The transformative terrain: An in-depth analysis of trends in self-managed abortion in India using NFHS-5 national data

In 2022, the World Health Organization endorsed self-managed abortion (SMA) with medical abortion pills as a safe abortion method. This study utilises India's National Family Health Survey Round 5 (2019-2021) data from 724,115 women to estimate state-level self-managed abortion (SMA). It examines SMA characteristics, trends over time, and self-reported complications in India using descriptive and multivariate analysis. This study finds significant regional disparities, with a higher proportion of self-managed abortions in the eastern (45%), central (39%), and north-eastern (31%) regions. A rising trend in SMA was observed, increasing from 19% in 2014-45% in 2021. There were higher odds of SMA among economically disadvantaged, less educated, and employed women. The study found no increased odds of self-reported complications in SMA, suggesting its safety and effectiveness, especially at early gestational ages. These findings underscore the importance of supporting reproductive choices, including access to quality drugs and information, while highlighting the continued relevance of provider-assisted care, particularly for surgical abortions and later gestational needs. This study offers crucial insights on SMA for programmatic and policy advocacy while underscoring the need for more research in the SMA field.