Approximately 9-20% of all maternal deaths in India are attributed to unsafe abortion. Researchers have suggested that medication abortion has the potential to expand women's access to abortion services. This dissertation aimed to: describe the availability of early abortion services in Bihar and Jharkhand, India and the health care provider and health facility level factors that may influence the provision of these services; gain a better understanding of the intentions of obstetrician-gynecologists and general physicians to provide abortion using mifepristone-misoprostol; and establish an understanding of the potential participation of mid-level providers in medication abortion provision. Data utilized in this study came from a project that applied a multistage cluster sample design to the former state of Bihar to achieve a sample of 1346 health facilities and 2039 family planning providers. Surveys were conducted in 2004. Multivariate logistic regression procedures were used to investigate the dissertation aims. Findings indicate that government health facilities have a negligible role in abortion provision in Bihar and Jharkhand. A significant percentage of ob-gyns and general physicians intend to provide mifepristone-misoprostol abortion. Male ob-gyns were significantly less likely to intend to provide medication abortion. Rural health facilities and facilities with three or more family planning providers were more likely to have general physicians intending to provide medication abortion. The majority of mid-level providers were interested in medication abortion training. Mid-level providers who were male, held more permissive abortion attitudes and those that provided abortions using pharmacological drugs were more likely to intend to participate in medication abortion training. More than half of general physicians and over a third of ob-gyns in the study held supportive attitudes towards non-physician participation in early medication abortion provision. Given that the majority of government health facilities in Bihar and Jharkhand are located in rural areas and that most of these facilities are staffed with at least one mid-level provider, great potential exists for pubic facilities to serve as important access points for poor and rural women to obtain safe abortion services if policies in India are adjusted to allow mid-level provider participation in abortion provision, especially medication abortion provision
