Abortion and Autonomy in Urban Uttar Pradesh, India

Despite India’s 1971 legalization of abortion, unsafe abortion remains a leading cause of maternal mortality. However, women’s autonomy may be a facilitator to safe abortion. This dissertation used longitudinal survey data to examine how autonomy is associated with abortion-related health behaviors and experiences among married women aged 15-49 in six cities in Uttar Pradesh, India. The first study used multilevel models to determine how women’s autonomy, individual- and community-level characteristics, and community gender norms are linked to abortion attainment. We estimated associations between baseline community-level gender norms and individual deviance from norms in several areas of autonomy (financial, mobility, marital control, and reproductive) and abortion attainment among 1,703 women. A cross-level interaction indicated that the likelihood of abortion rises as both a woman’s financial autonomy compared to her community rises and her community’s overall financial autonomy rises. The second study used logistic regression to examine associations between baseline autonomy, community gender norms, and social networks and self-managed abortion (abortion performed without a doctor or nurse; usually, but not always, using medication) in 310 women who reported an abortion between 2009-2014. Sixteen percent of women reported self-managed abortion (SMA), and of these, 75.40% were medication abortions and 74.94% reported no side effects or complications. Women in communities with more financial autonomy were more likely to report SMA. In this dissertation, the more monetary control that women in a community had, the more likely they were to obtain an abortion and to choose a self-managed abortion. SMA may be more discreet than facility-based abortion, which likely appeals to more vulnerable women and women in crowded urban neighborhoods where information and stigma spread quickly. However, women with the most education were more likely to choose facility-based abortion, likely reflecting the distinction between autonomy (e.g., financial autonomy) and status (e.g., educational achievement). Resources, such as money or social relationships, are key in enabling autonomous abortion decision-making, and autonomy or status due to different types and sources of resources may have a differential influence on women’s choices around abortion experience.Doctor of Philosoph