BACKGROUND MATERIAL (Study design & methodology, documentation of review of ethics committee, preliminary data, facilitating tools)
Item
- Title
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BACKGROUND MATERIAL
(Study design & methodology, documentation of review of ethics
committee, preliminary data, facilitating tools) - extracted text
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DRAFT NOT TO BE QUOTED
BACKGROUND MATERIAL
(Study design & methodology, documentation of review of ethics
committee, preliminary data, facilitating tools)
for
The meeting of
MEMBERS OF THE RESOURCE GROUP
To discuss the plan of analysis
Scheduled on
Sat-Sun, July 20-21, 2002
At YMCA International, Mumbai Central
by the members of the project titled
ABORTION RATE, COST AND CARE:
A COMMUNITY BASED STUDY
ABORTION ASSESSMENT PROJECT - INDIA (AAP-INDIA)
Pune
July, 2002
II UM
MM—
I—JHIK.
\
TABLE OF CONTENT1
$
*
*
I.
DRAFT STUDY DESIGN AND METHODOLOGY
II.
ETHICAL REVIEW: REPORT AND CERTIFICATION
III.
GLIMPSES
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1 The report is presented in three sections. Each section carries a table of content, too at the beginning ot
respective sections.
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DRAFT NOT TO BE QUOTED
DRAFT STUDY DESIGN AND METHODOLOGY
FOR
ABORTION RATE, COST AND CARE:
A COMMUNITY BASED STUDY IN TWO STATES
by
CEHAT, Pune
June, 2001
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TABLE OF CONTENT
1. Aims and objectives
2. Methodologies in fertility surveys and abortion incidence research: A Literature
review
3. Sampling design
4. Conduct of the study
5. Problem solving & sharing learning through daily/regular in-group sharing
6. Training of the team (researchers/field investigators)
7. Pretesting the tools
8. Ethical issues and concerns
9. Concepts and definitions
10. Limitations of the study
11. References
12. Annexures:
■
Annexure I: Estimating sample size
Tools of data collection
■ Annexure II: Village profile/Area profile recorder
Annexure III. Interview schedule for household level information.
■ Annexure IV: Woman’s Interviews Schedule
Annexure V: Letter for the respondents seeking informed consent and
response to the checklist tabled to the IEC.
■ Other
■ Annexure VI: Concepts and definitions
■ Annexure VII: Reproductive and abortion morbidities
■ Annexure VIII: Post-abortion complications: Post-procedure time lapse,
type of illness and perceptible symptoms
■ Annexure IX: Measurements (Rates, ratios, averages, proportions and
estimations)
■ Annexure X: Refrences (used in Annexures VI to IX)
■ Annexure XI:^Abortion research in India
•
xj? : SoonyR ,p?r$pl'e.
■
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1. AIMS AND OBJECTIVES OF THE STUDY
Aims: The overall aims of the study will be to study analytically women’s health
problems and health care seeking behaviour with a focus on rate of abortion and
related issues. Further, the study will enable providing inputs/feedback to society at
large and to different stake holders including policy makers to facilitate women’s
access to safe, legal and affordable abortion care services.
Objectives: The specific objectives will be.
a) To arrive at estimates related to abortion incidence rate, such as,
■ To arrive proportion of women from reproductive age who have had at least
one abortion.
■ To arrive at estimates of rate of abortions, both spontaneous and induced.
■ To arrive at average number of abortions per woman.
b) To arrive at estimate of burden and nature of abortion related morbidity for
women.
c) To document indications of /reasons for seeking abortion and to analyse the
changing pattern, if any.
d) To study women’s abortion needs in the light of their socio-cultural milieu.
e) To study women’s choice of provider to meet abortion care needs.
f) To study expenditure patterns on abortion care.
This would entail studying the following:
1. Socio-economic profile of the family / household.
2. Pregnancy histories/experiences, including abortions (life time) of women in the
sample population, focusing on last two years, the recall/index period defined for
this study. Recording life time abortions for the entire sample would allow us to
examine the changing patterns as regards reasons of abortion and some other major
issues, such as, providers approached, use of contraception, incidence of repeat
abortions.
3. Causes of spontaneous abortion as perceived by women and reasons, including
socio-cultural and economic, for seeking abortion/s (induced).
4. How pregnancies and abortions are dealt with - types of providers and procedures
used, and cultural practices relating to women's behaviour during these events in
terms of work loads, social support or lack of it etc.
5. Mortality and morbidity (nature/type), if any, resulting from induced and
spontaneous abortion/s.
6. Household Expenditures on these events. We will try to obtain information on both
direct and indirect cost including social cost.
Objectives (d) to (f) will be studied for abortions that took place during the reference
period of three years.
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2. METHODOLOGIES IN FERTILITY SURVEY AND ABORTION
INCIDENCE RESEARCH: A LITERATURE REVIEW
2.1 Purpose and background
It would be inappropriate not to make any reference to the methodologies that have
surveys to study either fertility trends and/or abortion incidence and related issues with
a brief reference to the other types of studies, such as hospital based and estimating
rates using mathematical models.
The literature review shows that a range of methodologies have been used. There are
issues of concern vis-a-vis various aspects of methodology, viz: sampling design,
deciding upon the sample size enabling generalisation; under-reporting and methods to
deal with it; formulation of tools of data collection. The literature review clearly shows
the evolution of methods and approaches to overcome the problems in studying
abortion through large-scale community based household surveys of women. However,
some issues remain unresolved to date and apparently appear to be the inherent issues
and constraints of survey based abortion research. While doing the literature review,
we have made an attempt to understand implications of various issues for design of
methodology for the study that we are taking up to enable laying mechanism to
improve accuracy of data and results.
Different methods have been used to arrive at abortion incidence rates. These include
direct methods - hospital based or community based empirical research, or indirect
methods such as arriving at estimates using mathematical models based on the known
parameters related to fertility.
Mathematical models: In case of abortion incidence studies, it was Davis and Blake
(1956 cf Kanitkar and Radkar) who hypothesised that socio-economic factors affect
fertility through a set of intermediate variables starting from exposure to intercourse
upto a pregnancy ending in a live birth. Later Bongaarts (1983) modified the
framework and identified 8 proximate determinants of fertility. They relate to
biological or behavioural factors like marriage, frequency of intercourse, spontaneous
intrauterine mortality, induced abortions, post-partum infecundability, use and
effectiveness of contraception, permanent sterility and duration of fertile period. He
further argued that from among 8 variable, 4 explain 96 per cent variation in fertilify
and thus only those could be used in estimation of total fertility. Nortman (19-)
suggested a model, which a variant of Bongaart’s mathematical model. These models
have been used in the past to arrive at abortion rates where data on other concerned
variables are available. However, these can’t substitute the empirical research but
certainly complement it.
The clinic or hospital based studies: Given the known constraints of the clinic or
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hospital based studies to capture the extent of abortion incidence, researchers strived,
especially since 70s, to get them from the community based studies. This was with the
hope that better estimates would be possible to help policy planning. The major
constraint of the clinic based studies is that only those women who approach health
care facilities for seeking abortion care could be included in the study leaving a large
population outside the purview of the study. Thus, getting the appropriate
denominator for arriving at estimates is one of the major constraint of the clinic or
hospital based studies.
The community based studies: They are primarily of two types - (a) prospective and
(b) retrospective. They have their weaknesses and strengths. Prospective studies turn
out to be more expensive as they require very large sample and multiple rounds; and
are difficult to conduct compared to retrospective studies. The ethical issues involved
in such studies also seem to be of grave nature and rather difficult to resolve.
However, there are advantages, too. For example, prospective studies are better suited
to capture early losses - during the first six weeks of gestation. (Yerushalmy et al.,
1956; Freedman et al., 1966; Chen et al., 1974; Potter et al., 1965 as quoted in
Casterline 1989). Cross-sectional retrospective studies are more likely to be costeffective as they allow obtaining data on wide range of aspects, including the trends
over the time in a single round unlike prospective studies. Our review of literature
indicates that researchers have chosen to go for the latter. However, retrospective
studies have their own limitations. Susceptibility to recall bias is one of the major
limitations of this approach. We have chosen to go for this approach. The discussion
that follows, therefore, restricts itself to the community-based studies.
2.2 Issues involved
2.2.1 Concept and Definition of‘pregnancy wastage’
The first and foremost issue in community based research is definition of pregnancy
wastage. It is ‘wastage’ or failing of a particular conception to reach to full term,
which otherwise would result into a live birth. To be in position to acknowledge
wastage or loss of a pregnancy, one should be able to recognise the conception.
Pregnancy wastage could be involuntary, that is, spontaneous abortion or it could be a
deliberate attempt to terminate the pregnancy and stop it from reaching to the full
terms, which is referred to as induced abortion. In case of the latter, it is clear that
conception is recognised. However, in case of the former, the issue of ‘recognisable or
observed conception’, especially those of early gestation remains. This has implications
for capturing the accurate denominator of all conceptions.
Clinical studies suggest that approximately 60 per cent of fertilised ova do not result in
a live birth. Of fertilised ova that implant in the uterus (thus, are not to be considered
as conceptions), approximately 35 per cent (21 of every 100 fertilised ova) do not
survive long enough to cause a delayed or missed menstrual period. (Gray, 1983 as
quoted in Casterline, 1989). However, in case of spontaneous losses, a high proportion
occur without being recognised, that is, the menstrual period is unaffected or is
delayed only briefly. (James, 1970; Kerr, 1971 as quoted in Casterline, 1989). Despite
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advances in medical technology, no conception can be detected before 5 weeks of
LMP (first day of the last menstruation/onset of the last menstruation) or alternatively
a week after the missed periods. If so, any natural/spontaneous loss before 5 weeks of
gestation goes undetected. These losses are termed as ‘occult losses/pregnancies’.
(MFC, 1990). These losses, therefore, would remain outside the purview of any
studies meant either to study natural and/or induced abortions.
The inherent constraints of identifying pregnancy wastage remains regardless of
whether the research is hospital based or retrospective community based. The
problems in the latter get accentuated for obvious reasons because the reported
abortions can not be validated by clinical diagnosis. Thus, in the retrospective studies,
clinically diagnosed pregnancy losses would not form a meaningful category to be
pursued. Instead, the category would be ‘observed or recognised pregnancy’.
Recognised/observed pregnancy, thus, is a gestation resulting in at least one missed or
delayed menstrual period. (Casterline, 1989).
2.2.2 Sample size and population parameter
The objectives of the present study demand that the sample size is large enough which
would allow generalisation. One of the important information that required to arrive at
appropriate sample size is to know the ‘population parameter’ for the phenomenon/
event under study.
It appears to be paradoxical, especially in a study of this type, which is primarily
intended to enable estimates of abortion incidence, more reliable and valid as there is
no such data available. And at the same it requires to have some understanding of the
extent of abortion that take place in the given population. If no such data are available
even to the extent that informed guesses could be made, undertaking a pilot study or
an exploratory study to arrive at such a population parameter appear to be an ideal
way of proceeding with a main survey (ref...). The issue of arriving at population
parameter has to be dealt with, both for spontaneous and induced abortion.
Population parameter for spontaneous abortion: It perhaps is less complex to arrive at
the population parameter for the spontaneous abortions unlike induced abortion. This
primarily is because the extent of spontaneous abortion is largely dependent on the
biological factors. To a great extent, it remains the same across the various populations
whereas induced abortion is not. However, the impact of external factors, such as,
environmental, nutrition on the extent and pattern of spontaneous abortion needs to be
taken note of. Below is some literature indicating the extent of uniformity across the
population and the also the studies demonstrating contribution of factors to variation
as regards the extent of spontaneous abortion across the populations.
As regards spontaneous abortions, results of some of the carefully designed studies in
various parts of the world would tell us the greater chances of its incidence rate being
similar. For example, WFS and other data sources do not firmly establish that the
likelihood of spontaneous loss differs among populations. (Leridon, 1977 cf.
Casterline, 1989). Prospective studies in Hawaii (French and Bierman, 1962) and New
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York City (Erhardt, 1963; Shapiro et al., 1970) yielded overall rates of loss of 237 per
1,000, 206 per 1,000 and 218 per 1,000 pregnancies. These rates are estimated
through a double-decrement life-table methodology, which takes care of recording of
losses during the early gestation period in a better way. Crude rates of loss from the
same prospective studies are much lower: 153 per 1,000 for Shapiro et al., and 117 per
1,000 for French and Bierman. Casterline (1989) concludes that after sixth gestational
week, at which point recognition of pregnancy is more certain, the rate of loss is
probably 150 per 1,000, which might be taken as the rate that one could reasonably
expect to attain in non-clinical studies. Potter and others (1965) recorded 136 per
1,000 (that is, 13.6 per cent of observed pregnancies) in rural Punjab. Accepted
estimate of overall spontaneous loss rates is stated to be 20 percent of recognised
pregnancies. (Bongaarts and Potter, 1983).
The extent of spontaneous abortion in a population may depend on the nutritional
status of women or maternal health. (Visaria, L.1999). Retel-Laurentin (1973) presents
data suggesting that high rates of fetal loss (33 per 100 pregnancies) due to a high
prevalence of veneral diseases account for relatively low levels of fertility among some
groups in Central Africa, and Gopalan and Nadamuni (1972) report a loss of 30 per
100 pregnancies among poorly nourished Indian women. In a study conducted in
Bhopal, India after a massive gas leakage, increase in fetal death ratio was
(spontaneous abortion per 100 pregnancy outcome, that is, spontaneous abortions, still
birth and live births) found to be statistically significant. (MFC, 1990).
This suggests that the variation as regards spontaneous abortion rates is less even
across the population, if the impact of external factors is not taken into account or
considered to be absent for the purpose of calculations. There is range within which it
takes place. However, the variation that occurs because of the external factors seems
to be quite wide ranging. In absence of any substantial, reasons to believe that such
external factors exist, the incidence rate of spontaneous abortion for the purpose of
‘ population parameter’ could be considered between the range of 15 to 20 per
cent of the pregnancies.
Population parameter for induced abortion: The similar studies elsewhere from other
than India have used data based on the case load at clinics and/or small scale
community based studies to determine ‘population parameter’. (Okonofua, et al.,
1999; Zamudio, et al., 1999). For two major reasons this appears to be adequate and
appropriate. One, these studies looked into only induced abortions. In both the
situations - Nigeria and Colombia respectively - health care facilities are sought by
majority of the women undergoing abortion. However, the difference was, in Nigeria,
women approached health care facilities for post abortion complications whereas in
Colombia, women sought abortion care from the health care facilities. The
denominator in both the cases were ‘women from the reproductive age’ and not
pregnancies. Two, these studies, since did not look into spontaneous aboitions, were
not required to look into the issues involved in deciding population parameter vis-a-vis
spontaneous abortions.
Population parameter as regards induced abortion would vary greatly across regions
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within a country and across the population. As stated earlier, the studies in the past
used the hospital based data to determine the population parameters vis-a-vis induced
abortion. In Indian context, we need to acknowledge the constraints in this regard. In
that, there is no national/state sampling frame for women by age or any other
characteristics of women having bearing on abortion incidence rates to use. The only
data available are from the state level MTP cells, which are quite inadequate. Among
others, this is because (a) it does not take into account a large number of abortions
done outside the legal abortion care facilities and (b) the registered MTP centres are
known to report less than the actual procedures. Our field level experiences,
interactions with medical professionals substantiate the latter. Some of the national
level surveys on fertility or reproductive health have arrived at abortion incidence rates
ranging between 5 to 8 per cent of observed pregnancies per year. (National Family
Health Survey - I, India and Mahaashtra; National Family Health Survey - II, India;
Reproductive and Health Survey, Maharashtra). This includes pregnancy loss on
account of spontaneous, induced abortions and still births. These incidence rates are
considered to be underestimation by about 5-7 times than the actual. One of the
apparent reasons for such an underestimation is that enquiry into ‘abortion’ was not
the thrust of these surveys.
The other estimate of pregnancy wastage that has been still used is the one by the Shah
Committee that was appointed in 1966 to examine the feasibility of bringing in the
abortion legislation. (MoHFW, 1966). Based on the data available then from a smallscale community based study, he came up with a formulation that there prevails about
one third of the pregnancy wastage of which two fifth (about 13%) is due to
spontaneous and the rest three fifth (about 20 %) is because of induced abortions. In
absence any other estimates, researchers have been using this formulation with
adjustments done vis-a-vis contemporary birth rates and population size at varius point
of time. (Table 1).
Table 1 Estimates of Number of induced abortions nationwide annually
Number of Induced Abortions Nationwide
_____________ (Millions)_________
______________ 3,9________ ■
Shah, 1966_________
______________ 6,5_____________
IPPF, 1970_________
______________ 4.6_____________ ‘
Goyal et al, 1976_____
______________
5.0______________
Unicef, 1991________
______________ 0.6______________
GQI, 1991-92_______
______________ 6,7______________
Chhabra and Nuna, 1994
4.8*
CEHAT, 1997_________________ _ _______________________________________
,
Source
* Using Shah Committee formula , extrapolated population and birtli rates for 1997, Government of India, Planning Commission, 8th
FYP, 1992-97, Vol I, New Delhi, 1992
The pattern of reasons to opt for abortion are changing over the years since the
Shah Committee stated its rationale for a particular proportionate share of pregnancy
loss and within that the proportionate share of spontaneous and induced abortion. One,
therefore, anticipates increase or decrease in number of induced abortions.
However, the trends regarding unmet needs of contraception, use of contraception,
son preference that have been revealed through various surveys support the hunch that
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the existing survey data on abortion is an under-reporting. For example, the percentage
of couples of reproductive ages using a modem contraceptive would have been 41 per
cent, 4.7 percentage points higher than the observed figure of 36.7 per cent. (Visaria,
1999). It is further stated that the contraceptive prevalence in the western-northern
states, Gujrat, Himachal Pradesh, Harayana, Maharashtra is severely depressed by 8-10
percentage points because of son preference. For Maharashtra, the proportion of
sterilised couples with two children increased from 16.6 in 1980 to 37.4 in 1992-93;
but among couples with two sons, the same percentage increased from 21.6 to 55.2 for
the same period. These trends indicate increased likelihood of induced abortions
for want of male children. (Visaria, P., 1999).
The reasons stated for opting for abortion were largely either spacing (27%) or limiting
the family size (67%, total number of induced abortion n = 1,197). (Bankole, et al.,
1998).
The findings of the NFHS -1 showed that in 1992-93, the ideal family size for India as
a whole was between two and three children. (UPS, 1994). The urge to go for
smaller family size, specific number and sex composition of the children logically
leads to increased use of contraceptives and sterilisation procedures. This is likely
to increase accidental pregnancies, which are not wanted. Or such an urge, assuming
no change in the existing pattern of use of contraception, would lead to more number
of abortions. According to one projection, women in the reproductive age groups are
increasing upto 2021. (Population Foundation of India, 1999 cf Kanitkar and Radkar,
undated). This, against the fact that the family size is declining, indicates the number of
unwanted pregnancies could increase (though not the proportion). Kanitkar and
Radkar (undated) project the trend showing increase in number of abortion. This,
according to them, is because of the small family norm and fertility decline. (Table 2).
Table 2
Projected values of indices of proximate determinants and abortion. 1992-2031
TA
Abortions
Year TFR
Cm
Ca
Cc__ Ci__ TF
940508
0,7110 0.5840 0.5580
15,0 0.9754 0.1377
1992
3.39
1216357
0
,9708
0.1648
15,5
0.6938 0.5755 0.5659
1996 __ 3.4
1437635
16,0 0.9668 0.1712
2001 __ 3J_
0,6587 0,5317 0,5722
17,0 0.9358 0,3089 __ 2958714
0,6236 0,4879 0,5785
2006 __ 2.8
3517194
17.5 0.9262 0.3333
2011 __ 2.6
0,6002 0.4587 0.5827
3894714
0,5768 0,4295 0.5868
18.0 0.9172 0.3488
2016 __ 2.4
4180465
18,5 0.9083 0,3573
2021 __ 2,2
0.5534 0.4003 0,5910
4997240
19.0 0.8920 0.4094
2026 __ 2,1
0,5417 0.3857 0.5931
5807000
19.5 0.8762 0.4549
2031
2.0
0.5300 0.3711 0.5952
This kind of discreet data and information with wide variation makes it extremely
difficult to come up with any one figure as estimates of abortion incidence. However,
there is enough reason to believe that the data obtained through any empirical research
- hospital or community based research and the one from the official records as well suffer from under-reporting. Researchers have different estimates of such
underreported abortions. One opinion is that, among all induced abortions half are not
reported. (Das, 1989). Similarly, Tiwari (1994), expressed that every year about 40 per
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cent of the abortions are not officially reported. According to Karkal (..) there are 3
legal abortions conducted per legal abortion, in rural areas and 4 to 5 in urban areas.
According to Jesani and Iyer (1993), this ratio is as high as 8 illegal abortions for each
1 legal abortion. Bandewar (2000) calculates this rate over the years and states that it
ranges between 8 to 7 illegal for each 1 legal abortion.
Another estimate, which may reveal the extent of under-reporting is based on the
empirical research in two of districts of Maharashtra. This research revealed that there
exists 3 non-registered abortion care centres for every one registered abortion centers.
Applying average number of MTPs per registered MTP centre, MTP rate turns out to
be 2.27 per cent of live births1. With 9271 MTP centres available, it gives the rate of
about 9 MTPs per 100 live-births, considering that there are about three non-registered
centres for every one registered centre. This does not take into account (a) the under
reporting of the MTPs, (b) abortions that take place outside the formal institutions.
This clearly indicates the large scale under-reporting of induced abortions in various
community-based studies. In anyway, we have less scope to make guesses about the
extent of induced abortion that remain unrecorded. Assuming that there is about 7-8
times of under-reporting/recording or that for every one legal abortion there exist 8
illegal ones, we arrive at the rate of 18 to 19 induced abortion per 100 live births.
However, it is to be notes that these guesses are also based on Shah Committee
formula.
The most recent estimates of induced abortion are based on the NFHS-I data using the
Bongaart’s model of proximate determinants of fertility. Kanitkar and Radkar
(undated), also came up with estimates of under-reporting. From the year 1988-89 to
1992-93, the percent unreported abortions in total induced abortion ranges, according
to their exercise, from 26.7 to 35.6. (Table 3).
Table 3 Estimates for induced abortion, India, 1988-92
Year
Estimated
induced
abortions
(1)____
(2)____
1888- 89
1889- 90
1990- 91
1991-92
1992- 93
794347
882769
901610
920854
940508
Reported
MTPs
(3)____
582161
596357
581215
636456
606015
Estimated
unreported
abortions
(4)____
212186
286412
320395
284398
334493
Percent
unreported
abortions in
total induced
abortions
(5)
26.7
32.4
35.5
30.9
35.6
1 This is based on the following statistics of the year 1993-94. For India, there were 9271 MTP
institutions which performed 609915. Population for India was 934,218,000 and CBR was 28.7 which
gives 26,812,056 total number of live birtths. We, tehrefore, calculated 2.23 number of MTPs per 100
live births. Assuming that there are about three non-registered centres for every one registered MTP
centre, and with average case load of 62.7 MTP per centre, we can say that there are about 8.8 MTPs
per 100 live births.
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The above data and discussion indicate that it is not an easy task to arrive at
‘population parameter’ for induced abortion with such varied estimates of its incidence
and equally varied estimates of under-reporting leading to under-estimates of the actual
abortion estimates.
The salient features of the above discussion based on the available abortion
incidence data are as follows:
■
■
■
■
Estimates based on Shah Committee formula about the pregnancy wastage are still
used in absence of any other empirical data allowing fresh estimates of abortion.
The existing estimates of spontaneous abortion without much impact of external
factors vary within the range of 15-20 per live births. Further, we assume that in a
cross-sectional study, such differentials in the population would get automatically
compemsated. It will therefore be appropriate to take either average or the outer
limit (to be at safer side) these estimates for the present study.
In Indian context, the estimates of induced abortions drawn from the empirical
research vary to a great extent. They are also much less compared to what it may
be in reality. These hunches about under-reporting are because
■ The official records are inadequate to consider as estimates as it suffers from
under reporting by the concerned providers, and it leaves out those abortion
which are not sought from the registered abortion care facilities.
■ The ratio of 3:1 of non-registered to registered MTP centres based on the
empirical research on abortion care centres facilitates to arrive at 9 MTPs per
100 live births, which does take into account the under-reporting by the MTP
centres and those abortions which take place outside the institutions. However,
it is difficult to arrive at estimates, which would adjust the induced abortion
rate. Assuming the ratio of legal to illegal abortion is 1:8, the abortion ratio per
100 live births turns out to be between 18-19.
■ There are changes in the patterns of reasons for seeking an abortion indicating
mostly increase in the incidence of abortions.
■ There are not much insights one gathers from the existing literature as to what
extent the increased use of contraception may have balancing effect on the
increased abortions because of the unconventional and unanticipated reasons
(son preference, abortion as a method of contraception, unmet need for
contraception etc.).
Given the serious constraints at various levels and in absence of any data even to
arrive at informed guesses, it appears that it would still be appropriate to go by the
Shah Committee estimates as population parameter. Also, using various estimates
based on the literature, especially for spontaneous abortions and calculations
based on the data available in case of induced abortions, the overall
pregnancy wastage ranges between about 30 to 40 per cent of live births. We
decide to take the average of 35 per cent pregnancy wastage of total live
births as the population parameter. Ideally, the study design in such a context
needs to be in such a way that, it will have an in-built mechanism to tap the extent
of ‘under-reporting’ of the observed pregnancies.
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2.2.3 Factors affecting abortion estimates in the retrospective community based
abortion incidence studies
Under-reporting: Under-reporting of the abortion incidence or lack of complete
coverage of pregnancy losses in retrospective inquiries have been widely
acknowledged by researchers, especially those engaged in abortion incidence and
fertility surveys. The problem is common to virtually all fertility surveys the world
over. (Casterline, 1989; Jones and Forrest, 1992). Jones and Forrest further note the
implications of failure to record all abortions which are not only to abortion studies but
also for any analysis dependent on complete reporting of pregnancies and accurate
measurement of pregnancy intervals. Regardless of whether abortion is legal or widely
practiced, substantial under reporting is often thought to occur. (Huntington, et al.,
Under-reporting could be intentional or unintentional. Legal context, cultural context,
stigma attachec to abortion, including spontaneous, are some of the reasons for
women to wi'hhold information about abortions. The reasons, which lead to
unintentional underreporting are memory lapse and abortions that go unrecognised,
for example, delayed menstrual periods, which may in reality be a spontaneous
abortion. Thus, there is less scope for either capturing or improving the under
reporting arising out of memory lapse or unrecognised of conception. Intentional
under-reporting may be improved to some extent by improving the methodologies,
such as, formulation of the tools of data collection, creating conducive environment
while conducting inter dews, quality of training of the field investigators. This still does
not ensure 100 per cent reporting of the recognisable abortions.
Under-reporting because of memory lapse in reporting pregnancy history: The
researchers engaged in the fertility surveys and related research have observed different
and at times opposite views about patterns and trends in memory lapse on part of the
respondents while responding to the set of questions formulated to trace pregnancy
history of women. In that, time factor, nature of the events - live birth, spontaneous
abortion, induced abortion, death of a child who died later - play a role. There is
evidence of omission of live births, especially those who later died, in the data from
most surveys and pregnancy losses are probably more easily forgotten than live births.
(Casterline, 1989). Anderson and others (1994) record virtually complete agreement
between the hospital records and the survey on the number of children ever born unlike
the trend observed in case of data on pregnancy loss. In an abortion incidence study
conducted in Estonia, it is revealed that underreporting of lifetime abortion is of the
same order as the under-reporting of recent abortion. (Anderson, et al., 1994).
However, Casterline (1989) in his communication based on analysis of data from WFS
from 40 developing countries says that in 17 of 22 countries, the percentage for the
most recent five years exceeds that for the period five to nine years prior to the survey
This strongly suggests omission of a larger proportion of losses as one proceeds
backwards from the surveys. A simple way of obtaining an estimate of the degree of
recall error due to memory decline is to subdivide the total recall period into two or
more equal sections and to ask about events that occurred within each section
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separately (Ross and Vaughan, 1986). Huntington and others based on the abortion
data from WFS, note that deliberate abortion is acknowledged less frequently than
spontaneous terminations. (Huntington, et al., 1993).
Implications of under-reporting to study design: Implications of under-reporting are at
two levels while designing the quantitative survey for studying abortion incidence
studies. One, it has implications in determining the sample size for a community based
cross-sectional quantitative survey. It is necessary that sample size is adjusted with the
help of the prevailing understanding or knowledge of under-reporting, which often is
inadequate, is based only on informed guesses. Two, it ideally is appropriate to have
some in-built mechanism in the research methodology which would help to capture, the
extent of (estimates of), at least, the intentional under-reporting of abortions, and
profile analysis of respondents. This, in turn should facilitate an adjustment of the
findings to arrive at more appropriate abortion incidence rates and ratios. The
following discusses the mechanism to deal with both the above mentioned concerns.
For adjusting sample size: Like many other factors, figures for under-reporting in case
of abortion incidence needs also to be estimated based on informed guesses. These
informed guesses, in absence of any substantial research on abortion incidence, in the
present case, are mostly drawn from small/large scale community based work either in
abortion or prevalence of women’s general, obstetric and gynaecological illnesses. We
relied on various available researches done by others in the past to arrive at informed
guesses regarding under-reporting as regards abortion, especially induced abortions.
(Annexure-XI).
Mechanism to arrive at estimates of under-reporting in the community based abortion
incidence studies: Some research studies on abortion incidence research conducted in
different parts of the world have recorded the methods to address to the issue of
underreporting. For example, Jones and Forrest (1992) evaluated the level of reporting
of abortions in the various national surveys in the US during 1976 to 1988. Two of the
methods used were as described here, (a) To compare the reported numbers of
abortions with the numbers estimated as actually having occurred among comparable
groups of women according to national counts external to the surveys, (b) To employ
a method of a brief self-administered questionnaire (SAQ) in addition to the fullfledged interview, which provided a second, independent opportunity for respondents
to reveal their abortion experience. In this the confidential approach to data collection
was believed to help women respond more fully. Both these methods have limitations
in themselves and will vary across the situations. For example, the assumption of
availability of ‘numbers external to the survey’ will not hold true in situations like
India where the records maintained by the state are known for their inadequacy. The
option of using alternative instrument for data collection may not be possible for
various reasons — cost implications, lack of literacy (which is a prerequisite for using
SAQ). However, some other innovative methods could be thought of.
Validity of survey responses: The issues regarding under-reporting and validity of the
responses are interrelated. Depending upon the subject matter under investigation,
methods could be adopted to improve validity of the responses. Anderson and others
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(1994) record three approaches to the validation of the survey responses. They are (a)
to compare the consistency of the respondent’s answers, either in a series of interviews
or in response to related questions in the same interview; (b) to compare respondents’
report about a given event or behaviour to that given by another respondent such as
family member or another related individual (Anderson and Silver, 1987; Haberman
and Elinson 1967; Koenig, et al., 1984 as quoted in Anderson, et al., 1994), (c) to
compare respondent’s report with an external standards or public source of
information such as employers’ records, police and court records, medical records, or
voting registration record (Anderson and Silver, 1986; Bradburn and Sudman, 1980.
Clausen 1968-69; Duncan and Mathiowitz, 1985; Loftus et al.; 1992; Traugott and
Katosh, 1979 as quoted in Anderson et al, 1994). Ross and Vaughan (1986) suggest
that internal consistency should be checked within 24 hours and any errors reported to
the interviewer and corrected if necessary, after a revisit to the subject.
For ensuring repeatability/reliability, it is suggested that re-interview of a random
sample of respondents by a different lay interviewer who is ignorant of the first
interview’s findings appears to be the most feasible and useful method of checking for
repeatability, despite its inherent disadvantages. (Ross and Vaughan, 1986). Such
mechanisms may not always be feasible. In Indian context, the large scale surveys, such
as, NFHS, chose to conduct a second round of interviews of a sub-sample by a
different team of investigators.
Reporting of dates and ages: It is well known from past experience that, in many of the
developing countries, women - particularly rural, non-literate - are not sure of the
dates of births. (WFS, Comparative studies No-11-20, May 1980). ‘Dating chart’ or
AGEVEN (age-event) chart were found to be usefill aid in some contexts. However, it
remains an issue of concern as error in misplacing the various life events along the
calender year is almost non-detectable.
Understanding respondents9 refusals: In any study, it often is insightful to know as
to who are the people/women who refused to participate in the study. This is all the
more important in the large-scale survey which are planned to be representative of the
population. Understanding the profile of the non-respondents, therefore, helps to
capture whether it is a particular sub-section of the population, which has refused to
participate. This also avoids the possibility of mis-interpretation of the data, which
arise on account of under representation of a particular group of people. The existing
literature has not stated the mechanisms to address to this issue. Thus, there is not
much we came across about strategies to obtain minimum relevant information about
the non-respondents.
2.2.4. Tools of data collection for arriving at abortion rates through a community
based studies
As discussed earlier, the large scale retrospective community based studies, regardless
of the area of enquiry or the subject under study, do suffer from the problems such as,
under-reporting, validity and repeatibility. These problems get more difficult in studies
when the subject matter under enquiry is tabooed, stigmatised, experience socioAbortion rate, care and cost: A community based study
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cultural sanctions as is the case with abortion. A major obstacle in estimating the
prevalence and determinant of unwanted pregnancy and unsafe abortion is the difficulty
of eliciting abortion histories from women. They may be reluctant to admit to survey
interviewers that they have terminated a pregnancy.
The literature on abortion surveys from the world over shows that over the years, the
formulation of the tools of data collection has improved. Alternative methods of
eliciting information from the respondents have been developed based on experiences
in the past. These alternative methods could be used either independent of eacn other
or in combination to complement each other.
The three major techniques/methods of data collection are described below in brief
highlighting their strengths and weaknesses.
Self-administered questionnaire: As the title reads, a questionnaire is to be self
administered by the respondents themselves. It, therefore, requires to be self
explanatory, crisp, short and with no ambiguity.
The advantage is that respondents may feel more comfortable to write down the
responses to the questions regarding any sensitive topics, such as abortion instead of
having to respond to them verbally.
Limitations: Respondents need to know reading and writing. Also, it has to be a
short and crisp to make it easier for respondents to fill it on their own with
minimum individual biases. Thus, it restricts any detailed data collection, which is
required on range of variables to enable analysis of range of correlates. It also can’t
study trends over the time as it requires tracing pregnancy histories, which is fairly
complex structure and organisation of set of questions. In absence of training and
orientation, respondents may not be able to respond to them on their own.
Randomised Response Technique (RRT): The technique was evolved by S L
Warner to assist in obtaining valid answers to questions that respondents may be
reluctant to answer in an interview situation. (I-Chen, et al., 1972). It was intended to
overcome the hurdles in the research on topics which are sensitive and difficult to
make respondents to open up to researchers, often strangers. The technique enables a
respondent to provide truthfill information on a sensitive or highly personal question
and not reveal to the interviewer his status on the question. It is based primarily on the
probability theories. Thus only a pair of questions could be posed to the respondents.
Of these, one is with known probability of occurrence of an event across the
population and other under investigation whose probability could then be found out by
simple subtraction.
Limitation: The very strength of the technique - maintaining the confidentiality of
the women who may have experienced abortion - becomes a limitation. Thus, the
technique is primarily usefill if it is only to find the abortion estimates. In absence
of any other data about the individual respondents, further research and/or analysis
of the data obtained on events recorded is obstructed a great deal.
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The abortion incidence research conducted in the past using techniques such as RRT
suggest that they were primarily to arrive at abortion incidence alone. The other
studies, which were intended to research the issue beyond capturing merely ‘abortion
incidence rate’, used survey methodologies and conventional tools of data collection.
(Zamudio, et al., 1999; Okonofua, et al., 1999). The difference, however, was
precautions taken and sensitivity built in the conceptualisation and planning of the
study, formulation of the tools and planning — sequence of the questionnaire, wordins;
of the questionnaire, use of filter questions etc.
Survey questionnaire: Most of the abortion incidence studies, either independent or
as part of the fertility survey, have recorded detailed pregnancy history of respondents
including abortion incidence and their types as reported by women respondents. This
allows data collection on life-time abortions, if required. Quality of data could be
improved by careful formulation of questionnaire - wording and sequence of questions;
ensuring consistency checks within the questionnaire (in-built checks); and by using
innovative alternative methods like ‘calender protocol’ or dating charts to improve
accuracy of da tes of occurrence of various life events in woman’s life.
Such adequately elaborate questionnaires allow researchers to collect data on range of
related variables - characteristics of women, reasons for undergoing abortion, change
in trends over the time through a cross-sectional study, and analysis of correlates. This
also allows more in-depth analysis of abortions during the reference period in the last
three to five years - recall/reference period.
Limitations: As discussed earlier, the obvious limitations are chances of under
reporting and invalid responses about sensitive events and related matters as
perceived by v/omen as result of socio-cultural, familial and legal context of
abortion.
Formulation of questions and probes: The data on abortion in the various fertility
surveys or abortion incidence studies have were gathered using (a) direct method of
tracing the pregnancy histories or (b) indirect method of using a filter question and a
follow up question. The filter question is a primarily an attempt to broach the subject in
a non-stigmatising manner. (Table 4).
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Table 4
Variants of the filter questions used in the indirect method of enquiry into
_________ abortion
Sr
Study/Country
Filter question and their
Follow up question
No
sequence in case of
_____multiple filters
1
Estonia (Anderson et Whether ever given a
If yes,
al., 1994)
birth?
Whether, the outcome was a
If yes,
result of an abortion, a
Had ever had a pregnancy miscarriage, or a stillbirth
that did not result in a live
birth?
2
Cote d’Ivoire
(Huntington et al.,
1993)
In the past, have your ever
been pregnant when you
did not want to be?
3
Indonesia (Hull et al.,
1993) * and Senegal
(Macro International,
1994) * - part of
DHS HI series
Sometimes a woman
becomes pregnant when
she does not want to be.
Have you ever become
pregnant when you did not
| wnat to be?
________
If yes. What did you do?
Responses offered are:
. nothing
. attempted to stop the
pregnancy, but did not succeed
and gave birth
.attempted to stop the
pregnancy and succeeded____
If yes,
When was the last time this
happened to you?
When that happened to you,
what did you do about it?
* as quoted in Huntington et al., 1996.
However, experience over the years as regards efficiency of one method over the other
shows that there can’t be one single rule which could tell us as what works better in
what situation. For example, WFS included questions about induced abortion either in
a separate series of questions about non-live births or within a group of integrated
questions about pregnancy history. Comparison of WFS data with government and
other local surveys indicate considerable underreporting; between 50 to 80 per cent of
total pregnancy loss is estimated to have been reported. (Huntington, et al., 1989;
Casterline, 1989). However, the same direct method of enquiry into induced abortion
in Romania could capture the abortion rate if 70.5 per 100 pregnancies. Huntington
and others (1996) demonstrate a wide range of variation in the results of studies, which
used indirect method of eliciting information on unwanted conception. (Table 5). Type
of setting for these studies differed. Interestingly, the ones conducted at family
planning or similar set ups came up with a much better results compared to the one
which were population based. Also, the indirect method of enquiry can’t capture
multiple abortions, an inherent limitation of the method. Thus, studying the trends over
the time by enquiring into women’s pregnancy history is not possible using the indirect
method.
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Table 5
Summary of results from studies reporting use of the unwanted-pregnancy filter question and the
follow-up question about abortion, by country, according to sample type and size, 1992-94
Country (date)
Type of
sample
Sample
size
(women)
Cote dTvoire(1992)
Ghana (1993)
Percent of
women
reporting
an
unwanted
pregnancy
percent of
total
sample
attempting
an
abortion
Among those reporting an unwanted
pregnancy, percent who
attempted
an
abortion
355
44
FP clients
28
MCH-FP
1,185
53
29
clients
Egypt (1994) FP clients
1,081
50
13
(prospecti
ve panel)
967
Turkey (1994) FP clients
47
30
Mali (1993)
1,300
Rural
29
6
population
Bolivia (1992-92)
807
Urban,
41
4.5
employed
Indonesia (1993)
28,168
DHS
13
2.1
Senegal (1993)
6,310
18
DHS
0.5
DHS : Demographic and health Survey
For Egypt, numbers and percents shown refer to pregnancies rather than to women.
Source: Huntington, et al., 1996
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65
55
attempted
abortion
unsuccessful
Had a
successful
abortion
_______ bL
__________ 6
13
59
42
25
19
6
65
19
4
11
61
8
11
7
4
13
3
10
1
2
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As seen earlier, in the Indian context, the large-scale retrospective fertility surveys
couldn’t come up with abortion incidence rates, which could be considered anywhere
close to actual. The rates apparently turn out to be very low. The methodologies,
including formulation of the tools was perhaps not adequate enough tc capture data on
abortion. Most of these surveys have used tracing and recording detailed pregnancy
history of women, which allowed abortions to get recorded. However, not many of
them paid adequate attention to specific methodological needs to capture abortions. Of
these various surveys, in case of NFHS I, gross underestimates of abortion incidence
have been attributed to the limitations in terms of the inadequate methodology to
obtain data on the subject matter as sensitive as abortion, by those who designed and
conducted these studies and peers as well. (Jejeebhoy, 99, Visaria, P. 99; Visaria, L,
99).
Review of the major surveys in Indian context, which have dealt with abortion
incidence, such as NFHS-I and II and RCH shows that they have used variants of the
direct method of enquiry for tracing pregnancy history. NFHS-I, did not have any
probes on pregnancy wastage while recording pregnancy history. NFHS-II improved
on this by including one single probe to know about abortion incidence while tracing
pregnancy histories. It began the enquiry into the first live birth. The probe on abortion
was to enquire for each of the interval between two live births. RCH survey recorded
only the latest pregnancy from the reference period, which also included pregnancy
wastage as one of the options for ‘pregnancy outcome’. However, none of these
surveys could record abortion rates, including spontaneous and induced along with still
births more than 7 per cent of the pregnancies.
The various participating countries in the WFS and DHS used two types of approaches
to record the pregnancy history, (a) Forward - where tracing of the pregnancies begins
with the first one up to the last one, (b) Backward approach - it operates in exactly the
reverse manner. In India, researchers have mostly used forward approach while
recording pregnancy histories.
2.2.5 Selection of the study area and study units
The prime concern while laying down the strategy for selecting the study area and
study units should be inclusion of respondents which would represent the population
under study, especially as regards those characteristics of the population having
bearing on the phenomenon under study. The critical issues, then are either to have the
knowledge of those characteristics of the population, which have bearing on the
occurrence of the phenomenon under study or know actually the proportionate
occurrence of the phenomenon for each of the sub-population. In absence of any
knowledge of these, which often is the case, multistage stratified sampling methods are
adopted for selecting study units. The advantage is that strata at higher level could be
defined using macro indicators for which data are available. In large scale population
based studies, these criteria need not necessarily be used as ‘analytical categories’ but
more so to ensure that the selected sample represents the population under study.
Below is a brief account of approaches used for stratification and selection of the units
drawn both from international and Indian experiences in silimar research.
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The otherwise well documented research the world over under WFS and DHS
programme has not discussed the topic of ‘selection of the study area and study units’
at length. However, in Indian context NFHS-I and -II do explain it elaborately and
adequately on most of the issues involved in this. Before we get into the details of
Indian studies, we would look into two of the abortion studies from outside.
The abortion incidence study conducted in Coloumbia was restricted to uiban area
alone. It used a specially stratified random sample procedure, with fixed proportions,
including clusters of unequal size and quotas. In each cluster (city block including 30
households), 10 women with experience of abortion had to be found based on the
hypothesis/assumption that three out of 10 women of reproductive age would have
abortion experience. The criteria used for stratification are not mentioned in the paper.
(Zamudio, et al., 1999). In another study form Nigeria, the study was restricted to two
study sites. In the selected areas, a two-stage stratified random sample - stratifed by
urban-rural residence and by health wards within the urban and the rural strata.
(Okonofua, et al., 1999). A systematic simple random sampling was used to identify
the eligible women. The existing national level suiveys of household were used as
sampling frame.
In Indian context, there are number of national surveys to study various aspects of
people and regions. Some of them take place annually, for example. National Sample
Survey (NSS). Of late, NFHS - and -II in 1990s, the major initiative to study the
fertility behaviour pattern of the population are the large-scale cross-sectional surveys.
Most of these surveys have done two stage stratified random/systematic random
sampling. The primary study units (PSUs) or first study units (FSU) in these surveys
have been villages in case of rural area and census enumeration blocks in case of urban
areas. The secondary sampling units were ‘households’. However, it is necessary that
there is adequate representation of all the sections of population under study while
PSUs are selected. NFHS and NSS series of surveys used different criteria to define
strata to categorise villages other than any one or two criteria (as it is difficult to have
any village level indices available) that could be used for selecting PSUs. With this
constraint, often at the first level of stratification, district level indices are used to
define strata to identify districts falling in these strata. The various possibilities for
these are use of administrative divisions, agro-climatic zones, population resources
regions or demographic zones. Villages from all the districts from one single strata are
then treated together to be categorised further on some logical criteria, for which data
would be available at the level of villages. They could be size of the village, per cent
population of SC and/or ST, distance from the nearest town etc. In case of urban area,
mostly cities with population more than 10 lakhs are treated separately. Of the rest,
towns are stratified using some criteria, viz. population size. Various combinations and
subtle stratification is possible. It depends upon the need of the study and also on the
availability of data on required criteria at various levels as to what could be extent and
levels of stratification to be used.
There are various schemes/indicators that have been used to define regions.
Demographic zones, administrative zones or agro-climatic zones (used in NFHS - I,
Maharashtra) or agro-economic (used in NSS), population resource regions,
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cartographic zones are some of the schemes name. Often there is tendency that agroeconomic and agro-climatic to coincide for obvious reasons. Efforts of the Planning
Commission and Census to develop these schemes were with an intention to facilitate
planning for respective areas of concern, viz: agriculture, economic development. The
most logical for the present study would be to use demographic zones as
conceptualised by Bose (Bose, 1994). He has used 21 indicators to arrive at an index
determining character of a particular district. In this scheme, the focus is on women,
health and education. However, this scheme of classification does not take into
account standard geographical indicators, the premise for most other scheme combined
with additional indicators.
Given the nature of the present study on the one hand and the overlap between these
schemes allow us to choose any of these schemes without much loss vis-a-vis findings
of the study. We would try to balance the choice for a particular scheme with
availability of data at the district level from 2001 census. Thus, the priority would be to
base the stratification on the 2001 census data as we are launching the field work in the
same year.
2.3 Wrap up
The above presentation of the literature review combined with the rationale for making
choices vis-a-vis various aspect of the present study is exactly the way went about
developing the methodology that is laid down in details in the following sections of the
document. It was an enriching experience to learn through the existing literature,
especially the large-scale surveys like WFS, DHS and NFHS and other surveys India to
study women’s illnesses. We could combine these methods with our understanding of
the abortion issue with its nuances and from women’s perspective based on our earlier
research in this area to make it more comprehensive and woman sensitive and within
the framework of‘ethical research practices’. The challenge would remain throughout
the study for two reasons. One, the earlier research in India have recorded high per
centage of under-reporting of abortion incidence. There is nothing other than making
guesses that we can fall back on as this is for the first time such a large scale
community based abortion incidence study is being undertaken with prime thrust on
abortion.
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3. SAMPLE DESIGN
The study will be conducted in the two states. One of them would be Maharashtra.
3.1 Universe/populalion
The sample under this research study is designed to provide state-level estimates as
well as urban rural estimates for rural and urban areas. The universe consists of ail
rural and urban areas (the entire population) of the state. The primary sampling units
(PSUs - villages from rural areas and wards from the urban areas) would be selected
from this universe. The secondary sampling units would be households
3.2 Sample size
Being the ‘rate’ study, it would be essential to design a representative population
based survey. This requires that we determine the sample size within the framework
of survey sampling. That is to say, arriving at sample size using systematic criteria and
‘factoring in’ various aspects, such as, design effect, under-reporting, non- response
and other losses which have critical bearing on applicability of the required statistical
tests for the purpose of generalisation.
Estimation of sample size: Assumption based on informed guesses (discussed at length
in the earlier section) about the population parameter/estimate of abortions is that one
third, that is about 33 per cent of the conceptions, observed pregnancies to be more
precise, are wasted during a given period of time. If so, to obtain a level of incidence
with 95% confidence interval and with a precision of plus or minus 2 (that is, error)
and plus or minus 1 standard error, we have to cover about 2222 conceptions, which
would allow to capture about 741 abortions. This would mean that we need to cover a
population of 64391 or about 13,000 households assuming a birth rate of 23/1000
population and if conceptions in one year are covered. (Annexure I). Conceptions if
covered in three years would reduce the number of households to one third, that is,
4,333.
The above calculations assume (a) it is a simple random sampling (SRS), (b) there is
zero ‘no response’ and no other losses, (c) the instruments are perfectly valid and
reliable thus having no ‘under-reporting’. In reality, these assumptions are untrue and
therefore they need to be factored in.
Based on the earlier community based research experience, we assumed 15% loss of
sample on account of ‘no response’ and under-reporting, inflating the sample size
to 5,000. As we are covering the entire state to select PSUs, from there would not be
any cluster/design effect to be factored in.
3.3 Allocation of the PSUs:
Allocation of the PSUs over the rural and urban areas is based on the following
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assumptions based on data and statistical requirements:
(a) The data show that rural/urban population proportion in Maharastra is about 3:2.
The sampled households (5,000) will be distributed over rural and urban areas in PPS
manner. That is, about 3000 households from rural area and about 2000 households
from urban area to be included in the sample.
2
(b) On an average 30 households (about 10 per cent of households in rural) and 20
household from urban PSUs will be included in the sample. This is primarily to reduce
the cluster effect by spreading the sampled units - households - over the larger
geographical area. This would help determining the number of PSUs to be selected
from each of the rural and urban areas. Thus the total PSUs from rural areas will be
100 (3000/30) and 100 PSUs from urban areas (2000/20 = 100).
There would be three levels of stratification. The first level of stratification would be
geographic. In that all the districts in Maharashtra will be grouped into six
administrative divisions, (we may make some changes as mentioned in the earlier
section.)
3.3.1. The rural sample: The frame, stratification and selection
The 1991 or 2001 Census, if available, list of villages would serve the sampling frame
in rural areas.
In the second level of stratification, the population size of each village will be taken
into consideration. The strata would be as follows:
Stratum 1:
Stratum 2:
Stratum 3:
Stratum 4:
Stratum 5:
Less them 150 households
150-299 households
300-599 households
600-999 households
More than or equal to 1,000 households
The fourth level of stratification would be ordering villages within each stratum by the
level of women literacy.
There will be 36 strata from which the PSUs will be drawn in proportion to the
population size of a particular strata with the total rural population.
We may make some changes in the proposed strategy of stratification for allocating
PSUs.
3.3.2. Selection of households:
Households would be selected using systematic random sampling with equal
2 The size of the urban blocks being larger, 10 per cent inclusion of the household from the PSUs may
lead to a substantial cluster effect unlike rural PSUs. Thus, it is fixed to 20.
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probability after undertaking an exercise of mapping and house listing. In case of
villages with more than 500 household, it will be segmented based on the existing
wards and to select two randomly selected wards.
3.3.3 The urban sample: The frame, stratification and selection
The list of 1991 Census Enumeration Blocks (CEBs) would serve as the sampling
framework. At the first stage, the districts would be grouped in the same manner as
would be done for rural area. Within each of these stratum, cities/town would be
divided into three strata: cities with population more than 10 lakhs, district headquarter
towns and other towns.
For district headquarters and other non-self seiecting town, a three-stage sample was
used: selection of cities/towns with PPS, followed by the selection of two census
blocks per selected town with equal probabilities, and finally the selection households
from each of the selected blocks.
4. CONDUCT OF THE STUDY
Launching of the field-work presupposes a successfi.il pilot testing and revision of the
methodology, including tools of data collection.
4.1 Making in-roads in the community
What purpose would it serve?
■ Primarily to interact with the village community and to establish rapport.
■ To get introduced ourselves and to know informally from people about
themselves as a community.
■ To share with them about the work/research study that we are there for and
about our organisation.
■ To create conducive environment for holding group meeting/s in the village.
These meetings would be to provide public space for the villagers to question
us about our work and its relevance etc.
■ To screen a slide show on women’s health in Marathi during these meetings.
This is not only to facilitate rapport establishment but also a means to express
our gratitude for their prospective participation in the study.
Through this process, if people from the village/community agree to participate in the
study, the entire research team would gear itself to initiate the process of data
collection.
Who from the research team would do it?
Two-three of the team members, one senior researcher and a couple ofjunior
researchers and/or field investigators will be involved in this activity.
What would it involve?
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probability after undertaking an exercise of mapping and house listing. In case of
villages with more than 500 household, it will be segmented based on the existing
wards and to select two randomly selected wards.
3.3.3 The urban sample: The frame, stratification and selection
The list of 1991 Census Enumeration Blocks (CEBs) would serve as the sampling
framework. At the first stage, the districts would be grouped in the same manner as
would be done for rural area. Within each of these stratum, cities/town would be
divided into three strata: cities with population more than 10 lakhs, district headquarter
towns and other towns.
For district headquarters and other non-self selecting town, a three-stage sample was
used: selection of cities/towns with PPS, followed by the selection of two census
blocks per selected town with equal probabilities, and finally the selection households
from each of the selected blocks.
4. CONDUCT OF THE STUDY
Launching of the field-work presupposes a successfill pilot testing and revision of the
methodology, including tools of data collection.
4.1 Making in-roads in the community
What purpose would it serve?
■ Primarily to interact with the village community and to establish rapport.
■ To get introduced ourselves and to know informally from people about
themselves as a community.
■ To share with them about the work/research study that we are there for and
about our organisation.
■ To create conducive environment for holding group meeting/s in the village.
These meetings would be to provide public space for the villagers to question
us about our work and its relevance etc.
■ To screen a slide show on women’s health in Marathi during these meetings.
This is not only to facilitate rapport establishment but also a means to express
our gratitude for their prospective participation in the study.
Through this process, if people from the village/community agree to participate in the
study, the entire research team would gear itself to initiate the process of data
collection.
Who from the research team would do it?
Two-three of the team members, one senior researcher and a couple of junior
researchers and/or field investigators will be involved in this activity.
What would it involve?
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Meeting and interacting closely with mahila mandal/locally active women’s
groups; grass roots level health workers and women in the village.
We may interact with some official/formal leaders/office holders; informal village
leaders.
We would try to interact with village community without the top-down pressure of
office holders. This implies that we try to establish rapport with the community
through the support of villagers rather than the power holders. Practically, women
should be in position to feel free to say ‘no’ if they wish and would be able to
participate in the study only if they want to do so and not because someone ‘up there’
wants them to do so.
Time requiredfor completing the task?
Would require a couple of days. However, if the community is generally welcoming
(after communicating them about the study), on the first day, we can start off the next
phase in parallel. The activities related to ‘building awareness on women’s health
related issue’ also can take place on later days during the field-work depending upon
the response of the community.
The dilemmas and issues involved?
It is likely that after spending time and energies to establish rapport, people may decide
not to participate in the study. And yet, this particular phase will not be compromised
upon. The denials because of the sensitive nature of the issue at hand would be
obvious. For us, the dilemma then is do we go for such a mode of rapport
establishment? Do we disclose the tools of data collection, especially ‘woman’s
interview schedule’ to any one who is interested to know what is all about? What
consequences would it have for ‘participation of the community’ and therefore for the
research?
This would be the most critical phase of the field-work that we have to carefully tackle
with in every village/community.
4.2 Preparing Village profile:
What purpose would it serve?
■
■
■
To know the socio-economic characteristics of the study area.
To arrive at the village level development index to explore whether it functions as
one of the explanatory variables vis-a-vis the subject matter under study, especially
abortion care and cost aspects.
To record some of the village/area events - routine and historical - to be used as
landmarks. This is to facilitate respondents to chronologically locate their life
events with better accuracy by using these landmarks as reference points.
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Who would do it?
Mostly by one of the experienced researchers who has skills to interact and deal with
varieties of personalities; to unravel the community dynamics through such
interactions; and to be able to share this understanding with the team when it meets at
the end of the day.
Tool to be used?
‘Area Profile Recorder’ will be used to get the information to prepare village profile.
(Annexure H).
Time requiredfor completing the task?
In about a days’ time it would be completed. The persons responsible to complete this
need not exclusively spend time on this, especially if some of the data items take time
to be filled in. It is advisable to complete village profile before the team starts
administering household interview schedules and woman’s interview schedule. At least
the section on ‘village events’ needs to be completed before HHD-IS and WOM-IS are
administered for logical reasons. However, on some data items the little stretched out
time schedule is logical as it involves meeting number of people engaged in various
activities. It requires tapping multiple sources of data, such as primary, secondary and
observation. Some of the data may also require cross confirmation, especially those
related to statistics. On some of the data items, it may take longer. However, it needs
to be completed before the team leaves the villages so as to save another trip/visit to
the village.
Timing with other activities during the field work?
Preparation of the village profile can go in parallel with the exercise of mapping the
village and listing the households.
4.3 Administering Household Interview Schedule
The purpose?
■
■
■
To identify the eligible women for individual interview - the core of the data
collection
To have the well-defined base population, the denominator, needed for
computation of abortion rates and other related demographic rates, if required.
To provide us values/scores/indices for the set of explanatory variables independent and/or intermediate, (pl refer to Annexure III)
Who would do it?
The team of the field investigators would actively engage themselves in this phase of
data collection.
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Tool to be used?
Household Interview Schedule (HHD-IS) will be used for this purpose. (Annexure
IV). We would prefer responsible male member/s to respond to this, especially the
section on economic activities, land ownership, business matters etc. More than one
respondents, including women of the household answering to this interview schedule
would be welcome and encouraged.
Timing with other activities during the field-work?
It will be started only after mapping and house listing are completed. This is because,
households could be selected/sampled only after this. It would precede the stage of
conducting women’s interview schedule primarily because eligible women will be
identified during interview to fill the household interview schedule.
Time requiredfor completing the task?
Filling of the one interview schedule would take about 30-35 minutes.
4.4 Administering Woman’s Interview Schedule
What purpose would it serve?
This is primarily to acquire data on abortion incidence, abortion related morbidity and
reasons for induced abortions. This would be achieved by asking women about their
obstetric history.
In addition to this, there is an in-depth exploration of spontaneous and induced
abortions that women had during the reference period of three years, (for detail pl see
Annexure IV)
Who would do it?
The team of the field investigators would be engaged in completing this phase of data
collection. At one single household, there certainly has to be a pair of the investigators
so that one can engage oneself into administering household questionnaire and the
other the woman’s interview schedule/rate questionnaire.
Tool to be used?
Woman’s interview schedule/Rate questionnaire (abortion incidence, morbidity)
will be administered. (Annexure IV). This will be administered to all the eligible
women, that is, ever married in the reproductive age (15-49 yrs) residing in the
sampled households.
The various sections would be miscarriages in recall period (care and cost in details);
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miscarriages in recall period (morbidities, care and cost); life time miscarnages (care
and cost in brief); induced abortions (care and cost in details), induced abortions
(morbidities, care and cost in details), sex selective abortions (care and cost in detai s),
sex selective abortions (morbidities, care and cost in details),
Timing with other activities during the field-work?
It will be conducted only after household interview schedule is administered and
completed.
Time requiredfor completing the task?
It would take about time in the range of 80-110 minutes depending upon number of
abortions the woman may have had both during her life-time and reference period or
the present study.
5. PROBLEM SOLVING & SHARING LEARNING THROUGH
DAILY/REGULAR IN-GROUP SHARING
The late-night meetings of the research team are essential for the following reasons.
(a) To facilitate and develop a shared understanding of the village community and its
dynamics, especially during the initial phases of establishing rapport with the
(b) To share with each other the problems faced during the field work and discuss
(c) To provide space for the investigators to share their emotions with the group and
share their understanding and analysis of women’s live situations
(d) To ensure that data collection is going on smoothly, appropnately and no violation
of ethical guidelines is taking place.
We would like to minute these discussions, highlighting at least the major issues.
6
TRAINING OF THE TEAM (RESEARCHERS & FIELD
INVESTIGATORS)
Training of the researchers and field investigators would be required primarily to
(a) develop perspective on women’s health and abortion,
(b) impart and develop skills, and
(c) build team solidarity.
(d) Orient and develop adequate understanding of research ethics
(e) orient them about the administrative procedures to be managed at the field level.
We see advantages in the entire team going through this training expenence together.
In that it would try minimise the psychological gap between ‘positions that various
individuals would be holding within the team. This would provide opportunity to e
new recruits to open themselves up to their fellow members and old team members as
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well. For the old team members it would help to know the new recruits as individuals
and as team members.
Qualifications of the field investigators
We would not be particular about having social science graduates. This primarily
because, one of the CEHAT research of a similar nature recruited women with only
about 8-10 years of schooling who did wonderful job during the community based field
work. The reasons, one among others, may have been the fresh perspective with which
they look at situations.
Following would be the thrust areas in the training modules. We are prepared a
detailed training manual laying down each session stating (1) learing objectives, (2)
resource persons, (3) time length of the session, (4) teaching aids and methods, (5)
content of the session. The themes presented below will have different sequence of
sessions to make it more logical and to maintain the flow of the content. We will be
using interactive sessions and will make use of appropriate games, skits, role plays to
seek active participation of the investigators. We will documenting the process for our
own learning and for others reference.
(a) Developing the perspective
(about a 5-6 days)
■
■
■
■
■
■
Orientation of the team: What are we getting into?
■ About CEHAT, its philosophy and thrust areas of work with special focus on
issues and concerns as regards women’s health;
■ The perspective with which the abortion research and advocacy in CEHAT has
been shaped by and pursued since its inception; its links with issues and
concerns in the realm of ‘women’s health’.
■ Objectives of the current research, that is AAP-I and abortion incidence study.
Social systems and organisations:
■ Social organisations (caste structure/tribal organisations and dynamics - we can
highlight through this session the concepts of ‘discrimination’ and
‘marginalisation’.).
■ Social institutions (marriage/family/inheritance).
■ Concept of patriarchy & gender.
■ Political organisations and structures .
Administrative structures (Various offices and their roles and responsibilities.
Organisation of the health care system in India (public and private mix; structure of
the public health care system).
Various go vernment development programmes and policies.
■ Development programmes (this in addition to understand the programmes
would also help investigators to know as to from where to get the concerned
data to fill in the area recorder).
■ Women’s health programmes and programmes for children (FWP, CSSM,
MCH, RCH, ICDS, immunisation).
Health care
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positive implications for individual growth which in turn would ensure quality of work.
This primarily will be achieved through use of various training methods, use of
physical spaces around us during the training period and different games.
There will be a sharing session, placed appropriately, for all the team members to open
up and share in brief their life experiences which hit them for gender discrimination
along with a brief life history and motivations to join on the project.
(d) Orient and develop adequate understanding of research ethics
(one day)
There will be about two formal sessions on research ethics and its significance.
However, most of the principles of ethics would be weaved with the entire training,
especially during the training of aministering the protocols and understanding the
protocols. NECSSRH guidelines will be used as a basic framework and CEHAT’s
guidelines will be discussed among the group to develop the understanding.
(e) Orienting on the administrative procedures
(one session of 2 hours or half a day by Kiran and Taras)
This is primarily to orient the team on some of the essential administrative procedures
that they would be required to do while in the field. This would include
■ Orienting them about CEHAT’s Rules and Regulations, salary structures, and
various structures, which are meant to facilitate democratic processes and
functioning within CEHAT. This would include to talk about WG, IEC, and SAG.
■ Teaching them to make vouchers and maintaining the accounts at the field level
We would use multiple modes for training, such as, group discussion, role plays,
lecture followed by open discussions and mock interviews.
Who would conduct training?
Resource people (from the institution, including team members or from outside) will be
requested to hold these sessions for the entire team.
Time required?
We anticipate a two weeks’ programme. This would allow the team to digest the
concepts and the study that is required to initiate the field work. It would also
stimulate the process of team gelling well together.
Resource material, resource persons; games and organisation of the sessions,
scheduling the sessions, preparing the presentations, deciding on who is going to
take what sessions from among us,
7. PILOT TESTING/PRETESTING
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This is to impart and develop the skills required to conduct the field work - mapping
and house listing, rapport establishment, conducting community meetings,
administering tools of data collection
Understanding the empirical research (continuation of what was touched upon
during the first few days).
■ Imparting skills in village mapping and house listing. Though all can undergo
training in this, we would have space to concentrate on a few who demonstrate
aptitude for taking up such a task, (this will be done independent of the entire
training. The decision such as whether the teams of village mappers and house
listers would be different or overlapping - fully or partially - would depend
much upon as how we will be placed with the list of PSUs.
■ Training the team in conducting community meetings before the field work in a
particular PSU starts as part of (a) rapport establishment and (b) informing the
community about the institution, work (c) advocacy on general health care
issues as a gesture of our gratitude for their prospective participation in the
study.
■ Preparing the team to administer various tools of data collection, (this would
require about 6-7 days)
■ Explaining the methodology and its rationale
■ Rationale for choosing this combination of methodologies, (quantitative
survey follo wed by the qualitative study
■ Protocols for the quantitative survey: Choice of the protocol, rationale for
each of the protocol, subheads in each of the protocol and their relevance
to the objectives of the study
■ Explaining each of the data item (variable) in each of the protocol.
■ Explaining the glossary and reference manual and to provide them hand on
practice for using them.
■ How to conduct interviews: Dos and donts.
■ Adequate training and practice in administering the various tools of data
collection through mock administration of various tools. In that, emphasis
would be on how to pose the questions and probes at appropriate places
without changing (adding) meaning of the original question.
• Seeking informed consent - significance and how to go about it.
• Sharing of some of the community based research on women’s illnesses
highlighting
• The problems faced by the respective teams; and means, methods and
strategies used by them in a particular situation.
Getting information on gynaecological morbidity, probes and their
administration.
• Sharing of experiences form NFHS .
■
(c) Building team solidarity
This is primarily to develop and facilitate team solidarity, to foster mutual trust
among the team members, and to develop respect for each other. This has great
significance while working in the field over long stretches away from home having
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Health care services.
■ The organisation of health care services (public and private - structures,
referral system).
■ The grass roots level health workers.
■ Cost of health care services.
■ Public expenditure against household expenditure on health care.
■ Direct and indirect cost incurred
Abortion: Facts and figures: Incidence, cost of abortion care,
■ Perspective:
■ Abortion and women’s movement in the global context
■ CEHAT’s perspective on abortion, CEHAT’s work on abortion and
abortion research in India
■ Legal aspects of abortion:
■ The global perspective on abortion legislation
■ The legislation in India and its salient features
■ Legislation and its historical context
■ The process of bringing the legislation in.
■ Medical aspects of abortion and human biology
■ Human reproduction, reproductive systems - men and women (the
technique of the body mapping shd be used for this.).
■ The concept of abortion: induced and spontaneous
■ Abortion methods (conventional methods and advances in medical field as
regards abortion methods)
■ Gynaecological morbidity and abortion complications: possible reasons,
patterns, symptoms
■ Significance of reported morbidity against the clinical morbidity
■ Quality of care
■ Structure, process and outcome: Comparison between medico-technical
model against a gender sensitive model
■ Significance of users’ perspective on quality of abortion care services
■ The current status of affair - general health care and abortion care.
■ Unsafe abortion as a public health issues: The contributing factors (women’s
status in the family and in the society, familial dynamics around women’s
abortion needs and sexuality, stigma attached to the act of abortion, quality of
abortion care services).
■ Politics of abortion:
■ State’s population control policy, women’s contraception and abortion
needs
■ Does the legislation grant women abortion as a right: how does it get
translated in reality?
■ The complexities and contradictions opposition of women’s and other
progressive groups to sex selective abortion and supporting abortion as
women’s rights.
■
■
(b) Imparting skills
(about 6-7 days)
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What purpose would it serve?
In general, pilot testing is meant primarily to examine feasibility and practicability of
the proposed methodology to obtain the data required to meet objectives of the study.
In that, applicability of each and every aspect of various tools of data collection
assumes special significance, especially if one is venturing into a population/community
based study. At times, researchers even landed up doing ‘mini studies’ to meet the
need of having pre-tested methodology and tools of data collection and to understand
the problems in data analysis.
In the present case, pre-testing has its own significance for various reasons.
a) It is first of this kind of community/population based abortion incidence study in
India. Implied in it is that we would be interacting with people/communities and
women to delve into as sensitive and tabooed issue as abortion in a situation
(household surveys) which inherently does not allow long spans for rapport
establishment and anthropological approaches.
b) We, at this point of time have decided not to disguise the study with any other
aspects and stick to abortion related matters alone.3 This is primarily for three
reasons.
■ One, our discussions with a gynaecologist suggests that it is difficult to tap the
linkages between abortion related morbidites and other RH morbidities in any
such population based study which primarily records perceived morbidities
based on symptoms.
■ Two, inclusion of reproductive illnesses would make the study too massive to
manage. It is likely that the data would remain under-utilised given the
constraints of resources. Thus an ethically inappropriate strategy,. Also, the
fact tha. there are community based studies available on women’s illnesses
today, it is less likely the data obtained on these aspects (which is not the thrust
of the study) obtained with constraints around it would add any more to our
existing knowledge on these aspects.
■ Three, we would be pilot testing the strategy of seeking written informed
consent.
It is, therefore, essential to pre-test whether women would welcome such a
study without any disguise.
In the present study, following would be the specific objectives of the pilot testing'
■
The extent to which eliciting information from women on their life time obstetric
experiences including live-births and non-live births (spontaneous and induced
abortions, still-births) is possible by using such a quantitative survey methodology.
In other words we have to pre-test whether the tool/s allow to define all the
There were two reasons as why we wanted initially to include reproductive illnesses of women. One.
to explore the linkages between abortions and other reproductive illnesses, especially the situations
where the reproductive illnesses get aggravated post abortion if the latter are conducted without taking
appropriate precautions. Two, for the purpose of disguising the efforts to study abortion rates in
anticipation that there would large scale under-reporting in absence of such disguise.
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required denominators and numerators with accuracy.
The extent to which women would be able to tell us the timing/exact years of their
life conceptions.
■ To tap the problems that women and investigators face in recording the years of
conceptions.
■ To tap the problems in recording the post-abortion complications. The same is
true for data on maternal mortality and reasons for lifetime induced abortions.
■ It will also be of critical importance to understand the problems in administering
sections on cost and care of ‘life-time abortion - spontaneous and induced’ and
also of in-depth enquiry on cost and care of ‘spontaneous and induced abortion
during the reference period’, the point in time when women start feeling fatigues
or tired affecting quality of responses etc.
■ Besides, the sequence of sections and questions, language/vocabulary, clarity in
the formulation of the questions etc. need to be examined during the pretesting.
■ To record the time required for completing the questionnaire. This would enable
time estimate for completing this phase in the main study for the stated sample
size.
■ To tap the quality and texture of the community response to the subject matter
that would be studied without any disguise.
■
The major dilemma that we may face would be if there is reaction and therefore the
denial to participate. If so, would it be rational to include subjects/issues regarding
women’s general health or reproductive health so that the ‘abortion’ as thrust of the
research study would not hit the community in a manner that would have negative
consequences. What then happens to extra information that we acquire? How do we
resolve the concerns that we expressed earlier about obtaining information on such
aspects for the reasons of disguising the study?
8. ETHICAL ISSUES AND CONCERNS
8.1 Seeking informed consent and mode of communication: The method of rapport
development would serve the purpose of making community to know about our work.
However, informed consent would be sought on one to one basis with each of the
respondents. Informing respondents through a written note would primarily involve
communicating to them in writing and in oral the following:
a) About CEHAT and its work.
b) The larger context of the research and overall objective of the research.
c) Significance of each one’s participation in the study.
d) The way the data obtained through this work would be utilised in the course of the
coming time.
e) About their right to withd raw at any stage if she wants.
f) About their right to question us about the work we are doing before we start an
interview and even later. (Annexure V).
As explained earlier in this communication there would be different respondents to
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respond to three different tools of data collection. They are:
i.
ii.
iii.
Key informants (for rapport establishment and for acquiring
information on village profile):
Members/head of the household (for obtaining information about
selected households using household interview schedule)
Women respondent (for administering the abortion rate interview
schedule)
In addition to the information on the items mentioned above, there would be specific
information for each of the above type of the respondents, communicating to them as
to why this particular information (eg. village profile) is being obtained and so on.
8.1.1 Constraints/limitations:
■ These notes will be in local language. The constraint of non-literate women and
other respondents not being able to read through such material remains. Foi them
we would read the letter out to them. In either of the situation, women will be
encouraged to clarify their doubts with us. Thus, oral briefing and interaction with
respondents would be part of the process of seeking informed consent.
■ As recommended by the ECG during the National Methodology workshop, Dec
11-13, we would pilot test seeking written informed consent of respondents. The
experiences will be communicated to ECG. If there is large proportion of denial, it
has risk of large ‘no-response’ than the proportion, which has been factored in
while estimating the sample size.
In case an interview requires more than one visits/sittings with a woman and for that
matter with any other respondents, we would seek informed consent every time before
we start the rest of the interview. Similarly consent of women respondents obtained
for the quantitative survey will not be considered to be so for her participation in the
cohort study. Thus, informed consent would be sought afresh during the Phase II cohort study.
In no situation, consent/permission by anyone other than respondent would be
treated as informed consent of the respondent.
8.1.2 Informed consent during the pilot testing: The same process as described
above will be followed for seeking informed consent during the pilot testing as well. In
addition, the respondents would be informed about the fact that it is part of the pilot
testing and that the data would not be used for preparation of the report. If in case
respondents exhibit less or no interest in participating in the study, we would use the
strategy to further tone down the purpose of the research (“deception”) as approved
by the ECG.
One of the most important strategies to be pilot tested, as mentioned earlier, is
that of‘seeking written informed consent’.
8.2 Privacy: Privacy will be maintained during women’s interviews. However, the fact
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that we plan to conduct the interview in the community setting at woman’s residence,
it would be difficult to have control over the situation. The quantitative nature of the
study would not allow us to make many visits so as to find women alone at home
(which is very possible in qualitative anthropological studies). The household surveys
of this nature conducted earlier have recorded these difficulties. Some allowed (as
nothing else could be done about it) other women to be present during an interview
with a respondent. (Madhiwalla, et al., 2000). Some others opted for dummy
interviews of the other women. (Ganatra, et. al., 1999). As reported by the researchers
it was primarily for the purpose of ‘not singling out women with abortion experience’.
This in the process may have also kept the family members occupied providing some
privacy to respondents while being interviewed. It. However, without any concrete
purpose and plan for utilisation of the data obtained from such dummy interviews, it
would have additional ethical problems to attend to rather than resolve them.
It is difficult to maintain 100 per cent privacy in these situations. However, following
will be done to address the issue partially:
a) We will make an attempt to fix timings of women’s interview after discussing with
her as to when would the better time for us to have the required privacy.
b) In case, others happen to be present, we will try to seek their cooperation to
provide woman privacy.
c) We will not have any dummy interviews conducted.
d) Despite all these efforts, if others sit through interviews, we would record the
situation specific observation (which may tell the influence of others’ presence on
the woman’s response pattern,
e) We must record who were those ones - relationship with the woman respondent.
While doing any of these, women’s concern and comfort should remain a priority.
Respondent’s, especially women respondents’ name will be protected either by putting
a sticker on the name on the protocols/interview schedules.
It needs to be noted that the study design is such that it includes all the women in the
reproductive age in a household, which would reduce to a great extent the risk of
singling out women who may have undergone abortions.
8.3 Protection to the respondents, especially women: Implied in it is the risk of
singling out women with abortion experience, which has the potential to crack
confidentiality around women’s abortion experiences. As it appears, there is no such
risk involved in the Phase I - Quantitative Survey, that is collecting data, which would
enable calculations of various rates. This is for two reasons. One, the methodology
that is required to meet the prime objective of the study., includes all women of the
reproductive age as respondents from the sampled household units. These women give
us ‘denominator for various calculations involved. Two, for each of the women, we
would require to record detailed obstetric history. Abortion episodes would get
recorded as part of this exercise. The tools that are designed have a table to record this
information, which is titled obstetric history. Three, as part of the strategy to tone
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down the explicit emphasise on abortion research initiative, the title of the project on
each of the tools of data collection would read ‘Pregnancy Outcome, Care and Cost
Study’ rather than ‘Abortion Rate, Care and Cost study’.
8.4 Expressing our gratitude to people for their cooperation and participation in
the study: The community based household survey spread over a large geographical
areas where the institution taking up a research neither has (/can’t) any roots in terms
of interventions or services not have future plans in that direction often face an ethical
dilemma as to what does the community or respondents get out of it. There is no direct
and easy answer to this is available except that in long term it would benefit the larger
society and facilitate furthering of knowledge (improved methodologies and
understanding of abortion seeking behaviour).
As explained under ‘making in-roads in the community’, we would spend time and
energies to disseminate health related information to the communities and women.
CEHAT has large number of educational material prepared primarily for rural
communities. We will have a poster exhibition in each of the PSUs for benefit of the
entire community. And a set of five posters will be given to the village panchayats and
ward offices We will also screen a slide-show on anaemia and women’s health in each
of the PSUs
No individ ual compensation is planned. No monetary compensation to anybody
participating in the study or facilitating the study at the local level. However, we
would offer educational material to Mahila Mandals, Panchayats, libraries, panchayat
mahila members, Tarun Mandal depending upon their interests, needs and women’s
and commi.nity’s accessibility to these structures/ institutes/offices.
9. CONCEPTS AND DEFINITIONS
We prepared glossary for three purposes, (for glossaries - Annexure VI, VII, VIII)
One, to understand various medical and clinical aspects of abortion, which was
necessary for the entire research team even before it got into laying down study design
and methodology. Two, it was essential to have clarity, especially about the symptoms
of various abortion related morbidity and other morbidity while formulating the set of
specific questions to be included in tools of data collection. Three, it would be an
handy reference for field investigators/ supervisors/ editors while in the field to be on
their own without getting stuck. Our earlier experience with preparation of such
appropriate glossaries supports these uses.
It
primarily
contains
definitions
and
concepts
regarding
abortion;
definitions/description of abortion morbidity; their clinical symptoms and their
perceptible and/or non-clinical symptoms. We used medical literature; referred to the
community-based studies and discussed with gynaecologist to make the glossary
appropriate, exhaustive and adequately self-explanatory. This would be available for
field investigators in local language, too. These concepts and illnesses will be discussed
thoroughly with the field investigators and others constituting the project team during
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their training.
10. LIMITATIONS OF THE STUDY
Abortion mortality rates will not be captured. This is because to be able to
arrive at such rates, a very large sample is required given its comparatively low
incidence (not a commonly occurring phenomenon). This was also suggested by
the TAC during the meeting held in Oct at New Delhi to discuss the proposal with
the respective researchers.
■ Unmarried women will not constitute the sample. Given the sensitive nature of
an act of abortion because of moralistic values attached to it, women’s sexuality
involved in it etc.:, we will not be studying abortions among unmarried. In such a
broad based cross-sectional community based study, there is less scope to have any
support mechanism, either community based or otherwise, in place in case woman
respondents, her tamily members would fall back on. The chances of unmarried
women having had undergone abortions are more likely to feel the need of such
support mechanism in case of community’s untowardly reactions upon the
knowledge of her so called illegitimate sexual indulgence leading to an abortion. If
so, inclusion of unmarried women in the sample obviously raises major ethical
issues. Without, any such support system in place, we would certainly exposing
them to unnecessary risks.
■ Accuracy in reporting of the dates of occurrence of life events is difficult to
ensure: A studied and meticulous attempt is being made to trace birth history with
as much accuracy as possible using appropriate combination of methods to do so.
For example, data collection on the pregnancy history will be collected using
appropriate combination of methods - integrated (live-births and pregnancy
wastage obtained and recorded together - pregnancy history using ‘calender’
protocol method. The proposed use of ‘calender’ protocol method is intended to
improve the ‘dating’ of obstetric events in woman’s life. This still may not ensure
accuracy in dates of events, especially pregnancy wastage.
■
11. REFERENCES
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survey responses on abortion evidence from Estonia.”, Demography, 31 (1), pp
115-132.
2. Anderson, B. A. and Silver, B. D. (1986). “Measurement and mismeasurement of
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3. Bandewar, S. and Sumant M. (2000). Quality of abortion care: ‘. CEHAT, Pune.
4. Bose, A. (1994). Demographic zones in India. B. R. Publishing Corporation. Delhi.
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7. Chen, L.S., Gessshe, A. M. and Mosley, W. H. (1974). “A prospective study of
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Quarterly, 32, pp588-606.
9. Das, N. P. (1989). “The impact of contraception and induced abortion in fertility in
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10. Davis, K. and Blake, J. (1956). “Social structure and fertility: An analytical
framework.”. Economic development and Cultural Change, 4(1), pp 211 -236.
11. Duncan, G. J. and Mathiowitz, A. (1985). A validation study of economic survey
data. Ann Arbor: University of Michigan, Institute of Social Research.
12. Erhardt, C. L. (1963). “Pregnancy losses in New York City, 1960”. Americal
Journal ofPublic Health, 53(9), pp 1337-1352.
13. Freedman, R., Coombs, L. and Friedman, J. (1962). “Probabilities of fetal
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14. French, F. E. and Bierman, J. E. (1962). “Probabilities of fetal mortality ”. Public
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15. Gray, R. H. (1983). “The impact of health and nutrition on natural fertility.” In
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Academic Press, New York, pp 139-162.
16. Haberman, P. W. and Elinson, J. (1967). ‘Tamily Income Reported in Surveys:
Husbands versus Wives.” Journal ofMarketing Research, 4, pp. 191-94.
17. Hull, T. H., Sarwono W. S. and Widyantoro, N. (1993). “Induced abortion in
Indonesia.”. Studies in Family Planning, 24(2), pp. 120-124.
18. Huntington D., Mensch B., Miller., (1996): “Survey questions for the measurement
of induced abortion”, Studies in Family Planning, 27(3), pp.155-161.
19.1-Cheng, Chi, Chow, L.P., and Rider R. V. (1972). “The randomised response
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Planning, Nov, pp 265-269.
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Survey, Maharashtra, India.
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Survey, India.
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-II, India.
23. James, W H (1970). “The incidence of spontaneous abortion.”, Population Studies
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SfiJesani A., Iyer, A. (1993). “Women and Abortion”, Economic and Political
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25. Jejeebhoy, S. (1999). “Reproductive health information in India: What are the
gaps?”. Economic and Political Weekly, 34(42&43), pp 3075-3080.
26. Jones E F and J D Forrest (1992). “Underreporting of abortion in surveys of US
women: 1976 to 1988.” Demography, 29 (1), pp 113-126.
27. Kanitkare, T., Radkar, A. (undated). “Unwanted pregnancies and role of induced
abortion in India.”. Unpublished paper.
28: Karkal, Nl. (. ;)
29. Kerr, M.G. (1971). “Prenatal mortality and genetic wastage in man.5?” in Journal of
Biosocial Science,3(2), pp: 223-237.
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30. Koenig, M. A., Simmons, G. B., and Misra, B. D. (1984). “Husband-wife
Inconsistencies in Contraceptive Use Response.” Population Studies, 38, pp 28131. Loftus, E. F., Smith, K. D., Klinger, M. R. et. al. (1992). “Memory and
mismemory for health events.”, in Questions about questions: Inquiries into the
cognitive bases of surveys, ed J. M. Tanur. Russell Sage Foundation New York
pp: 102-37.
32. Macro International. (1994). Communication of unpublished frequencies of
abortion from the Senegal DHS II, October.
33. Medico Friend Circle. (1990). Distorted lives: women’s reproductive health and
Bhopal Diaster.
34. Ministry of Health and Family Welfare (1966). Report of the Committee to study
the questions of Legalisation of Abortion.
35. Okonofua F.E., Odimegwu C., et al., (1999): ‘Assessing the prevalence and
determinants of unwanted pregnancy and induced abortion in Nigeria’, Studies in
Family Planning, Vol 30(1), pp. 67-77.
36. Population Foundation of India. (1999). Population Projections - 2051.
37. Potter, R. G., Wyon, M N. and Gorden, J.E. (1965). “Fetal wastage in eleven
Punjab villages.”. Human Biology, 37, pp. 262-273.
38. Retel-Laurentine, A. (1973). ‘Teondite et syphilis dans la region de la Volta
Noire.”. Population, 28(4), pp 793-815.
39. Ross D A., and J P Vaughan (1986). “Health Interview Surveys in Developing
countries: A Methodological Review.”, Studies in Family Planning, 17(2), pp 78-
40. Shapiro, S., Levine, H. S., and Abramowicz, M. (1970). “Factors associated with
early and late fetal loss.” Advances in Planned Parenthood, 6, pp 45-63.
41. Traugott, M. W. and Katosh, J. P. (1979). “Resposne validity in surveys of voting
behaviour.” Public Opinion Quarterly, 43, pp 359-77.
42. Tiwari, S. (1994). Report of Thematic meeting on RH: The need for
comprehensive policy and programme. May 4-5, 1994, organised by CEETNA
Ahmedabad.
43. Visaria, L (1999). “Proximate determinants of fertility in India: An exploration of
NFHS data.”. Economic and Political Weekly, 34(42&43), pp 3033-3040..
44. Warner, S. L. (1965). “Randomised response: A survey technique for eliminating
evasive answer bias.”. Journal of the American Statistical Association, 60, pp 6345. Yerushalmy, J., Bierman, J. M., Kemp, D. H., Conner, A. and et al. (1956).
“Longitudinal studies of pregnancy on the island of Kauai: Analusis of previous
reproductive history.”. American Journal of Obstetric and Gynaecology, 71 (1),
46 Zamudio L., Rubiano N., et al (1999): The incidence and social and demographic
characteristics of abortion in Columbia’, in Mundigo A.I., and Indriso C., (eds)
Abortion in the Developing World, World Health Organisation, Vistar Publication,
New Delhi.
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ANNEXURE I
ESTIMATING SAMPLE SIZE
(Detailed calculations for arriving at households sample size)
_______________ ________________ Table A
Assumptions for the population parameters and
precisions set for the purpose of generalisation
Population parameter/estimation of abortions_____
Confidence interval set
_______________
Standard error allowed
Birth rate for Maharashtra (source - NFHS-II)
Values
33 % of the conceptions are wasted
95%________________________
plus or minus 0.01______________
23 per 1,000 population________
Calculations:
V
p(l-p)
< 0.01
n
p (1-p)
- p(]-p) X 1000 where p = 1/3 and therefore q = 2/3
(0.01)2
n> (1/3) x (2/3)x 1000
Assuming CBR
population.
2222
23 (according to NFHS II and other data) per 1,000
a. Assuming CBR - 23 per 1,000 population
To capture 2222 conceptions, that is to capture 1481 births and 741 abortions,
population to be covered is
= (1481xl000)/23
= 64391
b. Assuming household size to be 5, households to be covered would be
= 64391/5
= 12,878 or approx 13,000 for conceptions covered in one year.
c. If conceptions are covered for three years, the household size would reduce to one
third, that is
13, 000/3 =4,333
d. With total loss of sample 15% (including no response and under reporting), the
sample size would be 4,973 or approximately about 5,000 households.
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PROBABILITIES
1. The overall sampling fraction, that is, the probability, f, of selecting a woman
from Maharashtra would be
f=(nX1.35)/N orf = (n X 1.15)/N
Where
n - number of women to be interviewed in Maharashtra adjusted for 35 per cent (or
15) to account for ‘no response’ and other loss; and
N
projected population of eligible women in Maharashtra (latest data).
The sampling rate (sampling fraction) would be the same in the urban and rural areas
of the state, and thus the sample would be completely self-weighted.
2. The probability of selecting a PSU (fl) was computed as:
fi
(a X sj) / summation sj
where
a
Si
summation Sj
number of PSUs selected from rural Maharashtra
the population size of the selected PSU
total rural population of the state
3. The probability of selecting a household from a selected PSU (f2) was computed
as:
f2 = f/fi
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C:\sunl\NAAS\Tools\Area recorder-purpose-2,doc
ANNEXURE-U
AREA (RURAL/URBAN) PROFILE RECORDER (APR)
Purpose
The objective of administering the APR is as below:
1. To know the socio-economic characteristics of the study area.
2. To arrive at the village level development index to explore whether it functions as one of the
explanatory variables vis-a-vis the subject matter under study, especially abortion care and
cost aspects.
3. To record some of the village/area events - routine and historical - to be used as landmarks.
This is to facilitate respondents to chronologically locate their life events with better
accuracy by using these landmarks as reference points.
Not many studies in the past, including the large-scale national surveys, have made use of such
data collected through area profile recorder, except using them for describing profile of the area
studied. However, we anticipate that these data would enable construction of a village/ward level
development index. Such an exercise was done by Sinha and Kanitkar (1994) was found to be
useful in examining the trends of correlation between general development status of the area (at
the level of village and ward) and people’s patterns of utilisation of health care services.
This particular protocol is designed to suit specifics of both, rural and urban, primary sampling
units (PSUs) to be included in the study.
Major heads for data collection
This protocol collects data/information about rural or urban status of the PSU and other
identificatory details, such as, village/ward, taluka, district, slum identification; social structure
(community’ identity in terms of religion; caste/tribe composition etc.); the overall development
status of the village in terms of availability of basic amenities; its approachability to the outside
world (approach roads, transport facilities, communication means etc.); its access to educational
facilities; its access to health care services (institutional and non-institutional; public and private;
primary and others).
Visit details: This is primarily to maintain the records of the details of the field visit including
the time frame (date/s of data collection etc.). It serves an administrative purpose and provides
details of the concerned field team members to facilitate clarification, if required about the data.
I. Identification of the study area: These are the details of the area under study. It includes
village or ward, taluka and district identification; identification details of urban wards (areas
name, ward and/or survey number) and the PSU number for the area given to it for this specific
research by the researchers.
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In case of slums, there are some additional information/data items to know whether it is
recognised or not, number of years that it is established. The recognised slums are supposed to
have access to some basic amenities.
II. Area, Population & Community Composition: This is intended to know, size of the area in
terms of population, number of households and area; population below poverty line. It also gets
data on the dominant and co-dominant religious groups, casts groups, tribal groups.
This would help us to arrive at density of population (population per sq. km), proportion of the
households/population living below poverty line.
The data on the dominant/co-dominant groups would help us understand differential access to
basic amenities, including health care facilities when analysed in the light of the individual
identities of the respondents. This will be an additional analysis available for the entire sample
other than dichotomous analysis of upper caste and lower caste. It is likely that the dominant/codominant groups (regardless of caste identity) have better access to amenities.
III. Access: Roads and transport facilities: This is primarily to know whether the population
living in the area under study has access to transport facilities determining their accessibility to
the world outside. It includes data on availability of ‘all whether road’, distance to the nearest
town, distance to the nearest pucca road, to the bus stop etc.
IV. Access to basic amenities: This is know the whether the population has access to the basic
amenities - electricity, drinking water (source and availability round the year), drainage facility
and toilet facility.
V. Access to education facilities: This is primarily to know whether the population has access to
education facilities in the area itself or whether children in the area have to travel some distance
to access educational facilities.
VI. Access to health care facilities:
Non-institutional health care service providers Insitutional This is know what kind of noninstitutional health care service providers are available. These include both nonformal/private/untrained health care providers and formal/public/trained health care providers
working at the grass roots level.
Institutional health care facilities: This is know what kind of institutional health care facilities
are available. Institutional health care facilities include, both public and private. It also enquires
into the type of health care services, including abortion care and type of health care service
providers that are available at these institutional health care facilities.
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VII. Access to other facilities: This looks into access to facilities such as, postal services,
telephone services, fair price shop, bank, weekly market, and pharmacy.
VIII. NGO Interventions: This is to know if there are any other groups active in the area,
period for which they have been active in the village or areas and nature of their activities. It also
seeks information about the local mandals, both women’s and youth’s and nature of their
activities.
IX. Major events in the area: This is to record the major village events, both annual
(festivals/fairs/birth anniversaries round the year) and historical (epidemics; natural calamities).
These will be used as reference points while interacting with respondents to help them place their
life events more accurately in a chronological sequence along calender years.
X. Source of information and observation: The area (rural/urban) profile recorder, towards the
end, records the sources of information for filling in this particular interview schedule.
Special attention required during pre-testing
Area (rural/urban) profile recorder
Section IV: Access to basic amenities
■
■
What type of toilet facility does the majority (more than 50%) of the population have access
to in the village/area? (mutually exclusive)
What about the rest of the population? (multiple choice)
(similar questions needs to be examined whether they work as per our imagination and
expectations).
Section VII: Access to health care services: Institutional health care facilities
■
What are the services provided?
It is an open ended question. PI see the pattern of responses - the extent of to which
respondents can spell them out, the extent to which there is clarity in what they are saying.
If it turns out to be vague, it is preferable to give them the cards with specific services listed
on them. It would be easier to classify as respondents are offered a structured
responses/alternatives.
References
Sinha R. K., and Kanitkar, T. (1994). “Acceptance of family planning and linkages with
development variables: Evidence from an 80-village”. The Journal ofFamily Welfare, 40(2), pp:
(Contd...
the protocol titled - Area Profile Recorder —>)
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APR-Purfyt&e
-jLL
Confidential: For research only
PSU NO:
SCHEDULE NO:
PREGNANCY OUTCOME: A COMMUNITY BASED STUDY
A household survey undertaken by
Centre for Enquiry into Health and Allied Themes (CEHAT), Pune.
(AREA PROFILE RECORDER)
VISIT DETAILS
Date (started on);
Date (Completed on):
Name of the team leader:
Signature and date:
Checked by (Name):
Signature and date:
I IDENTIFICATION OF THE STUDY AREA
101. Name of the village/town:
Village/Town code:
102. Name of the Taluka /tahsil:
Taluka code:
103. Name of the district
------ -------------------------------------------------104. Name of region
District code:
1
Region code:
105. Municipal Corporation Survey no (please
record actual survey number):
NA(in case of rural area)
106. Ward no (please record the actual
number):
| NA(in case of rural area)
107. Name of the area (applicable in case of
urban PSUs only):
PSU code:
9
___________________ ^APPLICABLE ONLY FOR SLUM AREA)
108. Name of the slum:
109. Status of the slum
(recognized/unrecognized):
It
110. Year of establishment of the slum (pl.
record the actual year):
Recognised:
Unrecognised:
NA(in case of nonslum area)..
NA (in case of nonslum area)
..1
..2
9
9"
——
Abortion rate, care and cost: A community based study
CEI1AT, Pune
APR-IS- 1/13
IL AREA, POPULATION & COMMUNITY COMPOSITION
NO.
201
INFORMATION
ABOUT
RESPONSES
SOURCE OF
INFORMATION
YEAR OF
INFORMATION
(Type of record /
office)
(Please ask and
record the year)
Area of the
village/ward/slum (in
Hectares):
202
Current Population of the
village/ward/slum:
203
Total number of
households in the
village/ward/slum:
204
Number of Below
Poverty Level (BPL)
households:
Abortion rate, care and cost: A community based study
CEHAT, Pune
APR-IS- 2/13
NO.
INFORMATION ABOUT
205
Dominant religious groups/communities1:
RESPONSES
1
2
206
Co-dominant religious groups/communities2:
207
Other religion:
208
Dominant caste groups1:
209
Co-dominant caste groups2:
210
Other caste:
211
Dominant scheduled tribe
212
213
NA.
1
2
NA
1
2
NA.
1
2
TvlA
1
2
NA.
1
2
NA.
1
2
NA.
Co-dominant scheduled tribe2:
1
Other scheduled tribe:
2
NA.
1
2
NA.
..9
3
4
..9
3
4
..9
..9
3
4
..9
3
4
..9
9
..9
3
4
..9
i
1 Dominant religion/dominant caste/ dominant scheduled tribe: Those religion /caste / tribe which have a
population of more than 50% in that PSU.
2 Co-dominant religion/dominant caste/ dominant scheduled tribe: Those religion /caste / tribe which have a
population of less than 50% in that PSU.
Abortion rate, care and cost: A community based study
CEHAT, Pune
APR-IS- 3/13
III. ACCESS: ROADS AND TRANSPORT FACILITIES
NO.
INFORMATION ABOUT
301.
Distance of the village/area from the
nearest town:
RESPONSES
Name of the town:
Distance in Kms:
302.
303.
304.
305.
306.
Distance of the village/ward/slum from
the nearest all weather road:
(If the village/ward/slum itself is
connected by all weather road, record
i0'km.)____________
Distance of the village from the nearest
bus stand/stop (state transport)
Distance of the ward/slum from the
nearest bus stand/stop
(I/'available in the ward/slum record 6O'
Km)________
Distance of the village/ward/slum from
the nearest Railway station:
(if available in the village/ward/slum
record 'O' Km)
"Distance of the village/ward/slum from
the nearest private transport stand/stop
(Tempo, Six sitter, Jeep etc.):
(1/ available in the village/ward/slum
i
record (0'Km)
Abortion rate, care and cost: A community based study
CEHAT, Pune
NA(z>2 case of urban PSUs)
9
Kms
Kms
NA<z>? case of urban PSUs)
9
Kms
NAfzn case qfrural PSUs)
9
Kms
Kms
APR-IS- 4/13
IV. ACCESS TO BASIC AMENITIES
(Electrification, drinking water and sanitation)
NO.
INFORMATION ABOUT
401.
Is the village/ward/slum electrified?
402.
403.
404.
405.
Yes
No....................
For the majority of the population what is Pipe line..........
the main source of drinking water in this
Bore well
village/ward/slum:
Well
River/pond/Lake
(Record all sources)
Other (specify)
Whether drinking water is available
round the year?
During last 5 years, how many months in
a year on average there is shortage of
water in this area?
During water shortage, is the water
supply to the village/ward/slum
private/public?
(Record all sources)
406.
RESPONSES
For the majority of the population what
type of drainage facility do you have in
the village/ward/slum?
Yes....
No
Months
o
■ ■2
A
B
C
D
E
1 (Go to 406)
2
Days
Public supply .
Private supply .
Other (specify)
.A
B
C
Underground drainage
Open drainage
No facility
A
B
C
(Record all sources)
407.
For the majority of the population what Open
type of toilet facility do you have in the Community
village/ward/slum?
ndividual
Abortion rate, care and cost: A community based study
CEHAT, Pune
..1
2
.3
APR-IS- 5/13
V. ACCESS TO EDUCATION FACILITIES
RESPONSES
INFORMATION ABOUT
NO.
Facilities
Which transport is
generally used?
Is the facility available in the
village/ward
(If not available in the village/ward
(If the facility is
record distance from the area in kms)
available within the
Iffacility available record ‘0’ km)
PSU, record NA)
501
Primary School
Kms
(1st to 4th standard)
502
Middle school
Secondary school
Higher sec. school
College / University
Abortion rate, care and cost: A community based study
CEHAT, Pune
9
NA
9
NA.
9
NA.
9
Kms
(1 ld' to 12h standard)
505
NA.
Kms
(8th to 10th standard)
504
9
Kms
(5th to 7th standard)
503
NA.
Kms
APR-IS- 6/13
VI. ACCESS TO HEALTH CARE SERVICES:
INSTITUTIONAL/NONINSTITUTIONAL
A. Health care providers
Type of health care service
providers _______
_____
Traditional healers (Bhagals etc who
treat in a traditional way)
Whether available ini the
_____ village/ward/_____
Yes
1
No
2
602
Zola Chhap (the ones who are mobile)
Yes
No
1
2
603
Local abortionist
Yes
No
1
2
604
Traditional birth attendants
Yes
No
1
2
605
Anganwadi Worker
Yes
No
1
2
606
Community health guide/worker
(CHW)
Yes
1
No
2
NA (in case of urban PSU)..,9
601
Type of health care service
___________ providers
Does he/she regularly come to the village?
607
Multipurpose worker (MPW)
Yes
1
No
2
NA (in case of urban PSU)...9
608
Auxiliary Nurse Midwife (ANM)
Yes
1
No
2
NA (in case of urban PSU)...9
Abortion rate, care and cost: A community based study
CEHAT, Pune
Numbers
present
APR-IS- 7/13
VI. ACCESS TO HEALTH CARE SERVICES: INSTITUTIONAL/NONINSTITUTIONAL
B. Health care institutions
No.
Type of health
care facility
Whether available in the
village/ward/
(If not available, record
distance from the nearest
facility (in kins)
Please record ‘0’ km if the
facility is available in the
area itself)
609 Govt. Mobile
Health care unit
Whether provides
abortion care?
Yes
1
NA,
9
Yes
1
NA.
Yes
No ,
2
Type of
service
providers
(ANMs, GP,
Gynaec,
surgeon,
paediatrician,
others)
Does any of
these govt
doctors are
engaged?
Who?
Km
NA.
610 Sub-centre
NA,
611 Primary Health
Centre *
NA.
6121 Rural/ Cottage
Hospital*
/Com Health
Centre
Which are the
services
provided?
(Pl record as
stated)
NA.
....9
Km
....9
Km
....9
Km
Yes
No .
1
2
1
2
9
(cont..)
* Non applicable for urban PSUs
Abortion rate, care and cost: A community based study
CEHAT, Pune
APR-1S- 8/13
(cont..)
Yes
No
Km .
NA.
Yes
No
1
2
.9
1
.2
Km
Yes
No.
1
.2
NA.
9
Km
Yes
No..
1
.2
NA.
9
Km
Yes
No..
1
.2
NA.
9
Km
Yes
No.
1
.2
NA.
613 Health posts**
614 District level /tertiary
hospital**
(with in-patient care)
615 Municipal/
Corporation hospital
616 Private Clinic/
Dispensary
(Only outpatient,
617 Private Hospital
(inadmission)
618 Health care facility of
NGO
619 Others health care
facility (specify)
Km
Km
** NA in case of rural PSUs
Abortion rate, care and cost: A community based study
CEHAT, Pune
APR-IS- 9/13
9
NO.
620.
RESPONSE
INFORMATION ABOUT
Does the village/ward/slum have X-ray, blood and
urine test facilities?
No
621
From where does the people from this PSU access
sonography facility?
623
Does the public health care facility based in the
village/ward or/the nearest one has an ambulance/
vehicle?
624
Is the facility by and large made available to people
when required?
2
km
If the above facilities are not available, then record
the nearest such type of facility?
622
Go to
622
Yes
Village/town
Village/town
Tai. name
District name
Name of the provider
Yes
1
No
27^ Goto
701
Yes
1
No
2
C. MINIMUM PUBLIC HEALTH CARE FACILITIES AVAILABLE
RESPONSE
NO.
PUBLIC HEALTH CARE SERVICES
625
Does the dai in your village use safe delivery kit
during delivery?
Yes
No .
626
In your village, were tetanus inj. and iron folic
tablets provided during delivery?
627
Does the sub-centre have adequate and daily supply
of basic drugs?
Inadequate/ no service at all.... 1
Irregular service available
2
Regular, adequately available ..3
Yes
1
No
2
628
Does the basic drugs available at the primary health
care centre provided free of cost?
629
Is doctor available 24 hours for all the days in the
primary health care centre?
All drugs available
1
Few drugs had to be bought 2
Most drugs had to be bought ..J
Yes
1
No
2
630
Does the primary health care centre have normal
delivery facility?
Yes
No .
Abortion rate, care and cost: A community based study
CEHAT, Pune
1
2
1
2
APR-IS-10/13
VII.
NO.
ACCESS TO OTHER FACILITIES
INFORMATION ABOUT
RESPONSE
Facilities
Whether available in the
___ village/ward/ slum?
Yes
1
No
2
Yes
1
No
2
Yes
1
No
2_
Yes
1
No
2
Yes
1
No
2_
Yes
1
2
No
701.
Pharmacy/Medical shop
702.
Fair price shop
703.
Post office
704.
Telephone
705.
Bank
706.
Weekly Market
VIII. NON GOVERNMENT ORGANISATION (NGO) AND THEIR ACTIVITIES
801. Is there any NGO active in the area: Yes
No
1
. 2 (Go to 807)
No.
Name of
the
NGO
Is it within the
village/ ward/
slum?
For how many years
are they working
here?
802
803
804
805
Yes
No
Yes
No
1
2
1
,2
yIT
T
No
Yes
No
2
What kind of services /
interventions are they
providing/making in the
________ area?________
806
completed year of work
completed year of work
completed year of work
7
2
completed year of work
Abortion rate, care and cost: A community based study
Cl/HAT, Pune
APR-IS-11/13
COMMUNITY LEVEL MANUALS
Mandals
807. Mahila Mandal
808. Bhishi Mandal
809. Bhajan Mandal
810. Others (specify)
Whether any of the
following Mandals are
active in the village?
Yes
1
No.
2 (Go to808)
Yes
1
No.
2 (Go to809)
Yes
1
No,
2 (Go to810)
Yes
1
No
2 (Go to901)
What kind of activities were
organized in the last year?
IX. MAJOR EVENTS IN THE AREA
Yearly festivals and fairs:______________________________________________________
901.
Major village/community festivals or fairs: (Record the month in which it is celebrated)
Name of the community festivals Zjayantis
Which month of the year?
a) ___________________________________
b) ___________________________________
c) __________________________________
d) ___________________________________
e) ___________________________________
Epidemics:_________________________________
902. Major epidemics & diseases in the village/community/area:
Epidemic or disease
Record month and year
a)____________________________________
_b)___________________________________
c)___________________________________
|d)
Natural calamity:____________________________
903. Whether the village/community had to face any
of the following calamities?_______________
a) Flood
Yes
.1
No.
. 2 (Go to b)
b) Drought (wet)
Yes
.1
No.
2 (Go to c)
9*
NA.
c) Drought (dry)
Yes
J
No.
2 (Go to d)
d) Earth Quake
Yes
.1
No.
2 (Go to e)
e) Others (specify)
1
Yes
No
2 (Go to 1001)
Which year:
(Pl record the year)
*Not applicable in case of urban PSU
Abortion rate, care and cost: A community based study
CEHAT, Pune
APR-IS- 12/13
X. SOURCE OF INFORMATION AND OBSERVATION
1001. Any other comment/observation by the researchers/investigators about the PSU/area:
Iv 1002. Major sources for obtaiuii^ the isfonaaiioB:
{Record all the sources contacted)
Talathi...................................... A
Sarpanch...................................B
Women Panchayat members .. .C
Men Panchayat members........... D
Village leader (local)................ E
Gram sevak................................ F
School teacher............................ G
Health personnel......................... H
Village level worker.................... I
Corporator................................. J
Local informal leader............... K
Person in the ward office............. L
Others (pl specify)..................... M
Abortion rote, care and cost: A community based study
CEHAT, Pune
APR-IS- 13/13
C:\sunl\NAAS\T00LS\HHS-IS-2Purpose.doc
ForAAP-I, ECG meeting
June 20-21, '01, Bombay
ANNEXURE-11I
HOUSEHOLD INTERVIEW SCHEDULE (HHD-IS)
Purpose
These data is expected to serve the following purposes:
(a) To identify the eligible women for individual interview - the core of the data collection
(b) To have the. well-defined base population, the denominator, needed for computation of
abortion rates and other related demographic rates, if required.
(c) To provide us values/scores/indices for the set of explanatory variables - independent and/or
intermediate.
This entails.
(a) To obtain detailed information about family/household composition in terms of household
members - listing, basic demographic data such as sex, age and marital status.
(b) To obtain data on variables/ indicators constituting socio-economic profile; educational
attainment of the family members.
Most of the large-scale community-based surveys, census in various countries; initiatives
implemented globally with common core methodologies, such as, WFS, DHS series, NFHS
series included household interview schedule in the set of data collection tools and as part of the
methodology with similar objectives.
Major heads for data collection
Visit details: This is for the administrative purpose to keep the track of how many visits made
and time required to complete a particular interview. This also records the status of the interview
- whether the dwelling was located, whether it was inhabited, if the respondents could be found,
whether the interview could be completed or there was refusal to participate in the study.
I. Identification of the field and the household location: These are the identification details of
the area under study and the sampled household. It includes village or ward, taluka and district
identification; identification details of urban wards (areas name, ward and/or survey number) and
the PSU number for the area given to it for this specific research by the researchers. Investigators
will record them.
Further, it records household number from the house listing (done by the team as part of this
project), address of the household with stated (by the respondent) and observed (by the
investigator) landmarks.
It records, relationship of the respondent (in case s/he is not head of the household and will be
only when head of the household is not available) with the head of the household; and number of
Abortion rate, care and cost: A. Community based study
CEHAT, Pune
HHD-IS-Purpose 1/4
C:\sunl\NAAS\T00IS\HHS-IS-2Purpose.doc
For AAP-I, ECG meeting
June 20-21, '01, Bombay
year s (in completed years and months) the family is staying in the village/area, primarily to know
length of the stay of the family in the area.
IL Household members: Profile. It is to know the demographic composition of the family of
the women who would be interviewed subsequently. Members of the household would constitute
the based population for the study.
Information on age, sex, relationship to head of the household, current marital status and
education,^ if married more than once will be collected. These data will be collected for all the
persons - usual resident’1 and visitors (including married daughters visiting parents’ place).
We are taking the de facto base population, by considering visitors and guests as part of the
sampled household. One prime reason is that it will help us to save the loss of sample, especially
of women, if they are away from their home of residence. Overall, women’s not being their at
their usual residence would get compensated by including women in other sampled households
who are ‘visitors’ . Our field-work phase (which we anticipate to begin from Aug, ’01) coincides
with the annual peak season of festivals in Maharashtra. We, therefore, anticipate considerable
number of women travelling to their natal homes on various occasions. De facto base population
would take care of the sample loss to some extent by including visitors in the sample.
Once, we decide to include visitors in the base population, it is necessary to ensure that all
visitors are included to be methodologically sound. We, therefore, have three probes to ensure
that all those are covered constituting 'de facto ’ base population. They are about (a) children and
infants, (b) domestic servants, friends, and lodgers who ‘usually live’ and (c) guests or visitors
temporarily in the household. This, we expect, would ensure that we know exactly the nature of
base population’, the denominator, without any ambiguity while arriving at various estimates.
This also includes a question to record information about multiple marriages, if any of the family
members, including women, have had. The rationale to pose this question is as follows. We
would require information about women’s multiple marriages for two purposes. One, to arrive at
more accurate age when women are not in position to say accurate date of birth. Two, to ensure
that pregnancy histoiy of the woman is traced through all marriages. Given our culture, we feel,
it would be less sensitive to include such a direct question (as many other surveys have done it)
on this in woman’s interview schedule (WOM-IS). It is also likely that women feel offended
when such a question is posed to them. Thus, inclusion of this question in this section of the
HHD-IS is a strategic one to be culture and women sensitive. In this attempt, we would obtain
information of men s multiple marriages, which is not necessarily required.
At aggregate level, the data obtained from this section would help us to lay down the profile of
the base population from sampled households in terms of family size, age, sex, educational
attainments, marital status.
' Please see Anncxure VI: Concepts and Definitions.
2 Please see Annexure VI: Concepts and Definitions.
Abortion rate, care and cost: A Community based study
CEHAT, Pune
HHD-IS-Purpose 2/4
I
i;
\\Com3\c\sunl\NAAS\TOOLS\lHIS4S-3Putpose.doc
For AAP-I, ECG meeting
1 June 20-21, '01, Bombay
The second part of this section seeks information on general health care seeking behaviour of the
family and their choice of provider. This information would give us the context in which woman
seek treatment for delivery and abortion needs, which is collected in the woman schedule.
IH. Access to basic amenities: This is know whether the household htis access to basic
amenities, such as, drinking water, electricity, type of fuel for cooking, bathroom and toilet
facilities.
The additional questions on availability of water (302 to 306 and 309 to 312) are to get insights
into the fact as to who (men or women) bears the burden of additional work load in case access
to basic amenities is difficult.
The data obtained in this section would constitute one of the sub-indices of the socio-economic
status of the household.
IV. Staple food grains: Sources and adequacy. This is to know whether the family/household
has access to adequate food throughout the year. It collects information on the staple food, its
source and adequacy round the year. This also would constitute one of the sub-indices of socio
economic status of the household.
V. Asset ownership and other sources of family income: This is to arrive at a gross indicator
contributing to the economic status of households. It collects data on assets, such as, house
ownership and land, irrigated land, livestock. It also obtains information about possession of
household appliances and vehicles along with the details if they are put to use for income
generation, and if does, whether the family can sustain itself in absence of this income. These
data would contribute to form one of the sub-indices of socio-economic status of the household.
VI. Occupation and income of the individual family members in the household: This section
records main occupation and subsidiary occupation3 of the members above age 6 years; income
from these occupations; self employment/business; and income from pensions, if any. This
would constitute one of the sub-indices, which would contribute to determining economic status
of the households.
'
i
We would be using the classification used by NSS for various terms, such as, main occupation,
categories/types of employment. We would be doing some more work on formulation of this
section, primarily to see as what is required, what works (based on others’ experiences) better in
the field situation in the survey whose focus is not study of ‘employment’ or ‘socio-economic
status’. However, we need to have some broad but sound indicator to talk about socio-economic
profile of the population under study. It constitutes one of the important explanatory variables
while studying cost of health/abortion care.
VII. Religion and caste: This is to record religion and caste/tribe of the head of the household.
J Please see Annexurc VI: Concepts and Definitions.
Abortion rate, care and cost: A Community based study
CEHAT, Pune
HHD-IS-Purpose 3/4
■ C; \sunl \NAAS\T00LS\HHS-IS-2Purpose.doc
For AAP-I, ECG meeting
June 20-21, '01, Bombay
Specia! attention required during pre-testing
Household interview schedule (HHD-IS)
1. Section H: Household members: Profile
208: Could you please tell us if anybody from the list has married more than once? If yes,
pl tell who they are and number of marriages s/he has has, including the current one.
2. Section VI: Occupation
Pre-testing in both rural and urban (including slums) will help clarify whether to retain
this as it is or drop it completely or change it.
(Contd...
the protocol titled - Household Interview Schedule —>)
Abortion rate, care and cost: A Community based study
CEHAT, Pune
HHD-IS-Purpose 4/4
- JI’
Confidential: For research only
Schedule no:
PSU No:
_
PREGN;VNCY OUTCOME: A COMMUNITY BASED STUDY
A household survey undertaken by
Centre for Enquiry into Health and Allied Themes (CEHAT), Pune.
HOUSEHOLD INTERVIEW SCHEDULE
_____ Interview: visit/s made & status
Total visits/time
l^Visit
2nd Visit
3rd Visit
Visit details
Visits made
Date
Time spent
Time Required
________________________ Status of the interview conducted:
Interview completed/uncompleted/other:_________
Completed
............................................................
Could not meet appropriate respondents after three visits
_2
Refused to participate in the study (Record reason).......
.4
Others (Specify)....
Signature
&
date
:
Interviewer’s name:
Checked in the field by (Name):
Signature & date:
TOTAL ELIGIBLE WOMEN (ever married women aged 15 to 60)
(to be calculated at the end from ^Household members: Profile, chart)
TOTAL ELIGIBLE WOMEN (ever married women aged 15 to 55)
(to be calculated at the end from ‘Women Schedule: Profile’ c}iart)
101
102
103
104
105
106
107
108
109
110
111
112
_________________ 1. Identification of the field location
Household No: (From the House Listing)
Village/Town code:
Name of village/town:__________
Taluka
code:
Name of taluka:_______________
District code:
Name of district:
Region code:
Name ofRegion______________
NA (in case of rural aren'l
Corporation or Municipal Survey No:
PSU No.:
Other details
Address of die household:______________________________
Could you please tell us any landmark to locate your household? (For investigator: Pl also ; . <
landmarks that are observed/noticed byyou)_____________
What is your name? (ftespondent):_____________________
What is your relationship with the head of the household?
How many years your family is living in this village/slum?
Moi-uv;
(record in completed years /months)
(Less than 1 year record in months)
Abortion rale, care and cost: A community based study
’
-i
2A. Household Members: Profile
Sr.
No
201
1)
2)
3)
4)
5)
6)
7)
8)
9)
10)
11)
12)
13)
14)
15)
(Note: list the name ofhousehold members in column 202. Then ask the the questions upto column no. 207.
______ Ask the question 208 to all members)_______________
______ Applicable for persons aged 6 years and more
Age (in
Sex
Relationship to
Once you have listed the name
Could you please tell
completed
Number of years of
Current
the head of
of the household numbers,
us if anybody from the
schooling
household ♦
years)**
Marital
before asking their details
list has married more
(Record
completed
years
status
***
probe by asking questions No
than once?
ofschooling.
209to211
{If'Yes')
For no schooling record
(Please give the names of tide
'O' years)
Please tell us who they
persons who usual!} live in
are and number of
If there is a degree,
your household, starting with
marriages,
including
record
a
degree
the head of the household.!)
the current one.
208
207
206
205
204
203
202
Eligible Women
years
Standard
After
Before
/degree
..yrs
M/F
..yrs
M/F
..yrs
M/F
..yrs
M/F
..yrs
M/F
..yrs
M/F
..yrs
M/F
..yrs
M/F
..yrs
M/F
■ ATS
M/F
Guests:
..yrs
M/F
Guests:
..yrs
M/F
Guests:
..yrs
M/F
Guests:
..yrs
M/F
Guests:
..yrs
M/F
Guests:
1
(contcL.)
2
(■
contci)
Note: Just to make sure that, I have a complete listing:
209 Are there any persons, such as, small children or infants that we have
____ not listed____________________________________
_____
210 In addition, are there any other people who may not be members of
your family, such as domestic servants, lodgers, or friends who usually
live here?___________________________________________
211 Do you have any guests or temporary visitors staying here, or anyone
else, who stayed here last night_______________________ _
* Codes for Q. 204:
Yes
Enter each in the above table
No
Yes
Enter each in the above table
No
Yes
Enter each in the above table
No
* "Codes For Q.205: Age
***Codes For Q. 206: Marital status
1
Relationship to the head of the household:
i 01- Head
08- Brother or sister
0- Age less than one year
1- Married
! 02- Wife or Husband
09- Brothers-in-law /sisters-in-law
95- Age 95 years or more
2- Widowed
I 03- Son or Daughter
10- sisters-in-law
3- Divorced
i 04- Son -in-law or Daughter-in-law
11- Nieces/nephews
4- Separated / Deserted
; 05- Grandchild
12- Other relatives
5- Unmarried
06-Parent
13- Adopted/fostered child
07- Father-in-la w/Mother-in-law
14 -Not related
I-----------------------------------------------i__________________________________________________
; 15-parents
3
2 B. Health sicking behaviour of the household
NO
212
QUESTIONS_________
Generally where do you go when anyone
in your family falls sick?
213
Why do you go here only for treatment?
214
Did anyone in your household fell sick in
the last one month?
If yes, what happened?
215
216
CODING CATEGORIES
Home remedy
Local untrained health care provider.
Government health care facility
Private
Other (specify)
Yes.
No..
..B
.C
.D
.1
2
Where did you take him/her for treatment? Home remedy...................................
Local untrained health care provider.
Government health care facility
Private
217
SKIP TO
..A
Other (specify)
Why did you take there only for
I treatment?
> Skip to 301
..A
..B
..C
.D
E
3. ACCESS TO BASIC AMENITIES
(Drinking water, source of lighting, fuel and sanitation facilities)
301
Usually from where do you bring drinking
water?
302
306.
Does your household own this
tap/Well/tube well?
At what distance is the drinking water
source from your house?
(write unit ofthe distance stated^
furlong mile, km etc.)
_______
How much time is required to make one
trip? (including smiting time)________
How many trips are generally required
for daily water requirement of your
household?
Who fetches water generally?
307.
Do you have electricity at your house?
303
304
305.
Tap
Weh
Tubewell/B orewell
River/Pond/Lake....
Other (specify)
Yes.........................
No.......................
...1
..2
..3
.4
5
.1
.2
ask 307
If there is a
tap in house
i
trip/trips
Women in the household.
Men
Both men & women
.
Servants..........................
Other (specify)
Yes
No............................
..1
.2
.3
.4
5
.1
2
4
NO
308.
___________ QUESTIONS_________
What type of fuel does your household
mainly use for coolcing?
SKIP TO
CODING CATEGORIES
Wood.................................
Crop Residual ...................
Kerosene............................
Cow dung cakes................
Coal/coke/lignite..............
Charcoal.............................
.1
.2
.3
4
.5
> skip to
6
313
.7
8
.9
10----
Electricity....................
Liquid petroleum Gas........
BioGas................................
Other (specify)__________
309
310
311
312
313
314
315
How much distance to you have to travel
to get wood?
(write unit ofdie distance stated:
furlang, mile, k.m. etc.))_____________
How much time is required to make one
trip? ____________________________
How many trips are generally required
for daily fuel wood requirementent of
your household?____________________
Who fetches wood generally?
(State relationship to the woman)
How many rooms do you use including
kitchen?___________________________
Do you have bathroom facility inside your
house?
What kind of toikt facility does your
household have?
trip/trips
Women in the household.
Men.................................
Both men & women.......
Servants...........................
Other (specify)
.1
2
.3
.4
5
No badiroom.........
Outside the house...
Inside the house ....
Open/No facility....
Community facility
Own Pit toilet........
Own Flush toilet...
..1
2
3
1
2
.3
.4
4. STAPLE FOOD GRAINS : SOURCES AND ADEQUACY
401
How do you meet tlie needs of staple grains for consumption of your own family?
(For investigator: pl record multiple sources, if any).________ _
Not
Others
Credit/
Market
Ration(PDS)
Grains
Own farm
Loan
consumed (specify)
a. Rice______
b. Wheat
c. Jowar/Bajra
d. Bajra
e. Nachani
f. Cereals
5
NO
402
403
404
405
406
_____________ QUESTIONS___________
How many times members of your family
usually eat in a day? _______ _
How many times usually does the men in
your household have tiffin? ______
How many times usually does the women in
your household have tiffin?______________
Do members in your family get enough food
to eat throughout the year? ______
How many day/month in a year do you have
food deficiency?
CODING CATEGORIES
................. times
SKIP TO
times
times
Yes.
No
............. 1 ............. 2
days/months
>Skip to 501
5. ASSET OWNERSHIP AND OTHER SOURCES OF FAMILY INCOME
________ Housing/abodc: Ownership and type
NO _____________ QUESTIONS
CODING CATEGORIES
SKIP TO
501
Do you own this house?
Yes.............................................. 1
No .............................................2
502
Does your household own any other house?
Yes.............................................. 1
No ............................
2
Type of house:
503 | Roof Thatched/cloth/Sack.
.A
(7b be observed and written)
Tiled/Tins.................
B
Cement......................
C
________ Others (specify) /........
D
504
WallThatched/cloth/Sack.
A
(To be observed and written)
Tiled/Tins..................
B
Cement......................
C
________Others (specify)..........
D
505
Floor Mud/cowdung
a'
i
(To be observed and written)
Cement/Koba..
B
Shahabadi tiles.
C
Polished tiles...
D
Wood.............
E
_______ Others (specify)_________
F
Agricultural land and livestock: Ownership and type
506
Does your household own any
Yes, household ownership>.................. A
agricultural land?
Yes, joint household........ ...................B
No...................................... ................... C- ^sldp to 509
507
How much land does your family
household ownership
joint household
own?
(Size and unit)
(Size and unit)
N.A....................... 9
N.A...................... 9
508
Out of this how much is irrigated?
household ownership
joint household
509
Does your family own any livestock?
(Size and unit)
(Size and unit)
N.A....................... 9
N.A...................... 9
Yes.......................... .1
No......................
> skip to 513
2
6
NO
510
511
512
513
514
515
_____________ QUESTIONS
Does your family earn any income
from the live-stock?_______
What is the monthly income of the
household from the livestock?
] SKIP TO
CODING CATEGORIES
1
...................... 2 ------------» skip to 513
/- month
or
Rs.______
/- month
Can your household ran without the
Yes
.1
income you get from livestock?
No
2
_____________Other Assets
Does your household own any of the following?
_____________ Asset______________
Yes
No
1. Wooden shelf (in kitchen)___________
1
2
2. Fan_______
1
2
3. Radio/Transistor__________________
1
2
4. Furniture (bed, chairs, table)
1
2
5. Mattress _______________________
2
1
6. Almirah/Cupboard_________________
1
V
7. BedZDivan/Cot
_________________
1
2
8. Television________________________
1
2
9. Telephone
_________________
1
2
10. Refrigerator_______________________
1
2
11. Sewing machine
______________
1
2
12. Bullock cart______________________
1
2
13. Water pump______________________
1
2
14. Bicycle
__________________
1
2
15. Motorcycle/moped/scooter___________
1
2
16. Cars/Jeep___________
1
2
17. Tractor
_________________
1
2
18. Thrasher_____
1
2
19. Other (spedfy)_________
1
2
Some of these assets, such as sewing machine,
Yes
1
bullock cart, cars/jeep, tractor, thrasher, are
No.
income generating. Does your household earn
Skip to 517
NA
anything from any of die above assets?______
What is the monthly income of the household
Rs.
/- month
from these assets?
Or
Rs.
_/- year
Yes
No..
Rs.
assets
516
517
Can your household run without the income you
get from these assets?
Which type of kitchenware this household mostly
uses?
Yes................
No.................
Clay................
Aluminium
Cast iron ........
Brass
.......
Stainless Steel.
Glass
..1
..2
..1
..2
.3
.4
.5
.6
7
Othe
6 OCCUPATION AND INCOME OF THE INDIVIDUAL FAMILY MEMBERS IN THE HOSUEHOLD
cross
(Nate:
check -with household member profile to ensure that all members are covered.
Monthly salary /wage
Main
Is (name) engaged in
Sr. no as
Sr.
from main
occupation*
paid work during the
No 1CW1*-*VV*
occupations)
last 1 year?
in
(No. of working days
coulumn
in the month x wage)
no. xvz,
605
604
________ 603________
602
601
Yes ...1
1
No 2 +(Go to 606)
Yes ... 1
2
No 2
(Go to 606)
Yes
...
1
3
No 2 ->• (Go to 606)
Yes ... 1
4
No 2 -> (Go to 606)
Yes...l
5
No 2
(Go to 606)
Yes...l
~~
6
No.... 2 -► (Go to 606)
Yes...l
7
No 2 (Go to 606)
Yes...l
8
No 2 -^(Go to 606)
Yes...l
9
No.... 2
(Go to 606)
Yes
...
1
10
No 2 -► (Go to 606)
“
Yes...!
11
2 -» (Go to 606)
No
Subsidiary
♦♦
occupation
606
Monthly income
I wage from Subsidiary
occupation (s)
(No. of working days in
the month x wage)
607
Pension
608
Total Income (per month/years)
TO BE CALCULA TED
(Total income by individual:
main occupation, subsidiary
occupation, pension)
605+607+608
6Q9A
609 B:
8
QUESTIONS
610
Are there any other member who spent money?
Sr.
No.
611
1
SKIP
TO
CODING CATEGORIES
NO
Yes
1
.2
Name
___ _No............................................
Relationship to the head of household
6’2
613
> skip to 615
Income
614 A
~.... ZRs.
Rs.
’ 2
Rs.
........... Rs.
3
4
614B:
Total Income (per month/year)
615 Are there any other sources of income for your Yes
family? For ex: another house owned by you is
No
rented out, STD booth, VCR, Computer,
Ricksha or any such thing?
Sourcel,
616 What is the monthly income from this/these
Source2
source/s?
Source3
(Record all source ofincome stated)
Source4
1
.2
Rs./- per month/yr.
Rs./- per month/yr.
Rs./- per month/yr.
Rs./- per month/yr.
Rs./- per month/yr.
Total
617
TOTAL ANNUAL INCOME OF THE
HOUSEHOLD:
(511+515+609B+614B+616)
> skip to 701
i
7, RELIGION AND CASTE
701 What is your religion (Name - head of the Hindu.........................
Muslim
household)?
Sikh
r
Buddhist/Neo Buddhist.
Jain
Christian
No religion
Others (specify)
Caste (Specify)
702 What is your caste/tribes (Name - head of the
Tribe (Specify) ............
household)?
No caste.....................
(pl record the stated caste/tribe)
Rs.Z- per month/yr
.1
.2
.3
.4
.5
.6
.7
8
1
2
3
9
ANNEXVRE-N
Confidential only for research:
Schedule No.:
PSUNO.:
PIUEGNANCY OUTCOME: A COMMUNITY BASED STUDY
A household survey undertaken by
Center for Enquiry in Health and Allied Themes (CEHAT), Pune
WOMAN’S INTERVIEW SCHEDULE: OBSTETRIC HISTORY
Interview: visit/s made and status
Visit details
Date
1st Visit
2nd Visit
4th Visit
3rd Visit
5111 Visit
Time required
for interview_______________
Name of the women respondent:
Total visits/time
Total Visits
made______________
Total Time
spent
Status of the interview conducted: (completed/incomplete/other)
Interview Completed
1
Interview incomplete
2
Cause of incomplete interview:
Could not meet appropriate respondents after five visits
Interview Refuse
4
Cause of refused (Specify):
Interviewer’s name:
Signature & date:
Checked in the field by (Name):
Signature & date:
1.
101
Identification of the field location
Household No: (From the House Listing)
102 Name of village/town:
Village/Town code:
Name of taluka:
Taluka code:
104 Name of district :
District code:
105
Region code:
103
Name of Region:
106 Corporation or Municipal Survey No:
107
PSUNo.:
NA (in case of rural area).
9
II. PERSONAL INFORMATION
(Religion, caste, age, marital status, age at marriage)
NO
QUESTIONS
SKIP TO
CODING CATEGORIES
201 What is your name? (write full name)
202 Which religion do you belong to?
Ex: Hindu/Muslim/Shikh
203 Which caste do you belong to?
204 (writefrom the household information.
In case he codes ofthe marital status is
1/2/3 and more details are required; do
necessaryprobing)
Current marital status?
Hindu
Muslim
Shikh.............................................
Christhan......................................
Baudh/Navbaudh..........................
Jain................................................
Don’t follow any religion............
Other (specify)
Don’t believe in any caste
Have no caste...............................
Married and cohabit....................
Married but husband stay...........
Married but gauna not performed.
Widowed.......................................
Divorced......................................
Separated/Deserted
..............
....2
....3
4
....5
...6
7
8
.7777
8888
1
2
3
4
5
...,6
205 Beside household work are you
engaged many other work?
206 (Ifnot gone to school Hrile ‘0’ years.
Ifdegree status, write degree)
Can you tell us your educational
attainment?
Completed years
Degree_______________
Section A_______
207 Can you please tell me your birth date?
Day/Month/Y ear
Can’t say:
208 (In case offirst marriage)
Can you tell your date of marriage?
Day/Month/Year
98
> skip to 207 in
'Section B’
in case of first
> marriage skip to
210
(In case of second marriage)
“ While filling up the household schedule
we got information if anybody in the family is
married more than once. Accordingly, here we
are referring to your first mairiage’1.
Can you tell me your date of marriage?
Or
At what age did you get married?_______ '
209 What is your date of second marriage?
Or
At what age did you get married for the second
time?
Year
----- EZ3—
Day/Month/Year
Year [---- 1
contd.
contd. _________
210 Don 7 ask this question. Calculate itfrom 208 or 209
In case of first
marriage and less
than nine months
skip to 217.
month
In case offirst marriage,
Calculate years of marriage
(Ifless than one year record in months)
(
(
Years
In case ofmore than one marriage
calculate current years of marriage
(Ifless than one year record in months)
(
r
Month
Years
After completed section A ask question 215
NO
QUESTIONS
CODING CATEGORIES
Section B
•
SKIP TO
______________ _
In case the >vomen is unable to state her age at menarche then consider her age at menarche as
13, and write it in the empty space beside the square/box
207 For calculating your present age we would be
asking you two questions.
At what age did you get your first period?
208 Did you attain menarche before marriage?
Completed years [
Can’t say.
98
Yes........ .
No...........
209 (If less than 1 year record in months, if less days
than 1 month record in days)
How long before marriage did your period Months
start?
Years
.1
.2
> to 211
i
210 (If less than 1 year record in months, if less days
than 1 month record in days)
How long after your marriage did your period Months
start?
Years
211 (In case ofsingle marriage)
Day/month/year
What is your date of marriage?
(in case ofsecond marriage)
“While filling up the household schedule
we got information if anybody in the family is
married more than once. Accordingly, here we
are referring to your first marriage”.
Skip to 210
Can’t say.
In case ofsingle
marriage skip to
414
In case ofsingle
> marriage skip to
214.
98
What is your date of first marriage?
212 What Is your date of second marriage?
Day/month/year
Can’t say
213 (Ifless than 1 year record in months)
> Skip to 214.
98
Months
How long after your first marriage did you Years
many for the second time?
contd
No.
of
Ind
Abr.
After you had this
Did you get
miscarriage did
complete rest after
you go to our
you had this
natal home
miscarriage?
(generally within 8
days)? If Yes, for
how many days
did you go?
732
733
731
1
"Yes.
1
No.
.2
Yes.
2
1
.2
Yes.
735
days
Skip to 739<
1
Yes.................... 1
To some extent....2
.day
No.
734
Yes....................1
To some extent....2
No.................... 3‘
day
3
Who shared your workload
(Record all responses stated)
Skip to 739<J
I
No.
For how
many days
did you get
complete
rest?
Yes....................1
To some extent....2
No.................... 31 days
day
No......................... 3“?
.2
Skip to 739^
contd
Workload and Family /Social support
days
Women from in-laws
family...........................
Women from natal home.
Other relatives (female)...
Men from in-laws family.
Friends..........................
Other (Specify).............
What workload of
yours was shared
by them?
(record all the
work stated)
736
A
..B
..C
..D
...E
.E
Women from in-laws
family...........................
Women from natal home.
Other relatives (female)...
Men from in-laws family.
Friends..........................
Other (Specify).............
A
..B
..C
..D
...E
..F
Women from in-laws
family?..........................
Women from natal home.
Other relatives (female)...
Men from in-laws family.
Friends..........................
Other (Specify).............
A
..B
..C
..D
...E
.E
Ask 44,6 only if any of her child is less
than 10 years, otherwise skip to 739.
Who looked after your children?
(record all responses stated)
737
Self.............................................
Women from your in-laws family.
Women from your natal family....
Other women relatives.................
Men from your in-laws family.....
Friends........................................
Other (specify)............................
NA............................................
Self............................................
Women from your in-laws family.
Women from your natal family.....
Other women relatives..................
Men from your in-laws family......
Friends........................................
Other (specify).........................
NA.............................................
Self............................................
Women from your in-laws family..
Women from your natal family.....
Other women relatives..................
Men from your in-laws family.......
Friends.........................................
Other (specify).......................
NA............................................
..A
...B
...C
...D
..E
..F
G
..2
..A
..B
..C
..D
..E
.E
G
.2
.A
.B
..C
..D
-E
.F
G
.2
contd.
20
>
/
/
/
/
/
/
>
<
(
I
(
f ’
X
X
V
x
*
x
X
X
*
*
*
*
*
*
*
*
I
*
<
I
*
I
I
I
Note: incase the abortion was done in a health care facility then ask 740 to 746 or otherwise skip to section 8.
Quality of abortion care: Women’s perspective
Now we would like to have your opinion about the quality of abortion care that you got.
——,----------------- ----------------------- ; Why WQti.M
of
Ind
Abr
738
1
2
3
21
from household work?
739______________
Help not available
Help available, but
I did not feel the need.
Other (specify)
Help not available
Help available, but
I did not feel the need.
Other (specify)
Help not available
Help available, but
I did not feel the need.
Other (specify)
1
2
.3
1
.2
.3
1
service.
providei sought consent
of your husband while
providing abortion
care?
740
Yes
No..............
Don’t know.
Yes
No
Don’t know.
Yes
XJA
2
.3
Don’t know.
What all precautions did the
provider tell you to take post
procedure?
Did the provider ask you to make
follow-up visit?
In case the woman went for a follow
up visit, ask often how many days of
her aborted did she go for a follow-up
______________ visit______________
742_
Yes
.1
days
No.
.2
741
Rest
......
No heavy work
Sexual abstinence
Other (specify)
Did not say anything.
.A
.B
.C
D
E
.1
2
.8
Rest.........................
No heavy work
Sexual abstinence
Other (specify)
Did not say anything.
.A
.B
.C
D
E
Yes
.1
.2
J
Rest.........................
No heavy work........
Sexual abstinence
Other (specify)
Did not say anything.
....A
...B
...C
_D
...E
Yes
.1
.2
.8
No.
No.
.1
days
.2
.1
days
.2
I
C:\sunl\NAAS\TOOLS\ANNEXURE-V-CONSENTLETTER-ECG-JUNEOl.doc
For AAP-I, ECG meeting
June 21-22, ‘01
ANNEXURE- V
DRAFT LETTER OF INTRODUCTION AND INFORMED CONSENT FORM
(to be used during field work)
An explanatory note for members of TAC, DEC and ECG
We have two phases of field work, (which would now run in parallel).
Household listing: This is optional. In case the census listing is available, we will
make use of this data. For the purpose of house listing, we do not think informed
consent is required to be sought.
2. Quantitative Household survey: We would be interacting with
• Adult male member of the household to fill the household questionnaire.
• All the ever married women from reproductive age (15-49 yrs)..
1
We would seek informed consent for each one of them separately. We may,
depending upon the situation, especially the comfort of women in the household,
explain the project to all the eligible respondents together or separately.
Everybody’s doubts would be clarified. If women are found not to be comfortable
with the situation and the group, we would meet them separately. Each one of
them would sign independently, a separate informed consent form.
The following draft letter of introduction along with the informed consent form is
designed for the purpose of ‘quantitative household survey’. It contains, in brief,
information about why the household information (from adult men) and pregnancy
history of women (from individual eligible women) is being gathered.
The major information heads in this letter of introduction are:
1
2.
3.
4.
5.
6.
7.
8.
9.
Information about the institute, its work and premise on which it is founded.
About the current study and its rationale.
Significance of their participation in the study.
Two types of information/data collection - household questionnaire; and
pregnancy history - women’s interview schedule in the quantitative household
survey
About selection of the sample and their inclusion in the study.
About their right to deny to participate, to withdraw and to know more about the
work, its significance and about the institution.
Assurance for confidentiality of the information obtained from them and respecting
autonomy (not revealing their identities, unless approved).
About the details of all the research team and IEC members to be able to approach
them when required. (Will be enclosed later).
Informed consent form.
The letter of introduction and informed consent form will be translated in the local
language eventually.
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LETTER OF INTRODUCTION and INFORMED CONSENT FORM
Dear Shri/Smt —
Greetings! We are a Research Centre of Anusandhan Trust, a non-profile educational
trust. The research centre CEHAT, which in Hindi mean ‘health’, is working in health
and related areas. The various thrust areas that are flourishing in our institution are
women’s health; health economics; health legislation, ethics, and patients’ rights, and
law; health and human rights; medical ethics. On each of these themes CEHAT is
committed to do Research, Action, Service and Advocacy. ‘Right to health care’ is the
premise on which the work in CEHAT has been built. People’s health has been looked
at from wider perspective and beyond techo-medical model.
Our team and some other researchers from the institute have been working on
women’s health issues for last 7 years. The current study is primarily to look into
pregnancy outcome and its health consequences for women. It is also to understand
the extent to which there is pregnancy wastage and to know the reasons for the same.
This, we hope, in the future would facilitate the planning of appropriate intervention
strategies to prevent unnecessary pregnancy wastage and untowardly pregnancy
outcomes. Such a prevention would contribute to improving women’s and children’s
health.
You may like to know that one in every three conceptions is wasted either because of
natural reasons including women’s poor health status and other circumstantial factors
such as workload and pattern, quality of nutrition or because a conceptions is
unwanted for various reasons. Given the fact that health care delivery system is
inadequate and provide less than quality care on the one hand and women’s inability to
access quality services all the time, it is likely that women face negative health
consequences. Ill-practices in health care service delivery system force women and
people to pay from their pocket for the health care they seek depriving them of their
right to health care from public health care facilities. Against this backdrop, your active
participation in this research would be of great significance in understanding the issue
at hand in a better way.
In this study, firstly, we would require some basic information about your household
for the purpose of understanding your socio-cultural background. This would
constitute one of the important analytical category for us to examine variations in the
patterns of women’s health status. This would be collected from one of the adult male
members of your family.
Secondly, we would require information from women of age between 15-55 years
about their life time conceptions and related infonnation. This has direct relevance to
the research problem at hand. This would be collected from individual women
belonging to this reproductive age group.
Your household has been included in the sample only because the sampling method
that we used for this study has picked you up. The prime concern for us is to have a
representative sample so that the findings of the study by and large could be
Abortion rate, care and cost: A community based study
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generalised to the population. Anybody, who is interested to know more about it, is
welcome to approach our team members for the same.
We would like to share with you that this phase will be followed by another one
involving in-depth interviews of a sub-sample for better understanding of how people
choose health care service providers, how much do they have to spend on it etc. We
would very much appreciate similar cooperation from you during this subsequent
phase.
We would like to explicitly mention here that we believe in respondent’s to know more
about the project activity and the institution, their right to deny to participate in this
study and to withdraw half way through. We deeply respect these rights or yours and
hereby assure you that they will not be violated. Neither of the team members of our
research project will force you at any point of time to either participate or continue
with interview against your wishes. The information gathered from you will be kept
confidential and will never be used against you. Your identity as an individual
respondent will not ever be revealed unless approved by you. Information gathered
from your would constitute part of the aggregated data and will not be presented
otherwise which may have potential for revealing your individual identities.
We will bring back to you the findings of the study upon completion of data analysis
and writing.
In case you want to know more about us and our work, please feel free to ask our
team members about the same.
Please find enclosed the list of researchers and some other key members that you can
approach to in case of problems that you face with the way the field team is interacting
with you. (will be provided then).
With this communication, may we request you to sign below as part of practicing
ethical social science research which states that you are participating in the research
only after obtaining thorough knowledge about it.
Thanking you.
The team
Annexure 1: List of the research team members and IEC members (not included at the
moment.
I?----------------------- has been communicated about the research project titled ‘------—4 by ------------ . I am satisfied with clarifications and explanations offered to me by
members of the research team working on the above mentioned project. I, hereby,
offer my consent to participate in the first phase of the study, that is the quantitative
household survey.
Name of the respondent
Signature of the respondent
Date
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ANNEXURE VI - CONCEPTS AND DEFINITIONS
(For the reference of the research teams)
Medical science
1.
Abortion : Abortion is the prevention of pregnancy that has already begun from going to term,
from eventuating in childbirth; and abortion may be accomplished through a variety of methods chemical, herbal, mechanical, surgical. (Petchsky, 1990)
■
■
Induced abortion: Willful termination of pregnancy. If the pregnancy is terminated through
medical or non-medical means before seven months. (Ahmed & Rahman, et al., 1998)
Spontaneous abortion: Expulsion from the uterus of the products that is occurring naturally. If
the pregnancy ended spontaneously and the pregnancy was less than seven months. (Ahmed
& Rahman, et al., 1998)
2. Abortion procedures :
■
"
Surgical procedures: Abortion procedure which involves use of surgical tools to clean the
uterus of products of conception.
Medical procedures: Abortion procedures where drugs are used for expulsion of conception
products.
3. Abstinence:
Restraining from the use of or indulgence
in sex.(Dorland’s Medical Dictionary,
1995)
-
4. Amniotic sac - Sac of fluid surrounding the foetus. (OBOS, 1992)
5. Certainly Induced: Women said so or evidence of genital trauma or foreign body of health
worker or relative said so if women died.
6. Contraception - A contraceptive device that physically prevents spermatozoa from entering the
endometrial cavity and fallopian tubes. (Dorland’s Medical Dictionary, 1995).
7. Counselling - Professional advice about a problem (Oxford dictionary)
8. Curettage - Scrapping the inside of the uterus with a metal loop, called a curette, to loosen and
remove tissue. (OBOS, 1992)
9. Dilatation - Enlarging the cervical opening by stretching it with tapered instruments called
dilators, or with laminaria. Many medical technicians use the word “dilatation” to mean the same
thing. (OBOS, 1992)
10. Habitual: Spontaneous abortions occurring in three or more successive pregnancies at about
same level of development of fetus (Length of gestation).
11 Illegal abortion: Any abortion performed outside the conditions of the MTP act of India (ICMR
1989)
12. Incomplete abortion: It encompasses both induced and spontaneous abortions.
13. Inevitable abortion: A condition in which vaginal bleeding has been profuse and the cervix has
become dilated & abortion will inevitably occur.
14. Length of gestation: It is usually counted from the first day of the LMP and not from the day of
conception (fertilization). (OBOS, 1992)
15. Live birth: A pregnancy is classified in having terminated in a live birth if a new bom showed
any sign of life - breathing, crying or movement. (Ahmed, et al; 1998)
16. LMP: Last menstrual period. (OBOS, 1992)
17. Morbidity: The condition of being diseased or morbid, the sick rate, the ratio of sick to well
persons in a community (Dorland's Medical dictionary, 1995).
18. Mortality: The quality of being mortal, death rate, the ratio of actual deaths to expected deaths
(Dorland's Medical Dictionary, 1995)
19. MTP Act: Medical Termination of Pregnancy Act (1971).
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20. Post partum amenorrhea (PPA): Often women experience absence of menses for certain period
after delivery. It varies from woman to woman. In India, it is around 10-12 months. (Roy and
Rao, 19-). This is generally referred to as non-susceptible period for fresh conception. Length of
such a period post abortion has less variation and is only about 5 months, consisting of about 3
months of gestation and 2 months of PPA.
21. Primie: First pregnancy
22. Sex determination test: Test done for determining the sex of the foetus.
23. Stillbirth: A pregnancy is classified as stillbirth if a new bom showed no signs of life and its
duration was seven months or more. (Ahmed & Rahaman, 1998)
24. Threatened: A condition in which vaginal bleeding is less than in inevitable abortion and the
cerix is not dilated and abortion may or may not occur.
25. Trimesters :
■
■
■
First trimester: It is the first thirteen weeks
Second trimester: It is the fourteenth through twenty-fourth weeks
Third trimester: It is twenty-five weeks LMP and later (OBOS, 1992).
26. Unsafe Abortion: Termination of pregnancy performed or treated by untrained or unskilled
persons.(OBOS, 1992)
A procedure for terminating unwanted pregnancy either by persons lacking the necessaiy
skills or in an environment lacking the minimal medical standards or both. (WHO 1994).
CONCEPTS AND DEFINITIONS
Social science research
Bad structure: If the structure of the building requires immediate repairs without which it is
unsafe for habitation or if it requires to be demolished and rebuild, it is treated as in bad
conditions.
De jure base population: This includes only the ‘usual resident’ as part of the base
population. The data are collected through household interview schedules in the survey. The
concept of ‘usual residents’, in WFS surveys the world over allowed a great extent of
flexibility. It ranged from not defining it all when posed to the respondents to the definition
with much stringent criteria, such as period of stay (pre and/or post survey) at the household,
eats at least eats one meal a day with the family. (WFS, Comparative Studies, No, 31-40).
De facto base population: It includes all the members of the household at the time
survey/conduct of the interview including visitors. (WFS, Comparative Studies, No, 31 -40).
House: Every structure, tent, shelter etc., is a house irrespective of its use. It may be used
for residential or non-residential purpose or both or even may be vacant. (NSS-59th Round).
Household: A group of persons normally living together and taking food from a common
kitchen will constitute a household. The members of a household may or may not be related
by blood to one another. (NSS-59th Round).
Household size: The number of normally resident members of a household is its size, it will
include temporary stay-ways but excludes temporary visitors and guests. (NSS-SQ* Round).
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Kaccha Structure . A structure which has walls and roof made of non-pucca materials is
regarded as a katcha structure. Non-pucca materials include unburnt bricks, bamboo, mud,
grass, leaves, and/or other thatch. Katcha structures can be of the following two types: (NSS59th Round).
a.
b.
Unserviceable katcha which includes all structures with thatched walls and thatched
roof i.e. walls made of grass, leaves, reeds etc. and roof of a similar materials and
Serviceable katcha which includes all katcha structures other than unserviceable
katcha structures.
Pucca Structure: A pucca structure is one whose walls and roofs (at least) are made of pucca
materials such as cement, concrete, oven burnt bricks, stone, stone blocks, jack boards
(cement plastered reeds), iron and other metal sheets, timber, tiles, slate, corrugated iron, zinc
or other metal sheets, asbes-tos cement sheet, etc. (NSS-59th Round).
Slum: A slum is a compact area with a collection of poorly build tenements, mostly of
temporary nature, crowded together usually with inadequate sanitary and drinking water
facilities in unhygienic conditions. Such an area will be considered as unde-clared slum for
the purpose of survey if at least 20 households live in that area. (NSS-SO* Round).
Semi-pucca structure: A structure, which cannot be classified as a pucca or a katcha
structure as per definition, is a semi-pucca structure. Such a structure will have either the
walls or the roof but not both, made of pucca materials. Walls/roof made partially of pucca
materials are regarded as katcha walls/roof.
Squatter settlement: An unauthorized settlement with unauthorized structures put up by
squattefs and not categorised and as slum area is treated as ‘squatter settlement’ (NSS-S^
Round).
Other Room: A room which does not satisfy the specification of 4 square metre floor area
and 2 metres height from the floor to the highest point of the ceiling or a room which though
satisfies the specification, not used for living purposes. A room satisfying the size criterion,
when shared by more than one household or when used for both residential and business
purposes is to be treated as other room.
Usual resident: The concept was used in the WFS. There was flexibility as to how to define
‘usual resident’ for individual participant countries in the survey. (WFS Comparative
Studies, No, 31-40).
We define ‘usual residents’ as those who have (a) shared the abode/house, (b) stayed with
the family/household for at least three months preceding the field-work and (c) and eat at
least one meal a day.
We define ‘visitors’ as those who are not ‘usual residents’ and either have stayed the
previous night or plan to stay overnight on the day of the interview.
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ANNEXURE VII
REPRODUCTIVE AND ABORTION MORBIDITIES
1. Amenorrhoea: Absence or abnormals toppage of the menses (Dorland’s Medical Dictionary, 1995)
2. Cervical laceration/tear (Post operative complication POC): The cervix may get injured during a
second - trimester abortion. A small tear heals without any treatment. However, a more serious
tear may require stitches, and there may be some bleeding from the tear. (OBOS, 1992)
3. Cervicitis: Cervical inflammation (Dorland’s Medical Dictionary, 1995)
4. Dysmenorrhoea: Painful menstruation. (Dorland’s Medical Dictionary, 1995)
5. Dyspareunia: Difficult or painful coitus.(Dorland’s Medical Dictionary, 1995)
6. Dysuria: Painful or difficult urination.(Dorland's Medical Dictionary, 1995)
7. Ectopic pregnancy: Pertaining to ectopia ie located away from normal position.(Dorland's
Medical Dictionary, 1995)
8. Endometriosis: Inflammation of the endometrium or an aberrant occurrence of tissue containing
typical endometrial granular and stromal elements in various locations in the pelvic cavity or
other areas of the body. (Dorland’s Medical dictionary, 1995)
9. Infertility: Lessening or absence of ability to produce offspring. (Dorland’s Medical dictionary
1995)
10. Menorrahagia: Botli, heavy bleeding and long periods (bleeding for more number of days)
together.(Dorland’s Medical dictionary, 1995)
11. Missed abortion/Continued pregnancy (POC): This is probable in early pregnancy, less than
four weeks after conception, that is, six weeks after LMP. The tissue removed from the uterus
immediately after abortion should be inspected to ensure that all pregnancy tissues have been
removed. The abortion has to be repeated in a week or so. (OBOS, 1992)
12. Perforation (POC): It occurs if an instrument pierces through the uterus wall. The pulse, blood
pressure, cramping and bleeding are closely monitored. The uterus generally quickly heals on its
own. However, if a large blood vessel or another organ is damaged, hospitalization and probably
surgery is needed. If abortion has been left incomplete due to perforation, it is finished in a
hospital.(OBOS, 1992)
13. Polymenorrhea: Abnormally frequent menstuation. (Dorland's Medical Dictionary, 1995)
14. Postabortal Syndrome (Blood in the Uterus) (POC): If the uterus does not contract properly or
if a blood clot blocks the cervical opening and prevents blood from leaving the uterus, blood
collects within it resulting in pain, cramping and sometimes nausea increase. The clots can be
removed either by deep massage directly over the uterus or if this fails by reaspirating the uterus
(OBOS 1992)
v
15. Primie amenorrhoea: Not getting the menses at appropriate age. this could be either congential
(which mostly are difficult to attend to) or could be on account of anaemia and weak health
status.(OBOS, 1992)
16. Pelvic Inflammatory Diseases (PID): Palpable and tender tissues around uterus, cervical motion
tenderness. These are the symptoms of PID.
17. Retained tissue (POC): Sometimes some tissue may be left behind after the abortion. Signs
include heavy bleeding, passage of large blood clots, strong cramps, bleeding for longer 3 weeks,
signs of pregnancy for more than one week. This tissue may get infected. To remove the tissue
either methergine or ergotrate are given to stimulate the uterus to contract and push the retained
tissue out or aspiration procedure is carried out. (OBOS, 1992, pp 359)
18. Sterility: To make a person or an animal unable to produce children or young, especially by
removing or blocking the sex organs.(Oxford Advanced Learner’s Dictionary)
19. Uterine haemorrahge (POC): It may occur in second trimester abortions due to retained tissue,
perforation or failure of uterus to contract. Drugs may be given to stimulate the uterine
contractions, or aspiration may be done to slow done the bleeding. (OBOS, 1992, pp 359)
20. Vaginal ulcer: Inflammation of vaginal wall
Abortion rates, care and cost: A Community based study,
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Reproductive and abortion morbidities I/ f
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ANNEXURE - VIII
POST-ABORTION COMPLICATIONS
(Post-procedure time lapse, type of illness and perceptible symptoms)
Post procedure time
lapse before
manifestation/
revealation of
symptoms
Within 24 hours after
abortion procedure
P pe of abortion
morbidity
Cervix al tear
Uterine perforation
Anaesthetic
Complications
After 24 hours and
within 8 days
Within 3 to 6 weeks
after abortion
procedure
6 weeks after the
abortion procedure
Incomplete abortion,
inflammation and
infection___________
Septecemia (entry of
infection in blood)
Intestinal injury during
abortion
Organic psychosis
I Menstrual problems
Symptoms of
Cervicitis, PID,
Vaginitis
Abortion rates, care and cost: A Community based study,
CEHAT, Pune
Perceptible symptoms
■ Severe lower abdominal pain
■ Painless bleeding
■ Painful bleeding_____________________
■ Severe pain in lower abdomen
■ Distention of abdomen.
■ Looks pale
■ Fainting attack______________________
■ Swelling all over abdomen
■ Breathlessness
■ Abnormal blood pressure______________
■ Severe lower abdominal pain
■ Fever
■ Foul smelling discharge_______________
■ Body becomes cold
■ Becomes unconscious
■ Fever
■ Severe pain in abdomen
■ Distention of abdomen________________
■ Disturbed behaviour_________________
■ Irregular menses
■ Painful menses
■ Heavy menses
■ Prolonged menses
■ Scanty menses_____________________
■ Fever
" Pain in lower abdomen
■ White vaginal discharge
■ Foul smelling vaginal discharge
■ Blood stained vaginal discharge
■ Excessive vaginal discharge with itching
■ Unable to have control over urinary bladaer
(bladder incontinence)
■ Painful intercourse (Dyspareunia).
■ Infertility
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AAN1EXXURE X: REFERENCES
(used in Annexure VI-X)
1. Ahmed M.K., Rahman M, et al. (1998): ‘Induced abortion in Matlab, Bangladesh: Trends and
Determinants’, International Family Planning Perspecives, Vol 24'3), pp. 128-132.
2. Bardhan A. Dr., Upadhyay R.K.et al. (1989): Illegal Abortion in Rural Areas, ICMR, New Delhi.
3. Bhatia J.C.,Cleland J, A Community Based Study of Gynecologic^ Morbidity in Southern India.
4. Chaudhari S.K. (1996): Practice of Fertility Control: A Comprehensive Textbook, (Fourth
Edition), B.I.Churchill Livingstone Pvt. Ltd.
5. The aftereffects of Abortion (1990): A text from the brochure of Elliot Institute, Home page
Index II Resources.
6. Dorland’s Pocket Medical Dictionary (1995): Oxford & IBH Publishing Co. Pvt.Ltd., Calcutta,
Edition 25.
7. Ganatra BR, Coyaji K J, Rao V N (1995): ‘Too Far, Too Little, Too late: A Community Based
Case Control Study on Maternal Mortality in Rural West Maharashtra Strate, India’.
8. Hardin G. (1982): ‘Some Biological Insights into Abortion’, BioScience, Nq\.32, No.9 October.
pp.720-27.
9. Khan A.R., Rochet, R. W., et al (1986): ‘Induced abortion in a rural area of Bangladesh’, Studies
in Family Planning, Vol. 17(2), pp95-99.
10. National Sample Survey, 52nd round.
11. Petchesky R.P. (1990): Abortion and Woman’s Choice: The State, Sexuality and Reproductive
Freedom, (Revised edition), North-eastern University Press, Boston.
12. The Boston Women’s Health Book Collective,(1992): The New Our Bodies, Ourselves : A book
by and for women, Simon & Schuster Inc. New York, London, Toronto; Sydney, Tokyo,
Singapore.
13. Tietze C.(1983): ‘Induced abortion a world review’. 5 th ed, A Population Council Fact Book, pp
4.
14. Swain S. (1986): Techniques of Abortion practiced in Tribal and Non-tribal Areas, Indian Journal
ofPreventive Social Medicine, NcAYl, No,l March. pp20-29.
15. Singh S., and Wulf D.(1994): ‘Estimated levels of induced abortion in six latin American
countries’, International Family Planning Perspectives, Vol 20(4). pp. 4-13.
16. Srinivasa D.K., Narayan K.A., et al. (1997): Prevalence of Maternal Morbidity in a South Indian
Community, JIPMER, Pondicherry, India, 605 006.
17. World Health Organisation (1994) Abortion: A tabulation of available data on the
frequency and mortality of unsafe abortion, 2nd ed. WHO, Division of Family Health,
Geneva.
18. World Fertility Survey: Comprative Studies, No 11-20, May 1980.
19. World Health Organisation, (1992-94): International statistical classification of diseases and
related health problems, 10th revision.
20. World Health Organisation (1994) Abortion: A tabulation of available data on the
frequency and mortality of unsafe abortion, 2nd ed. WHO, Division of Family Health,
Geneva.
21. Zamudio L., Rubiano N., et al.(1999): ‘The incidence and social and demographic characteristics
of abortion in Columbia’, in Mundigo A.I., and Indriso C., (eds) Abortion in the Developing
World, World Health Organisation, Vistar Publication, New Delhi.
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ANNEXURE IX
MEASUREMENTS
(Rates, ratios, averages, proportions and estimations)
1. Abortion rate: Number of abortion per 1000 women aged 15-49. It indicates the percentage of
women in the reproductive age group having an abortion in one year.
Crude rates of losses: losses per observed pregnancies (Casterline, 1989). This takes care of the
fact that not all pregnancies are recognised, especially the early conceptions before the 4-6 weeks
from the first day of the last menstrual period.
2. Abortion ratio; Different researchers seem to have defined it in various ways.
■ Number of induced and spontaneous abortions occurring in the population during the 12
month study period per 1000 live births during the same study period. (Khan et al 1986).
■
The number of births in the denominator occurring during a 12 month study period starting 6
months later than the period when the abortions in the numerator occurred. (Tietze, 1983)
■
Number of abortion per 100 pregnancies. (Zamudio, Rubiano, et al., 1999). The author states
that this is a particularly accurate indicator, because there is no bias introduced by greater or
lesser risk of pregnancy, which happens in other measures where the denominator includes all
women regardless of abortion risk.
3. Abortion mortality: Number of women dying as a result of abortion per 1000 live births
occurring during the same 12 month study period.(Khan, Rochet, et al., 1986)
4. Average number of abortions per woman: Number of abortion that a woman have had in her
life time. Sharper averages can be calculated if only ‘women at risk of abortions’ are considered.
5. Estimated total abortion rate: It is the average number of abortions a woman will have in her
life time This can be obtained by multiplying the average annual abortion rate, as defined above,
by 35 (to cover a woman’s reproductive life). It assumes that the current level of abortions
persists. (Singh &Wulf, 1994).
6. Maternal Morbidity: Morbidity in a woman who has been pregnant (regardless of the site and
duration of the pregnancy) from any cause related to or aggravated by the pregnancy or its
management but not from accidental or incidental causes. A term used interchangeably with
obstetric morbidity. (WHO, 1992-94)
7. Maternal mortality ratio: The number of maternal deaths occurring over a year per 100,000 live
births in that year; may also be expressed per 1000 or 10,000 live births. (WHO, 1992-94).
8. Women at risk of abortion: These are defined as those who have been pregnant at least once and
who are sexually active. (Zamudio, Rubiano, et al., 1999).
9. Units of observation/analysis in population based abortion incidence studies:
■
■
An individual woman: This would allow us to calculate
■ Average abortions per woman
■ Differentials across age and social class cohort as regards average number of abortions
per woman, repeat abortions, relationship between parity/pregnancy order and abortions,
especially induced etc.
An induced/spontaneous abortion event: This would allow us to calculate
■ the ratio of abortions to all pregnancies occurring at a point of time
■ the rate / ratio(?) of abortions per woman
Abortion rates, care and cost: A Community based study,
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Measurements j/l.
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C:\snnl\NAAS\TOOLS\Abortion research in India-table.doc
ANNEXURE-XI
ABORTION RESEARCH IN DIA
Sr
No.
Yr (conduct
of study
and pubn)
Pregnancy wastage* recorded
Type of the study
1.
199293/1994
Among all the pregnancies
reported in the survey, 7 per cent
was pregnancy wastage (still
births - 2%; spontaneous abortion
- 4%; and induced abortion - 1%
)
A state level cross-sectional sample survey to arrive at estimates at state
level and for rural and urban areas regarding fertility related
measurements. Multi-stage stratified random sampling procedure was
adopted.
Study area: Total state
Sample size: 4, 063 households; 4, 480 women (ever-marred women from
13-49).
Limitations: The survey was primarily to study fertility patterns. The focus
was not to record abortion incidence rate.
Source?
Researchers and
year of
publication____
UPS (1995):
‘National Family
Health SurveyMaharashtra’,
International
Institute of
Population
Sciences,
Bombay.
The questions to get data on abortion incidence were not adequate in terms
I of sequence, formulation, sensitivity and probes.____________________
Abortion rate, care and cost: A community based study
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Abortion research in India 1/6
C^simlWA^lS TC^OIS^Abortion research in India~table.doc
11.
Jan 1989 to
March 1990
During the period of 15 months
300 women had 372 induced
abortions.
For AAP-I, ECG, meeting
June 21-22, ‘01
It was a prospective study carried out in two adjoining villages in a PHC in
West Bengal.
Limitation: From the data abortion rates could not be calculated as it does
not state neither number of pregnancies during the reference period nor the
number of eligible women (women at risk).
12.
1988
8 per cent had spontaneous
abortion, 2 per cent fresh still
birth and 2 per cent macerated
still birth.
Hospital based study
Sample size - 200 consecutive cases of pregnancy in women less than 19
years admitted in the hospital.
Mondal, A.M.D.
(1998): ‘Induced
Abortions in Rural
Society and Need
for People’s
Awareness’,
Journal of
Obstetrics and
Gynaecology, Vol.
41, pp. 450-457,
Bhalerao, A.R.,
Desai, S.V.,
Dastur, N.A., et al.
(1990): ‘Outcome
of Teenage
Pregnancy’,
Journal of
Postgraduate
Medicine, Vol.
36(3), pp. 136139.
(♦’Pregnancy wastage’ in case of health care facility based study is based on the ‘clinical diagnosed’ and confirmed within the permissible limits of the accuracy
given the inherent constraints)
Abortion rate,care and cost: A community based study
CEHAT, Pune
Abortion research in India 6/6
I
»
ANNEXURE XlfSAMPLE PROFILE
»
Table 1 Regionwise representation of the districts in the rural sample
t
Districts
Thane
Raigarh
Ratnagiri
Sindhudurg
Nashik
_____ Represented in the rural sample survey
_______________ Tehsils
Bhiwandi (2), Shahapur, Dahanu_______
Uran, Panvel (2), Karjat
_
Dapoli, Sangameshwar
Kankauli (2)
___________________
Nandegaon, Niphad, Igatpuri (2), Dindori
Dhule
Dhule (2), Akrani, Talode
4
Jalgaon
Bhusawal, Jamner, Jalgaon, Erandor, ?jnalner
5
Ahmadnagar
Pune________
Satara_______
Sangli_______
Solapur_____
Kolhapur
xAurangabad
Jalna_______
Parbhani
Bid________
Osmanabad
Latur_______
Buldhana
Akola_______
Amaravati
Shirampur, Nevasa, Shevgaon, Kaijat, Akola
Haveli, Junnar, Shirur, Daund, Baramati, Mawal
Satara (2), Koregaon, Phaltan, Man, Karad (2)
Khanapur, Atpadi, J at
Solapur North, Manol, Malsliiras, Madha(2)
ShiroL Kagal, Gadhinglaj
Aurangabad, Sillod, Vaijpur___________
Jalna, Pamir________________ ___________
Basmath, Gangakhed, Pathri________________
Georai, Manjlegaon, Ambejogai, Kaij, Patoda
Kalamb, Tuljapur (2), Paranda__________ __
Latur, Ahmadpur, Ausa_________________
Jalgaon (Janiod), Deulgaon Raja____________
Akot, Patur
Warud (2), Dhami
______________
Kinwat(2), Deglur, Kandhar_____________ _
Maregaon, Umarkhed, Darwna, Ner_________
5_
6_
7
3_
Regions
>
R-l Greater Bombay*,
Thane, Raigarh,
Ratnagiri, Sindhudurg
R-2 Nashik, Dhule,
Jalgaon
R-3 Alimednagar, Pune,
Satara, Sangli, Solapur,
Kolhapur
R-4 Aurangabad, Jalna,
Parbhani, Bid,
Osinanabad, Latur,
Buldhana, Akola,
Amaravati
R-5 Nanded, Yavatmal,
Wardha, Nagpur
R-6 Bhandara,
Chandrapur, Gadchiroli
I
Nanded
Yavatmal
Wardha
Nagpur_____
Bhandara
Chandrapur
Gadchiroli
Karanja_______________________
Ramtek, Mouda (2)___________________ ___
Tumsar, Tirora, Arjuni Morgaon, Lakhandur
Warora, Mui, Rajura_______________
Sironcha, Aheri
’ This district did not get selected in the rural sample.
No of PSUs
4
4
2
2
-
3_
3_
3
T
3
V
T
3'
_2_
2
3
4’
T
i
T
4
T
T
1. An Application by the Project team to the IEC, CEHAT for
review of the project for its ethical content:
Team’s response to the Checklist - II
2. Ethics Review Report: IEC certification
3. Response to the queries raised by Joe Lobo
ABORTION RATE, COST AND CARE:
A COMMUNITY BASED STUDY IN TWO STATES
Our experiences during the pilot testing may bring us more clarity on the
extent to which we would be causing our respondents to face such risks.
2. What steps have been taken to mitigate the risks?
We at the moment would wait till pilot test and the experiences therein.
3. How do you balance the potential risks against the prospective benefits?
Not applicable.
4. How do you plan to protect the anonymity, confidentiality and the privacy
of the participants? Are there any specific concerns in these areas?
Please refer to point ‘2. Privacy’ and '3. Protection to the respondents’, in
the section titled '6. Ethical issues and concerns’, p no 17-18 in draft
methodology titled 'Study Design and Methodology for Abortion Rate,
Cost and Care: A Community based study in two states’.
5. What is the mode and procedure for seeking consent? What is the
information that you will be giving to the participants at the time of
seeking consent?
We, plan to pilot test seeking written informed consent from all the
respondents. We are sceptical about as in our society, 'signing papers’
has a connotation and people, especially among those who can’t read or
write generally tend to refrain from doing so. As a result, insistence for
written informed consent may lead to large percentage of denial. In this
regard, there would two possibilities that we envisage:
a) If the experiences in the pilot test are reasonable (at least about 50%
accept to give written consent), we would follow this system assuming
some would not accept to do so. However, for the rest we would not
insist for written consent, if they do not find it comfortable signing the
papers.
b) If the experience in the pilot test is not veiy encouraging, we will not
go for written informed consent but will go for seeking verbal informed
consent.
Please refer to Annex V for the 'draft consent letter’ that we plan to use
during the process. This will be used in either of the above stated
situation, except in the lattei* situation the section in the letter, which is
meant for respondents to sign will not be there.
In the past, in context of earlier research studies, we have sought
informed consent, but had not made attempts for written consent. The
scepticism in our minds as researchers about people’s response to
'seeking written consent’ though has reasons, it needs to be tested in the
field. Thus, we would make
a systematic attempt to do so, making a
beginning in the pilot test.
6. What are the criteria for selection
of your participants? What is your
sampling design?
methodology, p no 4^7)!°n
2' SamPllnS Design’ (Pl refer - the draft
sampling. From the selected
age (15-49 yrs) would be included.
Rtoed'X
i, Cd usin8 systematic random
° ’ & Women faUin8 in reproductive
7. How do you ensure voluntaiy participation?
informed consento?thTXp1c?vO
eCnaSt and COmmunicati^
seeking
This, we anticipate woukpartlclPants in ^e study. (Annex V)
respondents. Als0P th^ way we havrerL-X±ant^.?articiPation of the
role of team members we exnect that^8^6
team impositions and
teams will not
indolt -‘T"'10™1 !asslJ'1”"8
field
undergoing pre-field workStotag) coercbn wouldT/t •,rocesses aftw
team meetings at the end of the end t»
uld Pe taken care of. The
unique experiences gathered by team memh rC prob^ms faced
some
to make such assessments for themselve™ for fiefo d^ ?GlP the team
get the feel of the day’s events etc.
S’ f° f d edltor/ supervisor to
8 Sje“Sn^,fyeS’ in What
« -hat
“’T a
geographical
™easO»™ e^e
roots in terms of inteXentions o? X1TS':arah’"“thCT »as (/can’t) any
direction often face an ethical dilemma as towhmdo
pla"S ” that
respondents get out of it There
nn dd°eS the community or
available except that in lonXmHt wn h
eaSy anSwer t0 thi« is
facilitate furthering of t-nn i a °Uld bLneflt the larger society and
understanding of abortion sSkingblLvioq^^ methodologies and
Om^aMl “£ 'T^semiX jl ±
We
communities and women CEHAT has
related mformation to the
material prepared primly for Zl eom^v nTber °f educad<mal
exhibition in each of the PSUs for benefit ofThTenhre^11
3 P°Ster
cost us Rs >3/- for each of the P^, a f—Xib^
also screen a slide-show on anaemia and/or women’s health in each of
the PSUs.
We plan to do this as part of our rapport establishment processes. This,
therefore serves dual purpose - rapport establishment and imparting
health education to the community members.
No individual compensation is planned. No monetary compensation
would be offered to anybody participating in the study or facilitating
the study at the local level. However, we would offer educational
material (Lokvidyan booklets; booklets prepared during PHA campaign) to
Mahila Mandals, Panchayats, libraries, panchayat mahila members,
Tarun Mandal depending upon their interests, needs and women’s and
community’s accessibility to these structures/ institutes/ offices.
Dissemination of such material would depend upon the people’s need,
which would be assessed by the team leaders.
9. How many sessions and of what length do you anticipate or plan to have
for data collection with each participant?
As stated earlier in the draft methodology, we will have three protocols to
be administered during the first phase of the field-work, that is the
household quantitative survey. They are stated below along with the
estimated time required to complete interviews with individual
respondents or a group of respondents in case of village
profile/community recorder:
• Village profile/community recorder (Annex II, in the Draft
Methodology). There will be more than one respondent to collect data
on items in this protocol. This will require more than 15-20 minutes
with various respondents.
• Household questionnaire to be administered with adult male member
of the household (Annex III, in the draft Methodology). This, on an
average, would require about 25-30 minutes with an individual
respondent. This includes time to introduce ourselves, seek informed
consent and fill up the questionnaire.
• Women’s questionnaire to be administered with all women from falling
in reproductive age. (Annex IV, in the Draft Methodology). This, on an
average, would take about 25-30 minutes. This would include time
required for seeking informed consent.
In general, with no respondent, would it take more than an hour to fill in the
questionnaires. These interactions/interviews with respondents are expected
to be one-time sittings with some exceptions.
10. What are the plans for data sharing and dissemination of research
results vis-a-vis a) the respondents and b) the society at large?
Data sharing and dissemination at the level of respondents: In the
earlier projects (that I was engaged in at CEHAT) we have been taking
the findings of the study to the participants even before we took them to
the wider public domain. This would not be feasible in the present
context given the length and breadth of the geographical spread of the
field area and its discrete nature
Besides, the nature of the data is such that there is minimal scope of
individuals to get identified when we take it to the public domain as the
data will be presented in the aggregated manner. We, therefore, would
be able to share these data presented in aggregated manner to the
larger community/society and the respondents as well. (Ref NCESSRH,
III.4.3, P No. 14).
We would choose different forms while taking it to the community of
respondents, specifically the PSUs included in the study and academicia
and other concerned constituencies.
a) Taking the findings to the community studied (for instance PSUs):
The format: It would be in the form booklet in local language and with
the purpose of ‘educating the community on patterns of pregnancy
outcome and the extent of ill-consequences - morbidity patterns - that
prevail in the society at large’. We would be in position to offer some
preventive measures to them as part of educating them.
Mode of communication:
By post: Would have less impact and reach out as well.
In person: Involves human power and finances. Does not seem to be
feasible.
Utility to the community: Given the amount of energy and time that
this method would require us to expend, we see less utility to the
community even if we plan to share the study findings in person. This direct benefit to the respondents - also does not constitute the major
objective of the study, as we do not have advocacy component built in the
project commitment.
We, therefore, would prepare summary findings in the local (Marathi)
language to be sent to the key people - village leaders, various Mandal in
the PSUs, concerned offices at the community level which they would be
requested to share with their people. They can get back to us, when
required for specific purposes. We would also take care of the possible
harm that may be caused through dissemination of information and
using such a mode of communication. For example, we would choose the
key people during the field work to whom such material could be sent
etc.
Ctrl,
b) Taking study findings to other than the communities studied:
b.l With the peers and academicia: We would bring out a report
and/or research papers. These, primarily will be academic writings for
peers.
The purpose would be to:
• Disseminate research findings.
• To share our experiences vis-a-vis methodologies developed and
used.
• To share ethical research practices and the problems encountered.
CEHAT, has a system in place, for academic public peer reviews. We, as a
rule do invite academic experts in the concerned areas from outside of
CEHAT, representatives of the other concerned constituencies, which
may facilitate the processes of advocacy (in a broader sense) for such
public peer review workshops. Full-length reports are presented to the
group with transparency - meaning thereby, we do share with the group
the weaknesses and strengths of the study. There are discussants invited
(often more than one so that major thrust areas of the study/report are
subjected to thorough critique), who are expected to offer us critical
feedback.
b.2 With the society at large: We view this as primarily feeding into the
advocacy for improving women’s access to safe and legal abortion care
services. In that,
• we would do some writing for middle range health workers and
grassroots organisation working in the area of women’s health,
• write in the popular press.
These writings would weave the findings of the study in perspective notes
or advocacy notes.
b.3 The booklets that we would prepare for the communities studies
could be used in general also for grassroots organisations working in
health.
ETHICAL REVIEW REPORT
1. Name of Study
: Abortion Rate Cost and Care: A Community Based Study
2. Phase under Review:
Draft Methodology for the quantitative household survey
primarily intended to arrive at abortion rate.
3. Date of Meeting
: March 6lh , 2001
4. IEC Members present
: Anil Pilgaonkar, Bhargavi Davar, Chandra Karhadkar.
Joe Lobo (Chairperson). Sunita Bandewar (Secretary').
Tcjal Barai (Jt Secretary).
y
5.Study Team Members present
: Sunita Bandewar. Madhuri Sumant, Shelley Saha,
Bhagyashree Kliaire, Priti Bhogalc.
6. Work done to date on the study:
■
■
■
The project proposal was discussed with TAC.
Detailed draft methodology was prepared along with five
protocols (death card and household eligibility
questioonaires, which were dropped later).
Detailed discussion with the resource persons on the
draft methodology in the National Methodology
Workshop for APP-I in Dec, ’01.
7. Documentation presented to IEC members:
(1) The detailed draft methodology titled ‘Study Designand Methodology for
Abortion Rate, Cost and Care: A Community based study in two states',
Including the protocols,
(2) The draft consen t letter,
(3) Response to the Checklist-II of IEC-CEHAT.
8. Decision of the Institutional Ethics Committee, CEHAT
a. The Committee, (with the exception of Mr. J. Lobo- see Annexure II below), had
previously reviewed the Documentation presented to its members.
b. The Committee also interacted with the Study Team Members at the above meeting.
c. The Committee concluded that there was a clarity of focus to this stage of the study
both in itself and in the minds of the study team members, and that due
consideration has been paid to ethical issues as per the checklist.
d. The Committee therefore decides that this stage of the study should proceed as
planned and presented, while keeping in mind the points raised during the
discussions, which are listed in the Annexures below.
1/9
9. Other Outcomes of the Review Meeting:
9.1. Procedural Decisions: The Committee also decided as listed below on the
following general procedural issues
i.
ii.
CEHAT has allowed for the possibility that the IEC might want to discuss the study
between themselves before meeting with the Study Team representatives. IEC decided
that since the study team representatives were present they (the IEC members) could
benefit from being briefed personally by the study team members. However, IEC
reserved for itself the prerogative to discuss between themselves in camera any aspect of
the study, if it should decide to do so.
Where other ‘ethics’ monitoring agencies might be involved in any given study, IECCEHAT’s autonomy will be preserved, (see N.B at the end of Annexure I below)
9.2. Feed-back inputs
• Annexure I: Is a summary of issues that emerged in the IEC discussion on various aspects of
the study at the March 6th meeting.
• Annexure II: Is a list of queries from Mr. J.Lobo, who belatedly examined the documentation
presented. These queries do not impact in any way on the decision of the Committee.
The two Annexures are included here as feedback inputs to the study team and as items of
process documentation for the IEC.
2/9
ANNEXURE1
Summary of issues discussed
1. Need for developing a mechanism to ensure the authenticity of the data: This concern was expressed
for more than one reason.
(a) For the fist time such a large scale community based study is being conducted on abortion, cost direct and indirect - of abortion care, morbidity due to abortion.
(b) It would be spread across the entire state.
(c) The data would be generated from grassroots level and would be used at the higher level.
(d) It would generate huge data set.
The concern was expressed by some of the IEC members based on the experiences in the past
about ‘misuse’ of micro level data by others in case of household expenditure on health care and
people’s choice of provider, especially public against private health care service sector. These
data were misinterpreted quite often by others to suit their needs and in favour of their vested
interests. Such experiences in the past increase researchers’ responsibility to ensure authenticity
of the entire study.
Given the path-breaking nature of the study, some of the potential situations having implications
for authenticity of data obtained were mentioned and discussed by the IEC members. Following
are some of them:
•
•
2.
False positive syndrome: An infertile woman, in order to prove her fertility, may tend to report
having undergone abortion .
The difficulties in capturing abortion episodes, both, spontaneous and induced. (Team responded
that the review of global literature on abortion research has shown diat some of the difficulties in
recording abortions are almost beyond one’s control.). There is a possibility of both, under-reporting
of abortions and reporting of pseudo pregnancy.
With reference to the item ‘do you anticipate any risks (physical, psychological, social, and
economic and ...) to the participants? in the Checklist-II, it was suggested that the range of
possible risks could be studied and anticipated based on available literature. Bhargavi mentioned that
she has some of the relevant literature on this. Sunita would eventually acquire these references.
However, it was felt that, the study could go ahead.
3. In die same context, die research team if it puts in the required work regarding the above, it would be
in better position to address to the items ‘2. What steps have been taken to mitigate the risks?’,
and ‘3. How do you balance the potential risks against the prospective benefits?’ in the
Checklist-II.
4. Need to explicitly spell out the mechanisms and strategies to protect minor women
respondents: All ever married women of the reproductive age between 15-49 from the selected
households constitute ‘respondents’ in this study. It was felt that young women, especially between
15-19 years, would require a careful dealing while interviewing. The two major concerns were
expressed, (a) One, whether respondents of this age would necessarily be ‘competent’ enough to
offer us exact information. This would have implications for ‘authenticity’ of the data obtained, (b)
Two, the field investigators would be required to take extra efforts to be able to provide them space.
This would enable respondents to deal with the subject matter under study. Field investigators need
to develop specific mechanisms and undergo training to do so.
It was also felt that the best standards be developed for minors, which would provide them space and
privacy and would be sensitive to them. These standards then should to be applied to all respondents,
instead of having separate ones for them, which may not be as sensitive and appropriate as those
designed for the minors. In brief, we develop the standards keeping the needs of ‘minor
respondents’ in mind and apply the same for all.
3/9
Team has accepted this and it would work it out at the level of protocols and during the
training of the investigators.
5. Need to clearly state the steps to be followed to ensure privacy while conducting women’s
interviews: It was suggested that instead of keeping it flexible, as spelt out in the ‘Response to the
Checklist - IT, it could be sequenced in a stricter manner.
The team has accepted the suggestion by the IEC. It will be tested during the pilot test.
6. Seeking informed consent:
6.1 Why are we seeking written informed consent? Doesn’t it have the inherent risk of a larger
refusal rate and thus drop-out given the connotation that ‘signing papers’ has in the Indian
context?
Response by the team: (a) An attempt to initiate the process of setting such practices in Indian
context. It may take another two or three decades before it becomes a practice, (b) Given the fact that
the PSUs would be selected from all over the state, to explore whether the connotation holds true all
over the state. There is clarity among the researchers that written consent is not being sought for sake
of ‘completing legalities’ etc.
Besides, as explained in the Response to the Checklist-II, it would be tested during the pilot phase of
the study. This is keeping in mind necessarily the concerns expressed by the IEC members.
6.2 The need to incorporate some additional information, primarily limitations of the study, in the
consent letter:
The team expressed the constraints of the survey research, especially regarding its inability to
provide any concrete interventions or services to the communities (PSUs) studied. Given the vast
nature of the study and the way it is methodology has been laid down to balance the cost of the
study and quality of data, the survey has to proceed with certain pace. This implies less scope for
prolonged interactions with the community under study and individual respondents included in
the study.
IEC members felt that, with such a context, we need to explicitly spell out the constraints and
limitation of the study as well as of our field team vis-a-vis one-to-one benefits/retums of the
study that the respondents would be participating in. Some members shared with the group the
experiences in the past in this regard. For instance, women or any other members of the
community approached the field team - for their very personal problems. The team had less to
offer them. In case of the present project, too women would come and ask help from us. And the
team members would not be in position to do so. In the present study, the short stay in PSUs adds
further to these constraints as in case the team offers something - it need not necessarily be in
material terms - to the respondents, we would not be there to see its consequences, especially illconsequences, which may worsen women’s situation than improve it. And, thus the team needs
to be cautious about this, too. In another instance of domestic violence that takes place in front of
us while in the field, we still have no direct and clear strategies to know whether it is appropriate
to intervene or stay away. With these dilemmas and constraints that could be attributed to survey
methodology, it was felt that the team members could play the role of counsellor when required.
This implies that they are oriented about (a) the range of situations and (b) develop some skills to
interact with the community or respondents when required.
With this debate, it was suggested that the consent letter explicitly mentions the fact that we as
researchers in the future will not be providing any services to the community.
The team accepted this suggestion. The consent letter would include limitations of the study,
especially the fact that there is no intervention planned in the future as continuation or as a result
of this survey.
x
In this context, the team did share with the IEC that the team members experience discomfort
about the fact that we would not be able to go back to them. The team would like to have
something in place, which would help to keep in touch with the community and the individual
respondents.
4/9
IEC suggested that, it can be thought over and the team may develop some mechanism to do so.
One of the ideas shared was, to run a bulletin, which would carry primarily ‘voices cf people’
from these areas. This also has a potential to be an organisational activity and a responsibility in
the coming time to reach out and be in touch with all those with whom it has had interactions in
the past. It could be explored and worked out.
The idea appealed to the team. However, as it has implications in terms of resources, it would be
discussed within the organisation.
Informed consent of an individual and the community: Communities, though they would be informed
about the project and the significance of their participation in the study, at no point of time, would the
team consider community’s consent as that of individual respondents. There was enough clarity on
this among the team members and is exhibited in the ‘Response to the checklist-IF.
7. Voluntary participation: The team believes that ‘seeking informed consent’ would ensure voluntary
participation. In the ‘Response to the Checklist - IF, it was also articulated that the investigators
would be trained to avoid coercion during seeking informed consent. The evening sharing sessions
among the team members would help each other to understand and facilitate these processes.
However, IEC members expressed that despite our efforts, it may not ensure voluntary participation
of all the respondents at all the time. There is already a hierarchical structure in the interactions
between field researchers/mvestigators and respondents. In such situations, it would be very difficult
for people to say ‘no’ even if they want to do so. We need to keep in mind that ensuring ‘voluntary
participation’ is a process and it’s the responsibility of the team/researchers to facilitate it. ‘Seeking
informed consent’ is not a one-time act. It needs to be pursued at various stages and at various points
of time during the data collection and during ongoing interactions - one or more sittings - with
individual respondents.
The Team takes note of this discussion. Some of these concerns will be translated into imparting the
required training to the investigators. The Team would share the training module once fleshed out (at
present, the draft methodology tabled for IEC contained only the outline) with the IEC members.
They would also be invited to attend some of the sessions constituting the training of the
investigators.
8.
Rapport establishment, dissemination of resource material, conducting public meeting in each PS Us
before actually starting the survey: The team plans to conduct public meetings and organise health
awareness programme in each of the communities before starting the field work. This is
conceptualised as part of (a) a process of rapport establishment and (b) a means to express our
gratitude for their prospective participation in the study.
IEC members wanted to know how this would influence the response pattern and the biases.
The team responded that the public meeting though it is intended to share with the larger community
(beyond the respondents) /PSU about the project and its purpose, it would screen slide-show and/or
put up a poster exhibition on health issues that concern community and not necessarily women.
These health education programmes will not have anything on the issue that is under study, that is,
abortion. This, therefore, would take care of the concern expressed by IEC about exposing the
community and/or respondents to the abortion related material.
IEC suggested that these public meetings meant for rapport establishment and sharing with the
community about the study are documented to learn from in the future.
The team accepted this suggestion.
9.
How is this information going to be utilised - plan of analysis - is it worked out?
Response: The plan of analysis is not yet worked out by the team, though the protocols for the study
are guided and developed by stringently worked out objectives and detailed compilation of various
measurements that we would like to arrive at using these data. However, the tentative plan of analysis
will be worked out sometime soon. This is primarily to further ensure that there is no extra
5/9
information that would be collected and to also ensure that nothing is missing of what minimum is
required to meet the objectives the quantitative phase of the study.
10. About the protocols:
revision that took place to further streamline the
The team communicated to the IEC about the revisl°
nrotocols have rather broader
protocols, especially the h”"sehold
„as enclosed for EC’s reference)
to ent It L, However, th. other two protocols, content-
wise are almost the final with some likely additions on cost and care.
10.1 About names of the tolly members that would be recorded In the household questronnaire
Some of IEC member/s expressed the need to protect their identities.
than by code numbers, it would be appropnate to. take.car
“
researchers and
humane as long as their autonomy is not compromised.
would you take care of it?
Response of th. tto: Earlier .xponences in such s„™ys
IEC suggestion: I. can be termed as 'any relevanVequipped’ person. This the. would meh.de »y
Z ’"accepted th. suggestion, except
S
implication for the possible variation in the erro
aione from aU
1,. Reporting of the data. This was not specif,.do.““J"
be discussed and thrashed out in the coming
’01. Concerns were expressed as to the IEC "
practically possible to monitor and contro any p
regards data reporting could be of different type
»A
continue to deliberate on ‘how would it be
reporting of the data?’. Problems as
because of ‘incomplete reporting’, or
reporting’. It was clearly mentioned that
S 2 —--
toaS's to Sto EotoTTso. ” need to thto abto m.chxn.sms to exerers. control o»
such situations.
Some of the suggestions came up during the discussion were as follows;
of such situations to a great
(a) Peer reviews (within CEHAT and outside CEHAT) wouldtekecare
is Peer Review Committee
extent These mechanisms are already m place in CEHA1.
mere to the peers from outside of
presented
(PRC) within CEHAT. The studies upon completion are i
CEHAT by inviting public peer review workshops.
6/9
(b) The IEC can have access to raw data (not the interview schedules but the computerised data files
with raw data and yet without individual identities revealed) if anytime they feel the need to
ensure that it is neither incomplete reporting nor misplaced one.
Anyway, some such issues would remain concerns for IEC and there would be continued discussions
around them.
N.B. A query of the IEC, especially with reference to the fact that this particular project
throughout its tenure, would be reviewed for its ethical content by two committees (ECG, AAPIndia and IEC, CEHAT):
What is the role of the local IEC?
Sunita shared with the group in brief the discussion and the decision made by the ECG in this regard.
ECG has decided that the local IEC would have a larger role to play. It, upon in-depth ethical review
of the project at appropriate stages, would forward its detailed Ethical Review to the ECG. In case,
ECG needs some clarification etc. it would communicate the same to the team through AAP-India
secretariat. It would be the responsibility of the team to interact with the IEC and address the issues
raised by the ECG, if any.
7/9
ANNEXURE II.
J. Lobo’s request for some clarifications
Background:
I received the hard copy of Sunita’s Draft of the March 6th meeting, on the 17 of March, as there was a
problem with the email . As I was very busy with college work, bringing out the college magazine, I
could only get down to examining the material in the last week of March.
There were a number of queries I had, regarding the documentation which we were supposed to have
read before the March 6th meeting. I am raising them here even though belatedly, only to achieve greater
clarification if for no one else, then at least for myself. I have no reason to think that the issues raised will
change the 1EC decision to permit RAI to go ahead with the phase it had submitted for review. As said
earlier, at most, the answers to my quenes will help me understand the project under review better,
something which should have been done BEFORE the IEC meeting of March 6th. I cannot recollect
whether I had received the documentation as required, 10 days in advance and failed to go through it.
Anyway whatever the reason, I feel ‘ethically’ obliged to raise the issues for circulation and
clarification.
1. (Ref: Draft Methodology pg. 3 - Objectives)
• What is the principle behind tlie break-up of the objectives (a -e), and
(f- g), which would entail/justify a distinct methodological phase?.
2. (Ref: Draft Methodology pg. 7 - Making in-roads in the community)
• Under the points listed for “what purpose would it serve”, the issue of participation appears to be
taken for granted, especially the latter part of bulleted item 5 “... .a means to express our gratitude
for their prospective participation in the study.” Yet the very next paragraph raises the possibility of a
refusal “...If people ... .agree to participate in the study.” (Pg 8. The dilemmas and issues involved)
brings up the issue starkly. The rest of the paragraph however, does not indicate how it will be
resolved. What in operational terms does the phrase “And yet, this particular phase will not he
compromised upon’ mean ? Will the study team really offer the community a choice whether to
participate or not? And if so how is this structured into their interaction with the community? The
“dilemma” referred to is really non-existent. We want the community to participate. I will be less
comfortable speaking about “rapport”, and more at ease with a statement saying clearly that the
team will spend time persuading die community (in the best manner it can) to participate - (because
without that the study is a non-starter). And if we cannot persuade them to participate then there is no
point in pursuing the issue further. The team must get across the value of the study as a situation of
learning for all concerned.
3. (Ref: Annexure II Village Profile Recorder)
•
I accept that information pertinent to the objectives of the study should be recorded. But I m
having a problem with the following items which are going to be collected. Items numbering. 6,
14,15, 22, 23,24,25, 56, 57,59-65, 67-69,75-77, How do they tie in with the objectives of the study?
4. (Ref: pg. 9. Item 3.a. Household profile)
• I have similar problems with respect to the Household interview schedule.
I think the purpose should state “ to obtain information about the household pertment to the
objectives of the study”. I find that there is just too much information sought to be collected which
I cannot relate to either rate, cost, care of abortion. This could be a failing on my part. This is
especially so, since as Sunita documents, the protocols submitted to us have already been both
methodologically and ethically vetted by tlie TAC/ECG respectively. I would therefore be grateful,
if any member of the study team went through the questionnaire item by item and pointed for its
bearing on any of the three dimensions of the study.
5. (Ref: pg. 12 Timing of Cohort study)
,
• If there is no justifiable principle by which to distinguish (a - e) and (f-h), then there will not be
any need for “a substantial gap between the two phases”. But even if there is, what is the extent of
analysis that would be necessary or even desirable “before getting into this phase ?
8'9
6.(Ref: pg. 12 Regular In-Group sharing)
• How is item (d) going to be “ensured”? in operational terms?
7.(Ref: pg. 12 Training of the team)
• Specific details of the selection of the team of field investigators, their numbers, age, qualities (as
distinct from “qualifications”) etc., is not documented to tlie extent it merits, wnen compared with the
extensive details documented for the target group selection. An adequate team is as much an ethical
imperative as it is a methodological one.
• The explanatory comment: “We, therefore, would not mind taking such girls/women , is this a
‘preferred option’ or a ‘making do with what is available’? In either case an elaboration beyond what
is offered would be welcome
8.(Ref: pg.13 Thrust areas in training modules)
•
Why are ‘political organisations and structures, and local cooperatives and their functions thrust
areas in training? in terms of the objectives of the study?
9. (Ref: pg. 14 Pilot Testing)
• The statement “It is likely that the data would remain under-utilised... and therefore ethically
inappropriate” is, by my reading of the items, also pertinent to most of the queries I have raised
above, which relate to the Village Profile and the Household Questionnaire.
10. (Ref: pg.15, ethical issues and concerns)
“The method of rapport development would serve the purpose of making the community know about our
work” Does this mean Cehat’s work in general ? or the specific study team’s presence in the area, in
particular?
11. (Ref: pg. 16.)
“In no situation, consent/permission by anyone other than respondent would be treated as intormea
consent of the respondent” What happens if in the Household survey, the male is reluctant but the woman
is amenable?
12. (Ref: pg. 16.)
.
“we would use the strategy to further tone down the purpose of the research (“deception ) as approved by
the ECG” I cannot fathom the meaning of this?
13. (Ref:pg.l8)
.
c
.
“As part of the strategy to tone down the explicit emphasis on abortion..the title of the project. . .would
read ‘Pregnancy Outcome, Care and Cost study’ rather than ‘Abortion Rate, Care and Cost Study .This
to me is ethically debatable to say the least.
14. (Ref: pg 18 item 4 )
,
The problem with‘showing gratitude’is that the research organization can attempt it as a‘token while
fully realizing that it cannot effect “commensurate” compensation. Or the research organization can
attempt to compensate beyond a ‘token’, but then it must make a systematic effort to achieve as adequate
a compensation (in whatever form) as possible. The RAI team is not attempting a mere token
compensation. A more rigorous formulation then of the effort to compute adequate compensation would
be welcome.
J. Lobo
12/06/01
9/9
June 13, ’01
ABORTION RATE, CARE AND COST: A COMMUNITY BASED STUDY
Response to the EEC certification dated June 12, ’01
Response to queries in Annexure II: J Lobo’s request for some clarifications
The numbers below correspond to that in the above mentioned Annexure II.
1. We now plan to merge these phases for logical reasons. The protocol -woman’s interview
schedule is designed accordingly.
2. The issues raised here by Joe, as I understand them, are as follows:
a) The team is making an assumption about community’s participation in the study.
b) Researchers’ efforts and strategy are ‘to persuade’ and not ‘to establish rapport’.
I tend to differ on this point with Joe. ‘Rapport establishment’, to me, means that in the
process of‘getting to know each other’ and ‘developing mutual trust’, the community or
the respondent (should) have space to say ‘no’ to participate in the study. As part of the
rapport establishment, researchers do get across the value of the study as a situation of
learning for all concerned without being ‘imposing/pushy’ about it. We are using the
method of communicating objectives of the research study in a broader context by sharing
with them institution’s work and commitment. This, we are combining with giving them
some useful information on health related matters. This, we hope, would also help making
clear our intentions to the community/people.
The point about - ‘.. this particular phase will not be .compromised upon...’ is to highlight
two things. One, we will not stop being open, transparent and honest about the work we
are doing, even it may mean in certain situation more chances of refusal to participate
given the ‘tabooed’ nature of the subject under study. Two, we will not withdraw halfway
through from the activities of (offering them the health education programmes, such as,
screening slide-show) even if we get signals of their ‘refusal’. This is with the belief that
even if the community decides not participate in the study we would be making use of the
opportunity to provide the community some useful information.
The dilemma that referred to is about implications (viz. Community’s refusal to
participate in the study upon realisation just by glancing through the protocols that the
thrust of the study is abortion) of adopting such a mode of rapport establishment and
allowing access to the protocols if anybody wants to. We intended to argue (perhaps it is
not reaching this way to the readers) that the choice for us to reduce probable refusal is
not to be so open about the thrust of the project, which we are not opting for. And that is
the context of the statement we made about not compromising (or not letting it go) on the
approach to rapport establishment. I hope I am reading more clear now.
3. All the protocols have been fine-tuned to a great extent in the due course of time after
going through a rigorous process of examining relevance of each of the question.
cooperatives from the protocols. Also, there
Bigwig
Eg^iSSs
9. Same as 3.
llsaiss
household or women from the hmicehniri • A.
<n°< g° °d^ ways to Inclu^fc that
«hon_ (M we envlsage in a part,cu|ar siJ. m) of
the study.
12
ssssssss
It was shared with the IEC that TAG (and the resource persons in the methodology
workshop held in Dec)) suggested a major cutting down of the household questionnaire
(ref: Annexure-I (attached to the IEC certification: Summary of issues discussed’) in the
light of the focus of the study. We would also be sending you the refined protocols.
4. Same as above.
5. The two phases are planned together now.
6. Following are the mechanisms:
■
■
■
■
Training of the team
Constitution of the team: There would be a team leader to guide the team of 6-7
investigators. The team leader would be responsible for the team and its work.
Documentation of the discussion: Teams would be documenting the discussions
during these meetings for its own significance.
Regular interaction of senior researchers with the teams during the field work: Senior
researchers and/or members of the core team on the project would be interacting and
visiting with the field teams on a regular basis.
7. Team composition: Core team of five researchers which include one Sr Research Officer,
one Jr Research officer and three Research Assistants.
Field investigators:
Profile: We have selected about 33 women with age ranging from 22-35 yrs and with 1217 yrs of schooling/education level. It is a heterogenous groups in terms of their life
experiences, opportunities and exposure, educational backgrounds, class character etc.
The process of selection: It was difficult to get women/girls with a reasonable scoring
made on the parameters that we had set to make an assessment of candidates during the
interview, keeping in mind their anticipated job profile. We took about three rounds of
advertisements, about five rounds of interviews and three months of period to constitute
the team of qualified (using the above criteria) investigators. Panels of two members from
CEHAT interviewed the candidates. The candidates were given CEHAT’s brochure, a
short note on the project and literature on CEHAT’s work on abortion to read before they
interacted with the panel for the interview.
The parameters set for the assessment were social perspective - understanding of social
situations, women’s status, gender in every day life, capacity to observe, analytical skills,
communication skills, sincerity, willingness to travel, aptitude for the team work. They
were also asked to articulate reasons for exploring this job opportunity. Panel told them
about the nature of work that they will be required to undertake, salaries and allowances
that they would be getting and other relevant rules at the end of the interview. The job
profile of ‘field investigator’ determines their salary scale as per CEHAT’s functioning
and rules and regulations. Thus, they are placed at the same scale regardless of their
educational qualifications.
-2/^
the title of the project to ‘pregnancy outcome
would not be “deception” even in the
sense of genuine need of the research on sensitive topic as such. Besides, the kind of
strategies that we have conceptualised for rapport establishment, the content of consent
letter etc. does not keep the thrust of the project out of sight of the population under
study. Now, the fact that, in-depth interviews will be merged with the quantitative survey
tool, it is more than obvious to anybody who even glances through the protocols that the
focus of study is pregnancy wastage. However, according to me, by changing the title to
the above, would help people/community, especially those who would not be
participating in the study to be less skeptical about our work. This is not to deny them
clarifications and explanation when sought but for obvious reasons that there will be
lesser scope for doing so compared to what is possible with the participants in the study.
Sunita V B
Project in-charge
RAI, CEHAT, Pune
June 13, ‘01
HL GLIMPSES
This section carries the following
1. Training of Anveshis
As mentioned earlier, a systematic training was organised for the Anveshis. A brief report
based on impact assessment is presented here for your reference.
2. Field facilitating tools
2.1 Self-assessment
2.2 Response to the community meetings
2.3 Reported pregnancy outcome: Summary charts
2.4 Field conditions, community response & other experiences: Documentation by
Anveshis
2.4.1 Coding scheme (to analyse the above data)
2.4.2 Analysis
We developed some tools to facilitate the conduct of fieldwork and online documentation.
Their primary purpose was to develop a system, which will strengthen teams confidence,
sustain and further strengthen solidarity among themselves; enable self-sustaining
sharing; allow self critique. It was also to have a system in place which will allow on-line
documentation of their field experiences and field observation. The process ultimately
was also expected to improve quality of work through empowering mechanisms.
3. Preliminary data
3.1 Response pattern: A Summary
3.2 Reported pregnancy outcome
3.3 Comparative data on reported pregnancy outcome
Since we used the facilitating tools during the field work, w« could have PSU level data
on reported pregnancy outcome is presented in summary form.
ABORTION RATE, COST AND CARE:
A COMMUNITY BASED STUDY
1
TRAINING OF ANVESHIS
Objective
One month training programme was organised for the Anveshis mainly
■ to develop a common understanding of the project, its rationale and its content
■ to build perspective to conduct research in a ethical and gender sensitive manner
■ to impart skills required for collecting data like conducting interviews, establishing rapport
in the study area, community meeting, and taking care of logistics during feildwork
■ to maintain data quality at the field level.
Content
The major content areas on which Anveshis were given training were:
■ about our organisation
■ developing perspective on women’s health and abortion
■ politics of abortion
■ types of abortion
■ morbidities related to abortion
■ about the study
■ basic concepts about research methodology
■ administering tools of data collection
■ understanding our own bodies
■ contraception
■ health care service delivery system
■ cost of health care services
■ a brief introduction to social systems and sub-systems
■ understanding the concept of gender
■ Political and administrative structures of India
c practical sessions in administering tools and mapping
■ editing of questionnaires
Methods:
Participatory methods of training was adopted - discussions, presentations, group work, body
mapping, use of audio-visual aids.
Duration: Classroom training for 24 days, and two weeks of field training in administering and editing
tools and mapping.
Results/outcome:
In order to see/assess to see the changes in the perceptions and understanding of Anveshis over
the period of time after taking such an extensive training and detailed discussions about different
issues. The assessment was done by formulating two types of questions - multiple choice and
true or false.
D:\Shelley \RAI<coIs\Training ofthe field researchcrs.doc
The assessment was done on the major following issues/areas 1. Gender based understanding of men’s social roles and responsibilities
2. Gender based understanding of women’s social roles and responsibilities
3. Understanding of existing gender roles
4. Understanding of certain scientific facts
5. Perceptions about certain facts about abortion
6. Understanding of the health care system and right to health care
7. Understanding of the relationship between population growth and poverty
8. Understanding of the caste system and social norms
An analysis of both pre and post training assessment results show that
• The gender based understanding about men’s social roles and responsibilities show that most of the
anveshis had a better understanding prior to the training also.
• Regarding anveshis understanding about women’s social roles and responsibilities is little mixed. It
is seen that they have some patriarchal value ingrained and even after training we were not able to
bring about much change. For example, during the pretest we found that 18% of the anvenshi feel
that women are by nature more tolerant and post assessment shows that it only changed to 45%.
• Perceptions about abortion: actually we did not have many questions on abortion issues but still
among the formulated one the knowledge about the availability of safe abortion services was very
good. But anveshis’s perception about woman’s right to abortion services shows that prior to the
training only 41% anveshi thought that aborting a pregnancy is ethically wrong which after training
it changed to 72%. Initially the girls used to hesitate or did not feel comfortable to talk about the
abortion issues but a change is observed in the perceptions regarding the abortion issues over the
period of time and now the Anveshis talk comfortably about the same.
The understanding of the relationship between population growth and poverty and about common
scientific facts was not at all good during the pretesting. But a drastic change was noticed after the
training.
• Regarding the other parameters it was seen that training made an impact on the perception of the
anveshis.
An assessment of our training programme was also done by our anveshis. It was found that generally
they are very satisfied with our training programme in terms of content, methodology used and time
allocated. Only two exceptions were on the topics on ‘politics of abortion’ and ‘political and
administrative structures’ on which they thought that not much time was spent.
D:\Shelley\RAHools\Training of the field researchers.doc
2.1
ABORTION RATES, CARE AND COST: A COMMUNITY BASED STUDY
Self-assessment (filled in by Anveshis during the field work)
District and code:
Name of
Anveshi
Houselisitng and sampling
(selection of wards, identifying
boundaries, actual houselisting,
calculating probabilities, sampling
interval and selecting the households to
be included in our sample, assigning the
selected hhds to anveshis)
Tehsil and code:
Name of the PSU and code:
_________ TASKS PERFORMED
Ground work
Preparing for community
(travel and logistics,
meetings (informing the
accommodation.
community about the meeting and
finding out the suitability of the
time and venue, arrangements for
the meetings - light, place, putting
up the posters
Actually doing the
community meeting (who did
what in the community
meeting - poster presentation,
introduction of CEHAT and
project, documentation etc)
(Contd...)
\\Com3\c\sunl\NAAS\POA - 20-2lj'ulyO2\Self-assessment charts (filled in by anveshis).doc
1
(...Contd)
ABORTION RATES, CARE AND COST: A COMMUNITY BASED STUDY, CEHAT
Self-assessment (filled in by Anveshis during the field work)
District and code:
Name of
Anveshi
Tehsil and code:
Number of interviews conducted
(HHD and W)
\\Com3\c\sunl\NAAS'lJ>OA - 20-2ljul\fO2\Self-assessment charts (filled in by anveshisfdoc
TASKS PERFORMED
Editing
Name of the PSU and code:
Conducting team meetings at the end
of the day and documentation
2
2.2
jC\ BORTION rate, CBSt.CO sT: A COMMUNITY BASED STUDY
Response to the community meetings
(Filled by Anveshi during field work while in every PSU)
Whether a separate
Name &
code of the meeting held in harijan
vasti?
PSU
Request for repeat
meeting.: How far you
were able to meet their
demand?
D:\Shelley\RARools\community meeting IMP Variables.doc
Presence of
Men
Women
At what time the
meeting was held
(Morning, evening
etc.)
Location of the meeting
(Was it more
advantageous for
Male/Female?)
**
ABORTION RATES, CARE AND COST: A COMMUNITY BASED STUDY
REPORTED PREGNANCY OUTCOME: SUMMARY CHART
(filled in by anveshis during the field work in every PSU)
Information item
PSU details (Name and code)
HHDs (sampled and actually interviewed) _____________________________
1. Total number of hhds sampled_________
2. Number of hhds completely interviewed
3. Number of hhds refused to participate in
the study__________________________
4. Number of hhds found locked_________
5. Other reasons for which the hhd could
not be interviewed__________________
Eligible women found and interviewed
_____________________
4. Total number of eligible women________
5. Number of eligible women completely
interviewed________________________
6. Number of women refused to participate
in the study________________
7. Number of women not found upon three
visits____
_________________
8. Number of women withdrew halfway
9. Other reasons for which the woman
could not be interviewed
Conceptions and abortions in reference period____________
10. Total conceptions in the reference
period___________________________
11. Total live births in the reference period
12. Total spontaneous abortions in the
reference period
13. Total still births in the reference period
14. Total induced abortions in the reference
period
Conceptions and abortions in life time (other than reference period)
15. Total conceptions in the life time
16. Total live births in the life time
17. Total spontaneous abortions in the life
time
_____________________
18. Total still births in the life time____
19. Total induced abortions in the life time
Sex selection tests and abortions (total including life time and reference period)
20. Total number of sex selection tests_____
21. Total number of abortion following sex
selection tests
\\Com3\c\sunl\NAAS\POA - 20-2ljuly02\Reported Pregnancy Outcome- Summary Charts.doc
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2.4.1
CODING SCHEME
Col 2. Food:
Difficult to make arrangements 1
Manageable=2
Comfortably managed=3
For urban PSUs - difficulty for lunch =4
Col 3. Place of stay:
Col 4. Stay:
1. Within PSU
2. Rest house
3. Lodge
4. Stayed in relatives/friends house
5. Others (specify)
1. Very difficult to make arrangements
2. Managed without much difficulty
3. Comfortably managed
Write the time spent to arrange (average) place of stay
Col 5. Transport:
1. Difficulty
2. Manageable
3 No problem
Col 7. Telephone facilities:
1. available in the village/locality itself
2. had to walk some distance
3. had to travel by using some transport facility
Col 8. Caste of the leaders/contact persons to establish the first contacts in the village
Col 9. How the caste communities were physically situated:
1. Traditional (castewise clusters and harijan vasti/rajwada outside and
away from the Gaothan)
2. Mixed and nothing specific
Col 10. Key people responsible for community meeting:
1. TarunMandal
2. Gram Panchayat - gram sevak
3. AWW
4. Local social workers
5. ANM
6. Sarpanch
7. Dawandi
8. Others (specify)
Col 11. Specific use of resource material - Doctor nasal thethe/ AIDS material
1. Yes
2. No
D:\Shellc>'\RAriools\SUMMARY CHARTS-PSU prolilc-CODEB(X>K.doc
1
COL
Posters were displayed during our stay in the village (either by the community members or by
Anveshis or together):
1. Yes
2. No
col
How was the community meeting useful for the field work?
COL /S-
Whether the meeting was held before data collection started?
1. Yes
2. No
COL JA
When not displayed whom did we give the posters1. Anganwadi worker
2. Anganwadi assistant
3. GP member,
4. Sarpanch,
5. Teachers from the primary/secondary schools)
6. Other
Col !§•
Response of the community:
1. very welcoming and co-operative
2. somewhat okey
3. neutral
4. not co-operative and welcoming
COL
Language barrier 1. severe - had to hire translators/
2. managed with some assistance from some members in the community school going girls, IS - parallel in the local language were learnt from the
anganwadi worker or others,
3. No problem
COL ‘iO
Seeking informed consent:
1. Do you feel research participants by and large grasped what we wanted
to communicate with them and responded appropriately?
2. Do you think there was no comprehension at the other end despite our
efforts to simplify our communication with to the extent possible?
COL 2.1
Do you think that estimates of age in this community were close to “correct”?
1. Can’t say ( for example - Tringalwadi, Garpeth)
2. In case of certain women, estimates may not be very correct as there
was no information available on any of the base line indicator
3. By and large estimates should be right
4. By and large, since the birth dates and other dates were available we
could get the actual dates (urban areas for example)
D:\Shelley\RABtools\SUMMARY CHARTS-PSU profile-CODEBOOK.doc
2
Obi, 23
Did you meet the local abortionists in the PSU?
1. Yes
2. No
3. NA
Co L
Problems during data collection:
1. No space to sit and fill the schedule
2. Embarrassment in slums where people don’t have space - used to come
out almost unclothed
3. No problem
4. Other
Listing: Range of households listed
col 2Q
Time (in hours) - in listing of the PSU (starting with getting ward level data till the end of listing)
col
2g
How often we may have done the listing in wrong areas?
Problem in PSU maps:
1.
2.
3.
4.
5.
6.
Good map
Problem in locating the PSU
Problem in selecting the boundary but later identified
All the 4 boundaries could not be identified
Change of landmarks - how many landmarks were matching
In appropriate mapping - width of roads, distances
COL 30
PSU which did not have maps, from where did you get the information (if necessary use multiple
codes)
1. Municipal corporation/Corporation
2. Census office
3. Statistical department
4. Nagar sevak
5. Information not got at all
6. Census book
colSI .
Rural listing: problem in getting ward level data:
1. Yes
If yes,Tiow much time was spent in getting the ward level data?
At the end did you get all the information that is required? Eg in majrewadi, ward level data was
not available till the end.
Col 24
Problem during houselisting (if necessary use multiple codes):
1. Most of the families have migrated to Ustorila
2. Watchman did not let us to enter
3. Majority of the household people have gone out for job
4. Rough terrain
5. Other
6. NA
D:\Shelley\RAr\tools\SUMMARY CHARTS-PSU profile-CODEBOOK.doc
3
2.4.2
FIELD CONDITIONS, COMMUNITY MEETINGS, PROBLEMS FACED: AN
ASSESSMENT BY ANVESHIS
FIELD CONDITIONS (col 2 - 7):
Food: It is seen that anveshis got adequate food in urban areas comparative to rural areas where
they had insufficient food in approx 7% of the villages. At times they found it quite difficult to
manage food. In around 17% of urban areas the anveshis had problem in getting lunch due to the
absence of restaurants in those PSUs on the one hand and reluctance of the local residents to arrange
for their lunch.
Stay: In the rural areas in most of the times we stayed within the PSU as compared to the urban
areas. Most of the times in the urban areas it was not possible to stay within the PSU. For example,
in Mumabi and Thane. The first preference was given to stay within the village as it has many
advantages. In that understanding the community and culture was possible. It also helped facilitate
our field work. For Anveshis it was satisfying and gainful as they interact with the community and
were accessible to them when they wanted. Many a times we stayed in govt, facilities like rest
houses, hostels and health care centres. While working in Mumbai a flat was rented for staying.
Though in most of the cases we did not have to spend much time but in 14 areas we had to spent
half a day to one day to make staying arrangement.
Transport: Reaching rural PSUs was more difficult than urban areas (It was difficult to reach 25
PSUs in rural areas as compared to 2 in urban areas).
Telephone facilities: In the villages making phone calls was very difficult and time taking. Only 48
mral areas had the facilities within the PSU in comparison to 98 in urban areas. In about half of the
villages we had to use some transport facility to make the phone calls as they were sitauted at
distance from the PSUs.
RESPONSE OF THE COMMUNITY (col 8-181):
About the communities studied: Of the 103 rural PSUs, about 38 PSUs were such that at least two
caste groups and/or religious co-dominated. Among 100 urban PSU, 19 areas were slum areas, 20
areas were from the lower middle class, 36 areas were from the middle class and 25 areas belonged
to the upper middle class/elite class. Majority communities from the upper middle class and elite
class were non- cooperative and neutral during the data collection. In many of the areas the
watchmen did not let us enter in the societies. It was generally very difficult to convince the people
from the upper, middle class. In general, the people from rural communities were not only more
cooperative but also warm and welcoming compared to those from the urban areas.
1 This part also contains data from chart 2.2, filled by anveshis in the field.
D:\Shelley\RAI\chapters\A note on field conditions-cominunity meeting based on anveshis assessment.doc
1
Conducting community meetings
Unlike other large-scale surveys, we thought of conducting meeting in our selected PSUs, where all
villagers would be invited. The main objective of conducting the meetings was to build rapport with
the community through the support of the villagers rather than the power holders and also to inform
t e community about our organization and objective of our study. It would also serve as a means to
express our gratitude for their prospective participation in the study.
Of the 103 rural Psus we were able to conduct meeting in 91 PSUs. From 22 PSUs there was a
request for repeat meeting but we could meet their demand only in 16 cases. We also gave special
emphasis to conduct meetings in minority communities. Of the 103 PSUs, in 56 communities there
was a separate harijan vastis or rajwadas but only in 9 places we could conduct a separate meeting
The major reason for not being able to conduct the meetings in 12 PSUs is the reluctance of the
community, though there were other causes like rough terrain, some event in the village and
language problem. As far as urban areas are concerned we were able to conduct meeting in only one
area. We did not expect the community meetings to happen in the urban areas in anyway.
Although the community meeting was supposed to be held before data collection, it was not
possible to do so in 39 rural areas due to various unanticipated problems. According to our anveshis
t e community meetings were useful in the data collection process in terms like better acceptance
by the research participant during data collection and rendering logistical support It was felt that it
helped reduce refusals.
Except in 14/o rural PSUs, our meetings were attended by substantial number of villagers. While
calling people for the meeting special emphasis was given to make women attend the meeting and it
was seen that except in 9 areas we had substantial number of women. The timing and venue of the
meeting was fixed according to the suitability of the people of the PSU. It is seen that most of the
meetings (around 52) were conducted in the evening since it was convenient to the villagers
followed by the morning and afternoon time. In majority of the cases the meetings were held either
in the school or in temples.
Generally anveshis relied on villagers for assistance and co-operation in conducting community
meetings. Most of the time it was either sarpanch and/or anganwadi worker and/or local youths who
helped us organising the meetings. In other areas help to organise the meeting was rendered by
teacher and other local leaders. In some villages, the meetings were publicly announced through the
oca mechanism namely dawandi. In 9 areas, meetings were conducted without any help from
n order to give something to the community, we gave set of health posters and a basic health guide
o each PSU. When requested in some PSUs, more than one sets were also given. We were
particular as to who received the set of posters. In most cases it was the woman health worker
youth and/or school teacher. Despite our efforts only in 6 areas the posters were displayed before
the anveshis left the PSU.
We used some posters and charts to explain different health issues and the information about health
care system while conducting the meeting. In the first phase2 of our field work which was rural
2
In the first phase we completed 61 rural PSUs
D:kShellcy\RAr\chapters'A note on field conditions-community meeting based on anveshis assessment.doc
2
based community members from various PSUs demanded for information on AIDS and elated
issues We therefore, in the second phase used the books by Lokvigyan and Prayas m addition to
the PHA posters we. It is our general feeling that through these community meetings a bond was
developed with the communities. Each of the anveshis depending upon their interactions with the
communities continue to interact with members of these communities through letters and
telephones. Information exchange takes place at different level and is ot different type.
LISTING AND MAPPING (col 25-34):
gliosis
listing of more than 500 households. Villages with listing of less than 50 or up to 200 took less time
as compared to the villages where two wards were to be listed. In about 49 villages we could
complete the house listing in a day. In another 42 rural PSUs it took 1-2 days and m two vi ages it
took more than three days. The longer period required was because of the difficulty in getting the
ward level data and/or the difficult terrain. In one PSU, house listing took 5 days to comp ete. As
regards number of households, most of the blocks in the urban areas ranged between 101-200
households Only in 4 blocks it more. In urban areas, time required for house listing was much ess
once the boundaries of the PSU were identified. During the urban field work, boundary selection
was a major time taking task due to the various problems in the location maps. In urban areas the
time required for boundary identification varied between half an hour to 5 hours. In one PSU in
Mumbai we virtually spent the whole day to locate the PSU and left with uncertainly m our mind
about appropi lateness of the PSU.
Problems faced during listing: In more than 80% of the rural PSUs we faced problem in listing
either due to rough terrain and/or large geographical spread with no facility of intra-Ps,J
transportation, difficulty in getting reliable information about wards, boundaries and the ward level
population data. In few Mumbai PSUs, the watchmen in the societies did not permit us to enter.
Sometimes the odd working hours of the households members became a severe constraint. We
found the houses were locked and therefore we faced problem in recording names of the heads ot
the households.
• urban
’
Location maps: -In the
area we; located the boundaries of the PSU or the selected area with the
help of the location maps. Of the 100 urban PSUs we were unable to get maps of 21 PSUs, Of the
79 maps available, 31 maps were not very clear and we had problems in identifying and locating
1
in the boundary selection due to the changes in the
PSUs. Sometimes there were problems
landmarks (1991 census maps were 1used), all the boundaries/landmarks not stated clearly and/or
because of inappropriate or enlarged'maps. In Mumbai we had a major problem in locating PSUs as
the maps did not state ‘East or West’ side of a particular area.
In 21 cases where we did not have the maps we tried to get the block level information or the
location of the boundary from some concerned offices. Most of the time we got it from the
municipality or the corporation offices. In Mumbai we got the information from the census
handbooks. Sometimes we have to go to two or three places to get the information.
D:\ShclIey\RAI\chapters\A note on fielcj conditions-comniunity meeting based on anveshis asscssmcnt.doc
3
Inspite of care taken to identify selected PSU, we went wrong in 3 areas (2 in the rural areas and 1
in urban area). The problem occurred mainly because the selected areas now are named differently.
In all these areas, we had to redo the exercise.
PROBLEMS DURING DATA COLLECTION (col 19 and 24):
In general, more problem were faced during data collection in urban areas than in rural ones. The
nature of the problems faced were different in the two areas. In urban areas anveshi had to
administer and fill the interview schedules by standing either because there was absolutely no place
to sit (like slums in Mumbai) or they had to stand as the residents of the households did not offer
them a seat (like in societies). In a few urban PSUs our anveshis were embarrassed and felt
discomfort because of the way people presented themselves. Also, it was in urban areas that we
needed to spendI more energies to convince them about authenticity of our organisations and the
work it is engaged in.
The problems in rural areas were terrain (which in some cases were rough or was well spread out
and tnus have to walk long distances), lack of electricity and other causes like heavy rainfall during
data collection. Language was yet another problem in rural areas. In 6 rural PSUs the anveshis faced
language problem and of these we had to take the help of translator in 2 villages. In Mumbai we had
language problem in the sense that there are families who could speak only Gujrati and English. In
these households, other researches collected data in English.
PERCEPTION ABOUT QUALITY OF DATA (col 20-21).
Informed consent: In our study special effort were made that informed consent was sought in a
meaningful manner. Anveshis carry a little discomfort about how much people understood of what
was being communicated to them during the process of seeking informed consent in about 26 rural
PSUs. Anveshis perceive it to be because of problems in comprehension in what we were trying to
communicate to them. The problem was more accentuated in tribal tribal areas, in areas where there
was a language barrier and existed a cultural gap.
Data on Age: In the rural areas getting the accurate age was quite difficult and we had to take extra
eftorts to reach to the correct age. We used some extra probes to get the close to accurate age. Of all
the rural based PSUs, we could get the actual dates (the villages were more urbanized) only in 2
PSU compared to 55 in urban areas. Despite our efforts, uncertainly about accuracy of age
continues to exist at least in case of 23 rural PSUs.
D.\Shciley\R/\J\diaptcrs\A note on field conditions-eonmiunity meeting based on anveshis assessmcnt.doc
4
n
5
3.1
RESPONSE PATTERN: A SUMMARY
Result______________________
Households selected___________
Households completed__________
Households with no competent hhd
member________
Households absent ________
Households refused____________
Households left the PSU________
Dwelling destroyed
Problem in listing
___________
Access denied
___________
Others (eg cannot speak)
Eligible women____________
Women interviewed completely
Women not at home_________
Women refused____________
Other (eg cannot speak)
______ Urban
Number
Percent
2226
100.00
2046
91.9
0
0.0
96
______ Rural
_____Total
Number __ Percent
,
Number Percent
3458
100.00
5684
100.00
3332 __
96.35
5378
94.61
4
0.11
4
0.07
Mumbai
Number
738
643
0
Percent
100.00
87.12
0.0
65
0
0
2
16
1
4.31
2.92
0.0
0.0
0.08
0.71
0.04
108
5
7
1
1
0
0
3.12
0.14
0.20
0.02
0.02
0.0
0.0
204
70
7
__ 1_
3
16
1
3.58
1.23
0.12
0.01
0.05
0.28
0.01
42
34
0
0
2
16
0
5.69
4.60
0.0
0.0
0.27
2.16
0.0
2340
2088
214
31
7
100.00
89.2
9.14
1.32
0.29
3923
3593
306
__ 17
7
100.00
91.58
7.80
6263
5681
520
48
14
100.00
90.7
8.30
0.76
0.22
701
608
76
14
2
100.00
86.73
10.84
1.99
0.28
0.43
0.17
Note: The above data is of 201 PSUs of the total 203 PSU
D: Shelley'RAfrtoolsXPreliminaiy data-poajuly2002.doc
1
3.2
REPORTED PREGNANCY OUTCOMES
REPORTED
PREGNANCY
OUTCOME
Induced
Abortions
Spontaneous
Abortions
Still births
TOTAL
PREGNACY
WASTAGE
Live births
TOTAL
PREGNACIES
Urban
LIFETIME
Rural
Total
REFERENCE PERIOD______
Rural
Total
Mumbai
Mumbai
Urban
93
90
(3.6)
185
(4.9)
34
(11.0)
253
(4.3)
155
(1-4)
408
(2.4)
(6.1)
95
(7.4)
[62.0]
299
(5.1)
[38.0]
417
(3.75)
[100.0]
716
(4.2)
[NA]
88
(5.7)
[51.4]
80
(6.2)
[49.6]
128
(5-1)
[100.0]
208
(5.5)
[NA]
25
(8.0)
[41.8]
60
(1.0)
[58.2]
181
(1.6)
[100.0]
[NA]
17
[38.5]
[61.5]
17
31
(1.1)
(1.3)
(1.2)
[100.0]
48
(13)
[NA]
4
(1.3)
[24.9]
612
(10.5)
[75.1]
753
(6.8)
[100.0]
1365
(8.0)
[NA]
198
(13.0)
[35.4]
192
(15.0)
[64.6]
249
(100)
[100.0]
441
(H.7)
[NA]
63
(20.2)
[44.8]
5238
(89.6)
[55.2]
10375
(93.3)
[100.0]
15613
(92.0)
[NA]
1323
(87.0)
[43.5]
1090
(85.0)
[56.5]
2244
(90.0)
[100.0]
3334
(88.3)
[NA]
249
(79.8)
[33.5]
5841
(100.0)
[66.5]
11116
(100.0)
[100.0]
16957
(100.0)
[NA]
1519
[67.3]
2491
[100.0]
3773
(100.0)
[32.7]
1282
(100.0)
(100.0)
(100.0)
[NA]
312
(100.0)
[34.4]
[65.6]
[100.0]
[NA]
[44.0]
[66.0]
[100.0]
[NA]
241
(1.4)
Note: 1. Lifetime means through out the life span of the woman inclusive of reference period
(since Jan 1996)
2. Outcome ofpregnancies would not add up to the total pregnancy reported as there are cases
of twin pregnancies.
3. Braces means column percentages
4. Square brackets means row percentages in their respective categories
3.3
COMPARATIVE DATA OF PREGNANCY OUTCOMES
(in percentages)
~ REPORTED PREGNANCY
OUTCOME (LIFETIME)
Induced Abortions________
Spontaneous Abortions_______
Still births
TOTAL PREGNACY
WASTAGE_________
Live births_____________
NFHS -?
RCH1
CEHAT
QYAoH)
2.4
4.2
1.4
8.0
1.4
3.5
1.0
5.9
1.9
3.8
1.5
7.2
92.0
95.0
92.8
Few highlights of CEHAT’s study:
-
Abortion rate (lifetime) = 72 per 1000 livebirth
■
Induced Abortion rate (lifetime) - 26 per 1000 livebirth
■
Induced Abortion rate (reference period) - 55 per 1000 livebirth
■
Spontaneous Abortion rate (lifetime) - 46 per 1000 livebirth
B
Spontaneous Abortion rate (refereiKe period) = 62 per 1000 livebirth
1 Source: RCH-Rapid household survey, India
2 Source: NFHS - India, 1998-99, pg 95
i
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