This fact sheet summarizes findings for Tamil Nadu from a 2015 study that provides the first comprehensive estimates of the incidence of abortion and unintended pregnancy in six states in India.

Incidence of abortion and unintended pregnancy

• Induced abortion has been legal in India on a broad range of grounds since the Medical Termination of Pregnancy (MTP) Act was passed in 1971.* 
• An estimated 707,900 abortions are performed in Tamil Nadu annually. For 2015, this translates to 33 abortions per 1,000 women of reproductive age (15–49).
• Thirty-two percent of abortions occurring annually in the state—an estimated 228,600—are provided in health facilities. More than half (56%) of these are surgical and the remaining 44% are performed using medical methods of abortion (MMA).† Eighty-two percent of facility-based abortions are provided in private facilities, nearly 17% in public facilities and about 2% in NGO facilities.
• The majority of abortions in Tamil Nadu (63%) are done using MMA obtained in settings other than health facilities. Five percent are performed outside of health facilities using other, typically unsafe methods.
• An estimated 43% of all pregnancies in the state—945,900 in 2015—are unintended. Three-quarters (75%) of these unintended pregnancies end in abortion.

Postabortion care

• Each year in Tamil Nadu, roughly 183,300 women obtain facility-based postabortion care for complications resulting from induced abortion or miscarriage.
• The majority of women receiving postabortion care are treated for minor complications, such as incomplete abortion from MMA or prolonged or abnormal bleeding, and many of these women likely seek care unnecessarily because they mistake the normal process of MMA for a complication.
• An important minority of postabortion care patients experience one or more severe complication, such as infection (12%), physical injury (6%), sepsis (7%) or shock (3%). These complications are most likely the result of nonfacility abortions using methods other than MMA.

Provision of abortion-related care in health facilities

• As of 2015, an estimated 3,235 facilities in Tamil Nadu provide abortion-related care (induced abortion, postabortion care or both types of services); 14% of these facilities are public and 86% are private (including NGOs).
• Among facilities offering any abortion-related care, about 71% provide both induced abortion and postabortion care, 11% offer only postabortion care and 18% offer only abortion.
• Only 20% of public facilities offer any abortion-related care. This includes the majority of public hospitals (71%) but only 35% of community health centres and 6% of primary health centres.
• Although 49% of women in Tamil Nadu reside in rural areas, just 5% of facilities offering abortion-related services are located in these areas.

Types of abortions provided in facilities

• The vast majority (92%) of facility-based abortions take place in the first trimester of pregnancy (up to 12 weeks’ gestation), and nearly half (45%) occur in the first seven weeks of pregnancy. 
• Almost two-thirds of facility-based abortions are performed using the techniques recommended for early termination: manual or electric aspiration (20%) and MMA (44%). Although only 8% of facility-based abortions occur after the first trimester, more than one-third (36%) are performed using more invasive surgical procedures not recommended in the first trimester (dilatation and evacuation or dilatation and curettage).

Barriers to obtaining facility-based abortion

• In Tamil Nadu, 19% of public facilities that offer any abortion-related services provide only postabortion care. Among these facilities, the most common reasons reported for not offering induced abortion are lack of trained staff and lack of equipment or supplies).
• Unlike public facilities, which are automatically approved to provide induced abortion if they have a certified provider, private facilities must obtain registration before offering that service. Among private facilities offering any abortion-related care, 10% offer only postabortion care; for them, the most common reasons for not providing abortion are lack of trained staff, social or religious concerns, and lack of registration. 
• Staff at health facilities cite fear of social stigma as a key barrier preventing women from obtaining safe abortion care. Other barriers include cost and objections from husband or family.
• Moreover, some abortion providers deny women services for reasons that are not in keeping with national abortion guidelines, including because the women are perceived to be too young, are unmarried, do not have children or do not have consent from a family member. 

Recommendations

• Improve access to facility-based abortion services, especially in underserved rural areas, by ensuring that all public-sector facilities have adequate equipment and supplies, including MMA drugs.
• Expand the number of providers trained in abortion-related services, for example, by offering MMA training for current and new providers and by amending the MTP Act to allow nurses, auxiliary nurse midwives and practitioners trained in Indian systems of medicine to provide MMA and postabortion care.
• Streamline the process for registering private facilities to offer abortion services by ensuring that District Level Committees are functional, and expand the registration process to include those facilities that are providing MMA only.
• Ensure high-quality abortion care that adheres to national guidelines by training providers in current abortion techniques and best practices, in national abortion laws and in nonjudgmental service provision. 
• Use community-based health workers and public health campaigns to educate women about the availability of safe, legal abortion services in facilities, and inform them about the correct use of MMA and the abortion process following its use.
• Improve the quality and availability of voluntary contraceptive services for all women, including those receiving abortion and postabortion services, to help them prevent future unintended pregnancies. Services should include provision of a wide range of methods, counseling on consistent and correct use, and facilitation of method switching.