Assessment of delayed termination of pregnancy in India: Evidence from National Family Health Survey, 2019-21

Background: Compared to first trimester abortions, those in the second trimester significantly contribute to maternal morbidity and mortality, particularly in low- and middle-income settings where access to safe second trimester abortion services is restricted. This study aimed to evaluate the prevalence and factors associated with induced second trimester abortions in India. Data and methods: Retrospective calendar data for 7,696 women aged 15-49 years from fifth round of National Family Health Survey (2019-2021) was used for the study. Bivariate analysis was conducted to determine the prevalence of second trimester abortion, while logistic regression was utilized to model the factors associated with second trimester abortion. Results: thirteen percent of all women who underwent an abortion had delayed their termination till second trimester. A significant proportion of women without children and without a male child were observed to have a high rate of delayed termination. The likelihood of terminating the pregnancy at an advanced gestational stage was also found to be higher among women who had no children or a male child. Conclusions: The findings emphasize the urgent need to address son-preference prevalent in certain regions of India. Again, to improve the reproductive health of women in India accessible and comprehensive abortion care is imperative to prevent delays that could exacerbate complications and add many fold risks to women's health. Furthermore, there is a need for strengthened governmental initiatives, especially targeting underprivileged communities, to encourage the uptake of contraceptives.