Situating abortion within India’s health system: A national landscape study
1
CommonHealth, India, India
Popul. Med. 2026;8(Supplement Supplement 1):A1838
ABSTRACT
INTRODUCTION:
Although abortion is legally permitted in India under the Medical Termination of Pregnancy (MTP) Act, access to safe and timely services remains uneven and highly stratified. Abortion continues to be marginally positioned within India’s health system, shaped by legal conditionality, provider-centric models of care, and persistent stigma. From a health systems perspective, limited integration of abortion into governance, financing, service delivery, and information systems undermines equity, quality, and accountability, particularly for adolescents and marginalized populations.¹–³
METHODS:
This national-level landscape study synthesizes findings from multiple baseline scoping studies conducted under the Kaleidoscope Initiative. The analysis draws exclusively on secondary data, including legal and policy documents, budgetary allocations, health management information system (HMIS) data, media content, parliamentary records, and published literature. Thematic synthesis was undertaken across six domains relevant to health systems strengthening: governance and law, policy design, financing, service delivery, provider capacity, and health information systems.
RESULTS:
The synthesis reveals a persistent disconnect between progressive legal and policy intent and health system functioning. Abortion remains framed as a conditional medical exception rather than an essential health service, resulting in fragmented governance, under-prioritised financing, and inconsistent service availability. Provider shortages, fear of legal liability, weak referral pathways, and inadequate second-trimester capacity constrain service delivery, while data systems fail to capture disaggregated information necessary for accountability. Political caution and media narratives emphasizing criminality further reinforce stigma and limit public health framing of abortion care.⁴–⁷
CONCLUSIONS:
Integrating abortion into health systems strengthening is essential to advancing equitable access and reproductive autonomy in India. Findings underscore the need to reposition abortion as core healthcare within universal health coverage frameworks, align legal and policy regimes, invest in provider capacity and infrastructure, and strengthen rights-based governance and data systems. Without systemic integration, legal reforms alone will remain insufficient to ensure safe, accessible abortion care.
Although abortion is legally permitted in India under the Medical Termination of Pregnancy (MTP) Act, access to safe and timely services remains uneven and highly stratified. Abortion continues to be marginally positioned within India’s health system, shaped by legal conditionality, provider-centric models of care, and persistent stigma. From a health systems perspective, limited integration of abortion into governance, financing, service delivery, and information systems undermines equity, quality, and accountability, particularly for adolescents and marginalized populations.¹–³
METHODS:
This national-level landscape study synthesizes findings from multiple baseline scoping studies conducted under the Kaleidoscope Initiative. The analysis draws exclusively on secondary data, including legal and policy documents, budgetary allocations, health management information system (HMIS) data, media content, parliamentary records, and published literature. Thematic synthesis was undertaken across six domains relevant to health systems strengthening: governance and law, policy design, financing, service delivery, provider capacity, and health information systems.
RESULTS:
The synthesis reveals a persistent disconnect between progressive legal and policy intent and health system functioning. Abortion remains framed as a conditional medical exception rather than an essential health service, resulting in fragmented governance, under-prioritised financing, and inconsistent service availability. Provider shortages, fear of legal liability, weak referral pathways, and inadequate second-trimester capacity constrain service delivery, while data systems fail to capture disaggregated information necessary for accountability. Political caution and media narratives emphasizing criminality further reinforce stigma and limit public health framing of abortion care.⁴–⁷
CONCLUSIONS:
Integrating abortion into health systems strengthening is essential to advancing equitable access and reproductive autonomy in India. Findings underscore the need to reposition abortion as core healthcare within universal health coverage frameworks, align legal and policy regimes, invest in provider capacity and infrastructure, and strengthen rights-based governance and data systems. Without systemic integration, legal reforms alone will remain insufficient to ensure safe, accessible abortion care.
| eISSN: | 2654-1459 |
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