Cultural Beliefs and Decision-making in Induced Abortion: Facilitator and Barriers to Safe Abortion Services in Rural Haryana, India – A Qualitative Study

Abstract Background: Abortion remains a sensitive topic in rural India, with cultural, social, and healthcare-related factors influencing access to safe abortion services. We conducted this qualitative study to explore the beliefs, practices, and decision-making pathway surrounding induced abortion and to identify the facilitators and barriers to availing safe abortion services. Materials and Methods: A qualitative study was conducted in a rural village in Haryana between July and September 2022. We conducted focus group discussions with reproductive-age married females, married adult males, and accredited social health activists (ASHAs) workers. In-depth interviews were conducted with key stakeholders of the community, i.e. Sarpanch, multipurpose health worker, medical officer, ASHA, pharmacist (private sector), Gynecologist (subdistrict hospital), and district officer (preconception and prenatal diagnostic techniques department). Data were analyzed using thematic analysis. Results: We generated three themes which were: beliefs surrounding induced abortions, reasons and practices for induced abortion, and facilitators and barriers to safe abortions. Abortions were considered a sin in the community if not medically indicated. Larger family size, unplanned pregnancies, and sex selectivity were the most common reasons to opt for an abortion both traditional and modern methods of abortion were prevalent in the community. The husband and mother-in-law of most women possess the decision-making power in the context of opting for abortions. Conclusions: Abortion was considered a sin in the community, except if done for a congenital anomaly of the fetus. Both traditional and modern methods of abortion were prevalent in the community. The decision-makers for elective abortions were the husband and mother-in-law.