PMID- 31499333
OWN - NLM
STAT- MEDLINE
DCOM- 20200828
LR  - 20200828
IS  - 1873-5347 (Electronic)
IS  - 0277-9536 (Linking)
VI  - 239
DP  - 2019 Oct
TI  - "Like a mother-daughter relationship": Community health intermediaries' knowledge 
      of and attitudes to abortion in Karnataka, India.
PG  - 112525
LID - S0277-9536(19)30519-2 [pii]
LID - 10.1016/j.socscimed.2019.112525 [doi]
AB  - Community Health Intermediaries (CHIs)- ANMs, ASHAs, and pharmacists- are key to 
      realising task-sharing efforts to increase abortion access in LMICs, but their 
      knowledge of and attitudes to abortion remains underexplored. Evidence on 
      abortion task-sharing has focused primarily on CHIs' technical and clinical 
      abilities, overlooking social contexts and norms that influence attitudes and 
      behaviours. This mixed-methods study describes the abortion knowledge, attitudes, 
      and roles of three cadres of CHIs in rural districts of Karnataka, India. 
      Quantitative data on CHIs' abortion attitudes (n = 118) were collected using the 
      Stigmatising Attitudes, Behaviours, and Actions Scale (SABAS), followed by 
      in-depth interviews (n = 21) with a subset of the population over eight months in 
      2017. Findings show that CHIs, present at multiple points in women's abortion 
      trajectories, serve as barriers or facilitate access to abortion care. Their 
      abortion attitudes reflect social contexts and environments, drawing on social 
      norms surrounding fertility, woman- and mother-hood. They demonstrate poor 
      knowledge of abortion laws, conflating them with sex-selection laws. CHIs also 
      reflect poor knowledge of abortion methods. They report little to no training on 
      abortion. CHIs contend with entrenched social and structural inequalities in 
      carrying out their tasks, affecting the kind and quality of care they are able to 
      provide. Understanding CHIs' experiences, knowledge and attitudes can advance 
      abortion care-provision, support task-sharing efforts, and potentially improve 
      the quality of women's abortion-seeking experiences.
CI  - Copyright (c) 2019 Elsevier Ltd. All rights reserved.
FAU - Nandagiri, Rishita
AU  - Nandagiri R
AD  - Department of Social Policy, London School of Economics and Political Science, 
      Houghton Street, London, WC2A 2AE, United Kingdom. Electronic address: 
      r.nandagiri@lse.ac.uk.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20190903
PL  - England
TA  - Soc Sci Med
JT  - Social science & medicine (1982)
JID - 8303205
SB  - IM
MH  - Abortion, Induced/legislation & jurisprudence/*psychology
MH  - Adult
MH  - Aged
MH  - Community Health Workers/*organization & administration
MH  - Female
MH  - *Health Knowledge, Attitudes, Practice
MH  - Health Services Accessibility/organization & administration
MH  - Humans
MH  - India
MH  - Interviews as Topic
MH  - Male
MH  - Middle Aged
MH  - Mothers/*psychology
MH  - Nuclear Family/*psychology
MH  - Patient Acceptance of Health Care/psychology
MH  - Pharmacists/organization & administration
MH  - Professional Role
MH  - Rural Health Services/organization & administration
MH  - Social Environment
MH  - Social Norms
MH  - Social Stigma
MH  - Young Adult
OTO - NOTNLM
OT  - Abortion
OT  - Abortion attitudes
OT  - Abortion stigma
OT  - Community health intermediaries
OT  - Community health workers
OT  - India
OT  - Task-sharing
EDAT- 2019/09/10 06:00
MHDA- 2020/08/29 06:00
CRDT- 2019/09/10 06:00
PHST- 2019/03/13 00:00 [received]
PHST- 2019/08/24 00:00 [revised]
PHST- 2019/08/27 00:00 [accepted]
PHST- 2019/09/10 06:00 [pubmed]
PHST- 2020/08/29 06:00 [medline]
PHST- 2019/09/10 06:00 [entrez]
AID - S0277-9536(19)30519-2 [pii]
AID - 10.1016/j.socscimed.2019.112525 [doi]
PST - ppublish
SO  - Soc Sci Med. 2019 Oct;239:112525. doi: 10.1016/j.socscimed.2019.112525. Epub 2019 
      Sep 3.