10 key takeaways from the Lancet study on abortions in India

According to the first national study of the incidence of abortion and unintended pregnancy in India, an estimated 15.6 million abortions were performed in the country in 2015. This translates to an abortion rate of 47 per 1,000 women aged 15–49, which is similar to the abortion rate in neighboring South Asian countries. The study—published in The Lancet Global Health—was conducted jointly by researchers at the International Institute for Population Sciences (IIPS), Mumbai; the Population Council, New Delhi; and the New York-based Guttmacher Institute. It also found that the vast majority of abortions (81%) were achieved using medication abortion (which, in India, is commonly referred to as medical methods of abortion, or MMA) that was obtained either from a health facility or another source. Fourteen percent of abortions were performed surgically in health facilities, and the remaining 5% of abortions were performed outside of health facilities using other, typically unsafe, methods.

The study also estimated the incidence of unintended pregnancy in India and found that out of the total 48.1 million pregnancies in 2015, about half were unintended—meaning they were wanted later or not at all. The estimated unintended pregnancy rate was 70 per 1,000 women aged 15–49 in 2015, which is similar to the rates in neighboring Bangladesh (67) and Nepal (68), and much lower than the rate in Pakistan (93).

10 key takeaways from the Lancet study on abortions in India

• This is the first comprehensive national study of the incidence of abortion and unintended pregnancy in India. Although abortion has been legal under a broad range of circumstances since 1971, there has never before been a study specifically designed to measure national abortion incidence in India.


• An estimated 15.6 million abortions occur annually in India.


• Almost half of the 48.1 million pregnancies that occur in India each year are unintended.Two-thirds of all unintended pregnancies end in abortion.


• The national abortion rate in India is 47 per 1,000 women of reproductive age, which is similar to abortion rates in Pakistan (50), Nepal (42) and Bangladesh (39).


• Close to one in four abortions in India (22%) are provided in health facilities. Almost three in four abortions (73%) are obtained independently through purchasing medical methods of abortion from a chemist or informal vendor. The remaining 5% are obtained using various methods that are often dangerous.


• Medical methods of abortion (MMA)—using a combination of mifepristone and misoprostol—account for four in five abortions in India. Medical methods of abortion are safe and effective when used in accordance with World Health Organization guidelines.


• Only 5% of abortions in India occur in public health facilities, which are a key source of health care for poor and rural women.


• The majority of primary health centers and substantial proportions of community health centers, the most common types of public health facilities in India, do not offer abortion services. The most common reasons reported for not providing abortion services are lack of trained staff and lack of necessary equipment or supplies.


• The researchers propose various steps to increase the availability of abortion services in health facilities, such as:


• Training more doctors to provide abortions


• Expanding the number of approved abortion providers by permitting and training nurses, auxiliary nurse midwives, and AYUSH doctors to provide medical methods of abortion


• Equipping health facilities with necessary equipment and supplies so that they can provide surgical abortions and medical methods of abortion


• The study’s findings on unintended pregnancy suggest that there is the great need for improvements in contraceptive services so that programs can better help women and couples avoid pregnancies they do not want.

“Although abortion has been legal under a broad range of criteria in India since 1971, we have never had a reliable estimate of the number occurring until now,” says Dr. Chander Shekhar, professor in the Department of Fertility Studies at IIPS and co-principal investigator of the study. “This new evidence provides policymakers with information that is essential for designing and implementing effective reproductive health care programs.”

Unlike previous research on this topic, this study is the first specifically designed to measure the national incidence of abortion in India. The researchers used two direct methods for measuring incidence. One was compiling national sales and distribution data on MMA (mifepristone and mifepristone-misoprostol combipacks), which represents the vast majority of all abortions in India. The second was implementing a large-scale survey of public and private health facilities in six states—Assam, Bihar, Gujarat, Madhya Pradesh, Tamil Nadu and Uttar Pradesh—where close to half of the Indian women of reproductive age live. The number of abortions to women who used traditional methods was calculated using indirect measures.