# Supporting self-managed abortion care in “practice not premise”: a qualitative study of provider perspectives, roles, and information pathways to care in India*

## TL;DR

This study examines how healthcare providers in India view and support self-managed abortion, finding that while they often prefer clinician-managed care, they still play roles in providing information and support for self-managed options.

## Contribution

The study provides new insights into provider roles and perspectives on self-managed abortion in India, highlighting pathways for improving reproductive health policies.

## Key findings

- Most providers accept abortion conditionally but encourage clinician-managed care over self-managed abortion.
- Providers support self-managed abortion by offering information, dispensing medication, and managing pain.
- Pharmacy workers and local providers often guide individuals toward self-managed abortion care.

## Abstract

This qualitative study explored provider perspectives on self-managed abortion (SMA) in India, their roles, and how they share information about pathways to both clinician- and self-managed abortion care. We conducted 33 semi-structured interviews with a range of providers (medical, community health, and pharmacy) in three states in India: Jharkhand, Bihar, and Tamil Nadu. Using thematic analysis, we examined provider perspectives on SMA, their involvement in abortion care, and how they contribute to information sharing around access pathways. We categorised findings by provider type, direction of care pathways, abortion modality (clinician-managed vs. SMA), and the kind of care delivered. Our findings showed most providers described abortion as conditionally acceptable and primarily encouraged clinician-managed care. Concerns about SMA safety and potential liability often led them to discourage SMA. Nonetheless, participants acknowledged three areas where providers played a role in SMA: providing information, dispensing medication, and providing support (i.e. managing pain). Pharmacy workers and local providers shared information with abortion seekers on pathways to access SMA care. Some community health workers directed clients to pharmacies, but more often only provided SMA information and support. Despite provider concerns, support for and pathways to SMA exist in India. Understanding the dynamics of provider perspectives and roles can inform improvements to comprehensive reproductive health policies and programmes in order to promote person-centred abortion care – including SMA – and address provider concerns. Synergies are needed between the formal health sector and SMA support networks to advance person experiences and reinforce quality abortion care as a human right.

This study explored how various healthcare providers in India perceive self-managed abortion (SMA). It also looked at how they provide information about both abortion by clinicians and SMA. We found that most providers accept abortion on some conditions. They generally recommend abortion by clinician rather than SMA. They have concerns about SMA safety and potential liability for themselves. Despite these concerns, providers still play supportive roles in SMA. These include offering information, dispensing medications, and helping with issues like managing pain. Pharmacy workers and local health providers often guide abortion seekers towards self-managed care options. Community health workers tend to direct individuals to pharmacies for SMA resources and support. The findings show that support structures and informational pathways exist. Integrating these into broader reproductive health policies could enhance person-centred abortion care. Addressing the concerns of providers would promote safer and more accessible abortion care. Understanding provider perspectives and roles in SMA can help to improve comprehensive reproductive health programmes. Increased collaboration between formal health services and community-based SMA support networks is needed.