quacks to conduct MTPs, fixing of referral hospitals for
MTPs, providing with all the facilities at the PHCs for promoting safe
abortions, propagation of the use of family planning and spacing
methods in particular are the other important suggestions given by the
medical officers and others in the direction of the management of MTPs
at the PHCs. And the last but not the least is the spread of reproductive
health education with special reference to safe abortion at PHCs to the
rural women is essential to bring proper awareness and education on
these matters. This will definitely help to promote safe abortions at the
PHCs in both the Krishna and Guntur districts of Andhra Pradesh.
                                : 14 :

Table – 10: Medical officers and others suggestions for promoting safe
             Abortions in the PHC areas in Krishna and Guntur districts
             Of Andhra Pradesh.

S.No. Suggestions                 Krishna    Guntur      Total
                                  District   District

1.     Good MTP theatre
       with all facilities is        9          1         10
       essential
2.
       Trained and qualified         9          3         12
       doctors/staff must
       conduct MTP
3.
       Qualified lady doctors        8          3         11
       must be appointed to
       conduct MTP cases
4.
       Reproductive Health           2          6          8
       Education and on
       MTP to the women is
       essential

5.     Quacks role to                9          9         18
       conduct MTP must be
       avoided, fixing of
       referral hospital for
       MTPs, safe abortions,
       and recording of
       MTPcases, promotion
       of FP and provision of
       all facilities at PHCs
       and others if any.                -      4          4
6.
       No response
                                     : 15 :

II.      THE FACILITIES AVAILABLE AND THE PERFORMANCE OF
         ABORTIONS AT DIFFERENT HEALTH INSTITUTIONS IN
         KRISHNA AND GUNTUR DISTRICTS OF ANDHRA PRADESH

Methodology & Results and Discussions:
               In the study on “the need assessment of abortions in
Andhra Pradesh ” the information is collected from different sources to
assess the actual demand for abortion in both Krishna and Guntur
districts of Andhra Pradesh.         The information regarding the facilities
available and performance of abortions at various randomly selected
health institutions such as Community Health Centres (CHCs) District
Hospitals and Private Hospitals covering all the different places in the
two districts of Andhra Pradesh are collected to assess the actual
demand for abortions in these health institutions. Since these hospitals
are also considered as referral hospitals for the MTP cases, a study of
these hospitals helps significantly in understanding the topic under
study better. The following are the different public and private health
institutions studied in the two districts of Andhra Pradesh for the
purpose of the study. The list of Government and private hospitals
selected for the abortion study in Krishna and Guntur districts of Andhra
Pradesh is given under the APPENDEX – I of the report.

                The study covers altogether 26 Government hospitals (14
in Krishna and 12 in Guntur district) constitute the Community Health
Centres (CHCs), District and area hospitals. 25 Private Nursing Homes
(13 in Krishna and 12 in Guntur district) are also selected in both
Krishna and Guntur districts of Andhra Pradesh for the purpose of the
study.    The   medical   officers    and     practitioners   of   the   respective
Government and private hospitals are considered, as the respondents to
collect information on need assessment of abortions in their respective
institutions. In the event of the non-availability of the
                                : 16 :
Medical officers, the information is collected from the other responsible
health or paramedical staff in only one government hospital in Krishna
district.

Table – 1: Distribution of the number of pregnancy cases admitted
            During last one year according to the type of hospitals in
            Krishna and Guntur districts of Andhra Pradesh .

S.No. No.of Pregnancy cases        Krishna         Guntur          Total
      admitted during the        Govt. Pvt.     Govt. Pvt.     Govt. Pvt.
      last one year              Hosp Hosp      Hosp Hosp      Hosp Hosp
                                 itals  itals   itals  itals   itals   itals
1.        1 – 50                   3      3       2      -       5       3

2.        51 – 100                 3       1      1       -       4      1

3.        101 – 500                4       9      7      12      11      21

4.        501 +                    4       -      2       -       6      -

5.        Total                    14     13      12     12      26      25


             When a question is asked to know the number of pregnancy
cases admitted to the hospitals during the last one-year period, it is
noticed that a majority of the government and private hospitals are
reporting 101- 500 pregnancy cases. The number of pregnancy cases
admitted during the last one year is found to be more in the case of
private hospitals in contrast to government hospitals in both Krishna
and Guntur districts of Andhra Pradesh.         Some of the government
hospitals in Krishna district are registering more than 500 pregnancy
cases during the last one-year period (6 out of 26). Only a few of the
government hospitals (9 out of 26) and private hospitals (4 out of 25) are
recording pregnancy cases of less than 100 during the last one-year
period.
                               : 17 :

Table – 2: Distribution of Hospitals according to the pregnancy
             Outcome in the last one year in Krishna and
             Guntur districts of Andhra Pradesh.


S.No. Pregnancy outcome in         Krishna         Guntur          Total
      the last one year          Govt. Pvt.     Govt. Pvt.     Govt. Pvt.
                                 Hosp Hosp      Hosp Hosp      Hosp Hosp
                                 itals  itals   itals  itals   itals   itals
1.     No of Live Births
           1 – 50                   3      3      2       -        5     3
          51 – 100                  3      1      1       -        4     1
          101 +                     8      9      9      12       17    21



2.     No. Still Births
          Nil                       1      2      5       7        6     9
             1                      7      4      1       -        8     4
             2                      6      7      6       5       12    12

3.     No. Abortions
        Nil                         6      3      4       1       10     4
        < 10                        5      5      6       1       11     6
        11 +                        3      4      2      10        5    14


      Table – 2 clearly reveals that among all the deliveries, more than
95 percent of them are leading to live births in all the hospitals in the
districts covered. Most of the hospitals (17 government and 21 private
hospitals) in the two districts are having more than 100 deliveries in
their hospitals. The observation also reveals that slightly more number of
private hospitals in Krishna (9 out of 13) and Guntur (12 out of 12)
districts are conducting more than 100 deliveries in the last one year
period in contrast to government hospitals (8 out of 14 in Krishna and 9
out of 12 in Guntur district). But it is surprising to note that in almost
all the government and private hospitals, some of the deliveries are
leading to still births and abortions. Even though their proportions
                                 : 18 :
are very less, the prevalence of these still births and abortions in the case
of both government and private hospital deliveries in the last one year
period is a cause for alarm and this has to be reduced to the extent
possible to avoid human wastage.
Table – 3: Distribution of Hospitals according to the number of MTPs
              In Krishna and Guntur districts of Andhra Pradesh.

S.No. No. of MTP cases in the       Krishna          Guntur          Total
      last one year period        Govt. Pvt.      Govt. Pvt.     Govt. Pvt.
                                  Hosp Hosp       Hosp Hosp      Hosp Hosp
                                  itals  itals    itals  itals   itals   itals

1.        Nil                        4      2       2       -      6       2

2.        1 – 50                     7      7       8      1       15      8

3.        51 +                       3      4       2      11      5      15

4.        Total                     14     13      12      12      26     25



      Table – 3 brought out that most of the government and private
hospitals are conducting MTPs (abortions) in both Krishna and Guntur
districts alike in Andhra Pradesh. In Krishna district, a majority of the
hospitals both private (7 out of 13) and government (7 out of 14) are
doing less than 50 MTP cases during the last one year. In Guntur
district, 8 out of 12 government hospitals and 1 out of 12 private
hospitals are conducting less than 50 MTP cases in the last one-year
period.     But only 3 out of 14 government hospitals and 4 out of 13
private hospitals in Krishna district, whereas 2 out of 12 government
hospitals and 11 out of 12 private hospitals in Guntur district are doing
more than 50 MTP cases in the last one year period. Since a sizable
proportions of the MTP both government and private hospitals do cases
with some variations in Krishna and Guntur districts of
                               : 19 :
Andhra Pradesh, efforts must be directed to see that the abortions
performed in these hospitals are safe.

      It has been noticed that most of the government and private
hospitals are not having recorded particulars on age and educational
background of the MTP acceptors or cases in both the districts covered
under the study.    However, some 9 government hospitals (CHCs and
District/area hospitals) in Krishna District alone are providing only age
particulars of the MTP cases of their respective hospital cases. Among all
the 154 MTP cases spreading over 9 government hospitals in Krishna
district of Andhra Pradesh, a majority of the women falls in the age group
of 21-30 years (57 percent) followed by a lesser proportion of the cases
coming under less than 20 years of age (36 percent). Only a few of the
MTP cases are in the age of more than 30 years (7 percent). This clearly
reveals that significantly very high proportions (93 percent) of the young
women in the less than 30 years of age are accepting MTPs which will
include both married and unmarried women categories. So, all these
young women under- going MTPs at their young ages of less than 30
years must be provided with safe abortions to avoid abortion related
complications in their reproductive careers.
                                 : 20 :
Table – 4: Distribution of Hospitals according to the facilities
              available for conducting MTPs in Krishna and
              Guntur districts of Andhra Pradesh.
S.No. Type of facility for MTPs       Krishna        Guntur            Total
       in hospitals                Govt. Pvt. Govt. Pvt.           Govt. Pvt.
                                   Hosp Hosp Hosp Hosp             Hosp Hosp
                                    itals  itals  itals   itals    itals   itals
1.     Theatre with all the          13     12      9      12       22      24
       required facilities(D&C
       set)

2.     Suction      evacuator/      10       8      7      11       17      19
       M.R.Siringe/bending
       table/others

3.     Sufficient facilities to      2       3      5       8        7      11
       conduct MTPs

4.     No separate facilities        2       5      2       -        4      5
       are available in the
       hospital/other reasons

      In table – 4, most of the government (22 out of 26) and private
hospitals (24 out of 25) are reported having MTP theatre with all the
required facilities such as D & C set in both Krishna and Guntur
districts of Andhra Pradesh. And many of the government (17 out of 26)
and private hospitals (19 out of 25) in the two districts are also having
suction evacuator, M.R.Siringe, bending table and others to conduct
MTPs in their hospitals with one or the other item missing for the
purpose. A few government (7 out of 26) and private hospitals (11 out of
25) are revealing that they are having all the required facilities to conduct
MTPs in their hospitals. At the same time very few hospitals (4out of 26
in government and 5 out of 25 in private hospitals) are also informing
that they are not having sufficient facilities to conduct MTPs in their
respective hospitals. The findings shows that a majority of the
government and private hospitals with little variations in between
Krishna and Guntur districts in Andhra Pradesh are having the
                                : 21 :
required minimum facilities to conduct MTPs in their respective
hospitals.
Table – 5: Medical officers / Practitioners opinion on sufficient
             Facilities to conduct MTPs in hospitals in Krishna
             and Guntur districts of Andhra Pradesh.

S.No. Sufficiency of the            Krishna         Guntur          Total
      facilities available in     Govt. Pvt.     Govt. Pvt.     Govt. Pvt.
      the hospitals               Hosp Hosp      Hosp Hosp      Hosp Hosp
                                  itals  itals   itals  itals   itals   itals
1.     Yes                          7     13      10     12      17      25

2.     No                           7       -      2       -        9     -

3.     Total                        14     13     12       12       26   25

      Table – 5 points out clearly that apart from a few government
hospitals in Krishna (7 out of 14) and Guntur (2 out of 12) districts of
Andhra Pradesh, almost all the remaining hospitals are having sufficient
facilities to conduct MTPs (abortions) in their respective hospitals in both
the districts. Situation seems to be better in private hospitals in contrast
to government hospitals in both Krishna and Guntur districts of Andhra
Pradesh with regard to the availability of having sufficient facilities to
conduct MTPs (abortions) in the hospitals. The findings reveals that some
of the government hospitals of nearly half of them in the case of Krishna
(7 out of 14) and very few of them in the case of Guntur district (2 out of
12) needs better facilities for the safe conduct of MTPs (abortions) in such
hospitals.
               When the medical officers / practitioners are drawn their
attention to know the facilities required in their hospitals to conduct
MTPs, only 7 government hospitals in Krishna district and 2 government
hospitals in Guntur district are expecting to have needed facilities in
their hospitals to conduct MTPs. The required facilities
                                 : 22 :
seems to be bending table, Hemoglobinometer , M.R. Siringe , suction
operator and trained lady doctor in a majority of the government
Hospitals in Krishna district (3-7 hospitals) and one government hospital
in Guntur district of Andhra Pradesh. Only two government hospitals in
Krishna district are expecting to have all the needed facilities to conduct
MTPs in their hospitals because at present they are not having any
facility what so ever to conduct MTPs in their hospitals. The findings
reveals that some of the government hospitals which requires facilities
listed above in Krishna and Guntur districts needs to be provided to
conduct MTPs (abortions) safely in the hospitals.
              Opinions of the medical officers / practitioners with regard
to the availability of sufficient staff in the hospitals to conduct MTPs in
Krishna and Guntur districts reveals that almost all the government (22
out of 26) and private (25 out of 25) hospitals are having sufficient staff
to perform abortions in their respective hospitals except four government
hospitals of two each in Krishna and Guntur districts where there are no
sufficient staff to do MTPs in their hospitals. The private hospitals in
both the districts seems to be in better position in the case of having
sufficient staff to conduct MTPs (abortions) in their hospitals. Further,
the four government hospitals of two each in Krishna and Guntur
districts of Andhra Pradesh who needs staff to conduct MTPs are
expecting to have a trained or qualified lady medical officer in their
hospitals for this purpose.
            Regarding the supply of medicines to treat the MTP cases in
the hospitals in both the districts of Andhra Pradesh are concerned,
almost all the government (24 out of 26) and private (25 out of 25)
hospitals in Krishna and Guntur districts are having sufficient supply of
medicines to treat the MTP cases except two government hospitals in
Guntur district (2 out of 26) where there is no sufficient supply of
medicines for this purpose. The supply of medicines to treat the MTP
                              : 23 :
cases are an essential requirement to the hospitals to promote safe
abortions to rural women in the countryside . When the medical officers
/ practitioners are questioned about the requirement of medicines to
treat the MTP cases in the hospitals in the two districts of Andhra
Pradesh, only two government hospitals in Guntur district are expecting
to have medicines to treat MTP cases immediately. The findings reveals
that most of the government and private hospitals in Krishna and
Guntur districts of Andhra Pradesh are not expecting to have any
medicines to treat the MTP cases in their respective hospitals as they are
having sufficient medicines for better treatment of MTP cases.
Table – 6: Medical officers / practitioners opinion on the medical
            advise given to MTPs in hospitals in Krishna and
            Guntur districts of Andhra Pradesh.
S.No. Type of Medical Advise          Krishna        Guntur         Total
                                   Govt. Pvt. Govt. Pvt. Govt. Pvt.
                                   Hosp Hosp Hosp Hosp Hosp Hosp
                                   itals   itals  itals   itals itals   itals
1.     Advise     on      Family      9     11     10      12    19      23
       Planning

2.     Explain about the               5   4       1      4       6      8
       complications of illegal
       abortion and quacks

3.     Examine the case and            7   1       -      -       7      1
       refer to the Referral
       Hospital for treatment

4.     Check-up bleeding,
       treatment and do                4   -       -      7       4      7
       follow-up services

5.     Better to go for MTP            3   7       4      7       7      14
       before 3 months

6.     Avoid unwanted                  6   5       4      11     10      16
       pregnancy and use
       medicines
                                 : 24 :
      Table – 6 explains that the medical advise to the MTPcases in both
government and private hospitals in Krishna and Guntur districts seems
to be advise on family planning in general and spacing methods in
particular; avoid unwanted pregnancies and use medicines, explain
about the role of quacks and the complications arising out of
mishandling of MTP cases, examine the MTP cases and refer to the
referral hospitals if needed, advise the MTP cases to go for MTP before 3
months to avoid complications and the last one is check up the bleeding
etc give treatment as well as follow up services. These were the medical
advises given to the MTP cases in the hospitals with little variation in
between government and private hospitals in Krishna and Guntur
district of Andhra Pradesh. The Medical Officers and Practitioners are
expected to note all these MTP problems to give better and timely advise
to them to avoid problems arising out of the MTP complications.
                               : 25 :

Table – 7: Medical officers/ practitioner‟s opinion on the type of
            follow up services provided to MTP cases at hospitals
            in Krishna and Guntur districts of Andhra Pradesh.

S.No. Type of follow-up              Krishna         Guntur          Total
      services in the              Govt. Pvt.     Govt. Pvt.     Govt. Pvt.
      hospitals                    Hosp Hosp      Hosp Hosp      Hosp Hosp
                                   itals  itals   itals  itals   itals   itals
1.     Check-up the cases,          10     11       3     11      13      22
       bleeding its and give
       treatment

2.     Give Medicines and               10   8      4      10      14     18
       advises on MTPs

3.     Tell the MTP case to             5    2      3      10      8      12
       come to the hospital
       regularly for treatment

4.     Provide good follow-up           2    2      4      10      6      12
       services

5.     Refer to the referral
       hospitals in the case of         3    1      -       -      3       1
       complications

6.     Advise on F.P.and
       Spacing Methods.                 1    2      1       -      2       2


      Table – 7 reveals that slightly higher proportion of the private
hospitals in addition to the lower proportion of government hospitals in
both Krishna and Guntur districts of Andhra Pradesh are extending the
following follow up services to the MTP cases done in their hospitals.
They are „ check up the MTP cases, bleeding etc and give treatment „,
„ advises on MTPs and gives medicines if required „, „ inform the MTP
cases to come to the hospital for treatment regularly „ , „ providing all the
required good follow-up services to the MTP cases „ , „ advise on family
planning in general and spacing methods in particular and the
                                 : 26 :
last one is referring to the referral hospitals in case of complications of
the MTP cases. These follow-up services listed clearly reveals the good
follow-up services rendered by government and private hospitals in
Krishna and Guntur districts of Andhra Pradesh towards the MTP cases
done by such hospitals.

Table – 8: Medical officers / practitioners opinion on promoting MTP
             Counseling to the women in the hospitals in Krishna and
             Guntur districts of Andhra Pradesh.


S.No. Promotion of MTP             Krishna         Guntur          Total
      counseling                 Govt. Pvt.     Govt. Pvt.     Govt. Pvt.
                                 Hosp Hosp      Hosp Hosp      Hosp Hosp
                                 itals  itals   itals  itals   itals   itals
1.     Yes                        12     11       8     10      20      21

2.     No                          2       2      4       2      6       4

3.     Total                       14     13      12     12      26     25



      Table – 8 explains that a majority of the government and private
hospitals in both Krishna and Guntur districts in Andhra Pradesh are
extending MTP counseling to the women attending to their hospitals.
Only a few government and private hospitals in both the districts are not
providing any MTP counseling to the women visiting their hospitals. The
findings reveals that the provision of MTP counseling in government and
private hospitals seems to be better in both Krishna and Guntur districts
of Andhra Pradesh.
                                    : 27 :

     Table – 9: Medical officers / practitioners opinion on the approximate
                 demand for MTPs in one year in the hospitals in Krishna
                 and Guntur districts of Andhra Pradesh.

S.No.       Demand for MTP in one         Krishna         Guntur          Total
            year                        Govt. Pvt.     Govt. Pvt.     Govt. Pvt.
                                        Hosp Hosp      Hosp Hosp      Hosp Hosp
                                        itals  itals   itals  itals   itals   itals
1.          Nil                           -      -       2      -       2       -

2.          < 25                             5   1      4       -       9      1

3.          26 – 50                          3   2      3       -       6      2

4.          51 – 100                         4   2      3      11       7      13

5.          101 +                            2   8       -     1        2      9



           Table – 9 brings to forward that the approximate demand for MTPs
     in one year in both government and private hospitals seems to be around
     100 cases in both Krishna and Guntur districts of Andhra Pradesh. In
     the case of the government hospitals in both the districts a majority of
     the hospitals are having MTP demand of less than 100 cases in the last
     one year in contrast to the private hospitals. However, among some of the
     hospitals where the demand for MTP appear to be more than 100 cases,
     the private hospitals seems to be more in number in contrast to the
     government hospitals.    The finding reveals that most of the hospitals
     irrespective of the type of hospital are getting MTP cases of less than 100
     in the last one year in both the districts. Most of the government
     hospitals with less than 100 MTP cases and a majority of private
     hospitals with more than 100 MTP cases in the last one year is found to
     be the approximate demand for MTPs in both Krishna and Guntur
     districts of Andhra Pradesh.
                                       : 28 :

3. CONCLUSIONS AND IMPLICATIONS:


                The conclusions for this article are drawn from the study to know the
various facilities available at the PHCs to conduct the MTPs in a total of 28 PHCs of 15
PHCs in Krishna and 13 PHCs in Guntur districts of Andhra Pradesh selected on random
basis to cover the entire two districts. The findings reveal that the demand for MTPs in
the PHCs in the two districts studied is very poor. The number of MTPs conducted during
the last one year among the recorded five PHCs reveals that it is around 25 in number.
The medical officers in the PHCs are conducting these abortions. Only one PHC is able
to give the age and educational particulars of MTP cases in the two districts studied in the
state. All the MTP cases fall in between 20-30 years and are illiterate women. The
available facilities at the PHCs to conduct abortions seems to be very poor and needs to
be improved to a greater extent. But with regard to the referral cases of MTPs are
concerned, many of the PHCs in the two districts are referring quite a good number of
MTP cases to the nearby CHCs for treatment. So, there is potential need to strengthen
these referral community health centres to conduct referral MTPs better as they are
supplied from the nearby PHCs. The age and educational particulars of the referral MTPs
reveals that it includes a sizable proportions of both unmarried and married categories of
less than 30 years of age of the women. And even though most of the women are
illiterates some of them are having primary and secondary education too. The study
further reveals that the private hospitals in general and the quacks in particular are able to
attract more of MTP cases in the villages in contrast to the government health centres. So,
most of these cases might be illegal abortions which are not safe and are more prone to
diseases and deaths later. The important stated reasons for availing the abortion services
from the private hospitals and quacks in the rural areas seems to be the availability of
better facilities to conduct MTPs in such places. So, the confidence of having better
abortion facilities available with the private hospitals and among the quacks might be an
important factor in attracting more MTPs in the rural areas to such places in contrast to
the governmental health centres and hospitals. The approximate demand for MTPs to
PHCs in the villages seems to range from 1-100 cases in one year. The demand
fluctuations vary from one PHC to the other PHC as the demand in some places may be
more and it may be negligible in certain places. So, depending upon the demand for
MTPs in that particular area or PHC, there is the need to establish such MTP clinics for
the benefit of the needy poor rural women. It is interesting to note the various suggestions
given by the medical officers for safe conduct of abortions in the rural areas such as 1.
The qualified and trained doctor or staff should conduct MTPs in the hospitals / PHCs, 2.
The PHCs must be provided with good MTP theatre with all required equipment‟s and
facilities, 3. A qualified lady medical officer preferably must involve in conducting MTPs
at PHCs, 4. Referral hospitals for MTPs must be fixed 5. Promotion of the use of family
planning and spacing methods in particular, 6. Reducing the role of quacks in conducting
the MTPs and 7. Bringing proper awareness on reproductive health issues among the
rural women to take proper precautions are some of the important suggestions worth
noting. The reproductive health information, education, and communication to the rural
                                      : 29 :

Women with special reference to safe abortions at PHCs are an essential prerequisite to
keep them healthy in their life.

            The information regarding the facilities available and performance of abortions
at randomly selected health institutions such as Community Health Centres (CHCs),
District hospitals and private hospitals covering all the different places in the two districts
of Andhra Pradesh are collected to assess the actual demand for abortions in these health
institutions. The study covered altogether 26 Government hospitals (14 in Krishna and 12
in Guntur districts) constituting the Community Health Centres (CHCs), District and area
hospitals and 25 private nursing homes (13 in Krishna and 12 in Guntur districts) in both
the districts studied in Andhra Pradesh. The medical officers of the health centres are the
main respondents of this study. The major findings of the study reveals that the private
hospitals are getting more of pregnancy cases for delivery in the last one year in contrast
to government hospitals. It is found that a majority of the hospitals are reporting 100- 500
pregnancy cases in one year. It is also found that both government and private hospitals
do sizable proportions of MTP cases with some variations in Krishna and Guntur districts
of Andhra Pradesh. But it is surprising to note that most of the government and private
hospitals are not having recorded particulars on age and educational background of the
MTP acceptors or cases in both the districts covered under the study. The available
recorded evidence reveals that the age of the MTP cases is in between 21-30 years and a
majority of the women are under illiterate category.

                 Regarding the facilities to conduct MTPs in both government and private
hospitals of these two districts of A.P. are concerned, a majority of them are having
required minimum facilities to conduct MTPs in their respective hospitals. It is
heartening to observe that some of the government hospitals in both the districts are not
having sufficient facilities to conduct MTPs in their hospitals. Regarding the MTP
facilities, the situation seems to be slightly better in private hospitals in the two districts
covered in this respect in Andhra Pradesh. So, all the government hospitals in the two
districts must be well equipped to conduct safe abortions in their respective hospitals. All
the government and private hospitals in both the districts of A.P. except in a few of them
are having sufficient staff and medicines to undertake MTPs in their hospitals. However,
the staff position and the availability of medicines seems to be far better in the case of
private hospitals in contrast to the government hospitals in the study area in providing the
MTP services to the people in both the districts of A.P. The medical advises for MTP
cases in hospitals are found to be 1. Advice on the use of family planning and spacing
methods 2. Avoid unwanted pregnancies 3. Explain about the role of quacks and the
complications arising out of the mishandling of the MTP cases 4. Examine the MTP
cases and refer to the referral hospitals if needed 5. Advice the MTP cases to go for MTP
before three months to avoid the complications and 6. Check the bleeding etc. and give
treatment as well as follow up services. The private hospitals are doing better follow up
services and MTP counseling to the women visited to their hospitals in contrast to the
government hospitals in both the districts studied here. The estimated demand for
induced abortions in the two districts of A.P. appears to be less than 100 in the case of
                                     : 30 :

government hospitals and it is more than 100 cases in the case of private hospitals during
the last one-year period.

               The policy implications of the abortion study reveals that since there is
growing demand for MTPs from the villages, each PHC must be well equipped with good
MTP clinics to cater to the abortion needs of the rural people. Every PHC must keep a
record of the MTP cases done in their hospitals enlisting all the required information of
the MTP cases done in their hospitals. At present most of the health centres and hospitals
are not keeping these MTP records properly and even the available records are having lot
of gaps with out filling. Further a majority of the illegal abortions done by the quacks in
the rural areas are found to be not recorded and are done with out any evidence and
records. If all these abortion cases are recorded, then it may be possible to assess the
actual demand for the induced abortions from the villages in particular. It has been
noticed that some of the PHCs are referring a sizable proportions of the MTPs to the
nearby referral hospitals for better treatment and services. So, the referral hospitals must
be well equipped to conduct the MTPs to the extent possible to serve the community
better. Well-qualified lady medical officer must be appointed to conduct MTP cases in
the referral hospitals. Since a majority of the MTPs are unmarried and married young
women, these women must be properly advised to go for safe abortions before three
months of pregnancy and with less complications and to avoid going for induced
abortions by accepting family planning methods earlier. The good MTP facilities at
government hospitals will definitely reduce the induced abortions conducted by quacks in
the rural areas and save them from becoming victims of disease and death. Since the
private hospitals are having better MTP facilities and qualified staff, most of the women
are taking abortion services from these hospitals. The strengthening of the government
health centres and hospitals with all the required MTP facilities, equipment‟s and staff
may attract many of the rural women to take MTP services from these hospitals and helps
them to accept safe induced abortions with less complications and with less cost too. This
will also avoid many of the women to visit quacks in the rural areas and to avail safe and
better abortion services.
                                    : 31 :


Reference:

1. Sundhya Barge, Manjunath Kini & Sunita Nair “ situation analysis of MTP facilities
   in Gujarat ” Working paper No. 4 Centre for Operations Research and Training
   (CORT), Baroda, 1994. Pages 1-23.

2. National Family Health Survey (NFHS), (MCH and family planning)- Andhra
   Pradesh – 1992 PRC, A.U., Visakhapatnam & IIPS, Mumbai, May 1995, page 64.

3. Model registration scheme- survey of causes of death (Rural) 1984, 1986 & 1989 – A
   Report, series 3, No.17 & 19 & 22 statement no. xx, Registrar General, India, New
   Delhi.

4. YEAR BOOK – 1991-92 „ Family Welfare Programme in India, Department of
   Family Welfare, Ministry of Health and Family Welfare, Government of India, New
   Delhi, Page – 147.
                                 : 32 :

                             APPENDEX – 1


Krishna District


List of Public Institutions           List of Private Institutions
1. Community        Health   Centre, 1.      Karuna      Nursing    Home,
   Nuzivedu.                                 Avanigadda.
2. University General Hospital, 2.           Laxmi      Nursing     Home,
   Vijayawada.                               Vijawada.
3. Community        Health   Centre, 3.      Sri Vijetha Nursing Home,
   Gannavaram.                               Gannavaram.
4. Community        Health   Centre, 4.      Srinivasa Nursing Home,
   Nandigama.                                Nandigama.
5. Community        Health   Centre, 5.      Sushma Mother and Child
   Jaggaiah peta.                            Nursing                Home,
6. Community        Health   Centre,         Jaggaiahpeta.
   Vuyyur.                            6.     Pinnamaneni Nursing Home,
                                             Vuyyur.
7. Community        Health   Centre,
   Challapalle.                       7.     Shanti     Nursing     Home,
8. Community        Health   Centre,         Challapali.
   Avanigadda.                        8.     Sri    Nageswara      Nursing
9. District                 Hospital,        Home, Machilipatnam.
   Machilipatnam.                     9.     Kavinew     Nursing    Home,
10.Community Health Centre,                  Kaikalur.
   Kaikalur.                          10. Kodanda         Rerna    Nursing
11.Govt. Area Hospital, Gudiwada.            Home, Gudiwada.
12. Govt. Hospital, Tiruvuru.         11. Vijaya        Nursing     Home,
13.Community Health Centre,                  Tiruvur.
   (upgraded), Talledevapalu.         12. Lingamaneni Nursing Home
14.Community Health Centre,                  Kathipudi centre (Mova)
   Vengutur.                          13. Vijaya        Nursing     Home,
                                             Nuziveedu.
                              : 33 :

                           Guntur District

List of Public Institutions         List of Private Institutions
1. Government Hospital, Guntur.     1. Venkateswara Nursing Home,
2. Government Hospital, Bapatla.       Mangalagiri.
3. Community Health Centre,         2. Nagarjuna Nursing Home,
   Chilekaluripeta.                    Chilakaluripeta.
4. Community Health Centre,         3. Padmavati Nursing Home,
   Repalle.                            Tenali.
5. Government Hospital,             4. A Private Nursing Home,(actual
   Mangalagiri.                        name is not noted) Guntur.
6. Government Hospital,             5. Raghavaiah Memorial Nursing
   Narasaraopeta.                      Home, Repalle.
7. Community Health Centre,         6. Pragati Nursing Home,
   Ponnuru.                            Sattenapalle.
8. Community Health Centre,         7. Venkateswara Nursing Home,
   Macherla.                           Narasaraopeta.
9. Government Hospital, Gurajala.   8. Praja Vydyasala, Ponnur.
10.Government Hospital,             9. Prasanti Nursing Home,
   Vimukonda.                          Bapatla.
11.Government Hospital              10.Dr.K.N.Murty, Padmavathi
   Sattenapalli.                       Nursing Home, Macherla.
12.Government Hospital, Tenali.     11.Suneetha Nursing Home,
                                       Gurujala.
                                    12.Vinukonda Nursing Home,
                                       Vinukonda.




                         ******************
                INDUCED ABORTIONS IN ANDHRA PRADESH-
            A study in Krishna and Guntur districts of Andhra Pradesh, India.


                                                    Dr.M.M.Krishna Reddy *

                                         Abstract

                    An attempt to study the status of induced abortions from the point of
view of both Government and private health institutions such as PHCs, hospitals and
private nursing homes or medical practitioners respectively in Krishna and Guntur
districts of Andhra Pradesh is made on a randomly drawn sample during the August,
1999. The important findings are that only a few PHCs in the two districts are conducting
abortions in their health centres. This clearly reveals the poor demand to abortions in the
case of PHCs. But majorities of the PHCs are referring the MTP cases to the nearby
referral hospitals for treatment. This trend clearly reveals the greater demand for induced
abortions from the rural villages of the two districts. The lack of sufficient facilities and
poor availability of qualified lady doctors in the health centres are discouraging the rural
women to visit these centres to avail the MTP facilities there. At the same time the
availability of better facilities and qualified lady doctors in the private nursing homes are
able to attract many of the MTP cases from the rural villages. In this respect the quacks
are able to manage more number of MTP cases and all these illegal abortion cases are
leading to abortion related complications and suffering even at the cost of their lives. All
these finding clearly reflects the need to equip the PHCs and Hospitals with all required
facilities to conduct safe abortions by appointing the qualified lady doctors in those
hospitals. There is the immediate need to establish MTP clinics in every PHC and all the
referral hospitals will be well equipped with advanced MTP facilities by appointing a
well-qualified lady medical officers. This will definitely go a long way to solve the
demand for abortions in the rural areas. Further many of the Government health centres
or Hospitals and private nursing homes are not maintaining the MTP registers and
records properly. The MTP registers and records must be maintained properly in the
Government health centres, hospitals and private nursing homes through updating and
effective supervision measures to know the status of induced abortions in different
districts in the state. Further the available recorded MTP cases reveals that most of them
are young women of both unmarried and married categories and are either illiterates or
studied up to primary education coming from the poor families of the rural villages.
These women need proper education and awareness on reproductive health issues in
general and conduct of abortions in particular to go for safe abortions with fewer
complications. They need proper MTP counseling in the matter of preventing abortions
before through the practice of different family planning measures and accepting abortion
before three months in the case of unwanted pregnancies.


-----------------------------------------------------------------------------------------------------------
* Research Investigator, Population Research Centre, A.U. Waltair-530 003, A.P.
     INDIA.

				
DOCUMENT INFO
Shared By:
Categories:
Stats:
views:5
posted:2/20/2011
language:English
pages:35