Abortion Practices in Nepal: What does Evidence Show?

Twenty-five years have passed since the global community agreed in Nairobi to address the high maternal mortality by implementing the Safe Motherhood Initiative. However, every year around 22 million women seek unsafe abortion in developing countries. Globally, the unsafe abortion accounts for 13% maternal deaths. Out of the total aborted women, around five million women were admitted to hospitals as a result of unsafe abortion. Similarly, more than three million women suffer from severe complications from unsafe abortion every year. In 2002, responding to the public voices and high attribution of unsafe abortion on maternal mortality, Nepal granted legal access to safe abortion introducing safe abortion act. Women can seek abortion up to 12 weeks of gestation for any indication. However, sex selective pregnancy termination is prohibited in Nepal. This study aimed to assess the results of various studies on abortion practices in Nepal. Literature published in PubMed, Lancet, Medline, WHO and Google Scholar web pages from 1990 to 2014 were used to prepare this paper. From 2004 to 2014, more than half a million women sought safe abortion care in Nepal. Despite the considerable progress, unsafe abortion is still a major issue in Nepal as it has been estimated that it constitutes half of all abortions undertaken every year. Published literature further showed that still an unmet need of safe abortion services exists in Nepal. However, the overall awareness of legal abortion was found to be high among Nepalese women. We found negative attitude of most people towards women who sought abortion care. Similarly, a large number of unmarried women were found at risk for seeking abortion care due to socio-cultural norms, values and stigmas in Nepal.

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Pattern of Abortion Care in a Tertiary Level Maternity Hospital in Nepal

Journal of Nepal Medical Association ◽

10.31729/jnma.2262 ◽

2013 ◽

Vol 52 (191) ◽

Cited By ~ 1

Author(s):

Punya Paudel ◽

Luna Paudel ◽

Manisha Bhochhibhoya ◽

Sapana Amatya Vaidhya ◽

Nabina Shah ◽

...

Keyword(s):

Hospital Admissions ◽

Tertiary Care ◽

Unwanted Pregnancy ◽

Safe Motherhood ◽

Unsafe Abortion ◽

Care Hospital ◽

Safe Abortion ◽

Abortion Care ◽

Care Services ◽

The Future

Introduction: Complications from unsafe abortion are believed to account for the largest proportion of hospital admissions for gynaecological services in developing countries and not to mention the cost it imparts to the health system of a country. Therefore, it is equally important to find out the prevalence and the pattern of abortion among the women who utilize the safe abortion care services and provide a framework to target various health promotion programs including safe-motherhood and reproductive health; such that the future interventions to avoid the unintended pregnancy and unsafe abortion can be implemented accordingly.Methods: A cross-sectional study was conducted in a tertiary care hospital in Kathmandu, Nepal. Social and demographic information of all the women seeking induced abortions from January 2011 to December 2012 were included and the result was analyzed.Result: Abortion contributed to about 1.68% of the total patient served in the hospital that provides both obstetrical and gynecological services. Of the total 4830 patients who underwent induced abortion in this period, the mean age was 27, 92.3% were from the Kathmandu valley and more than one-third women (35.2%) were illiterate who couldn't read and write. Majorities were more than two parity and belonged to higher caste.Conclusion: The socio-demographic profile of the abortion clients in Nepal has remained similar over the years. We need to address the accessibility and availability to the safe abortion care services along with other safe motherhood programs guaranteeing access to safe abortion and post-abortion care to all group of women and also, women education regarding contraception to avoid repeated abortions or unwanted pregnancy in the future._______________________________________________________________________________________Keywords: abortion; pattern; socio-demographic.

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Role of birth spacing, family planning services, safe abortion services and post-abortion care in reducing maternal mortality

Best Practice & Research Clinical Obstetrics & Gynaecology ◽

10.1016/j.bpobgyn.2016.07.008 ◽

2016 ◽

Vol 36 ◽

pp. 145-155 ◽

Cited By ~ 20

Author(s):

Bela Ganatra ◽

Anibal Faundes

Keyword(s):

Family Planning ◽

Maternal Mortality ◽

Birth Spacing ◽

Family Planning Services ◽

Safe Abortion ◽

Abortion Care ◽

Post Abortion Care ◽

Post Abortion

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Pregnancy Safety and Termination

10.1093/med/9780190667351.003.0002 ◽

2018 ◽

Author(s):

Natalie S. Whaley ◽

Adam Evans

Keyword(s):

High Risk ◽

Pregnancy Termination ◽

Obstetric Care ◽

Evidence Based ◽

Neurologic Disease ◽

Safe Abortion ◽

Or Management ◽

Pregnancy Failure ◽

High Risk Women ◽

Abortion Care

Access to compassionate, nonjudgmental, and safe abortion care for medically complex women is an important component of obstetric care for high-risk women. The care of women with neurologic disease who seek pregnancy termination or management of pregnancy failure includes consideration of their particular medical, anesthesia, and surgical needs. Counseling regarding pregnancy options is an important first step in helping women achieve their family planning goals. Understanding the safety of abortion, as well as options for medical, surgical, or labor induction termination can help providers discuss pregnancy options with women. Resources are available to help non-obstetric providers ensure their patients have access to medically sound, evidence-based information about pregnancy termination.

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Maternal Health in Crisis: A Scoping Review of Barriers and Facilitators to Safe Abortion Care in Humanitarian Crises

Frontiers in Global Women's Health ◽

10.3389/fgwh.2021.699121 ◽

2021 ◽

Vol 2 ◽

Author(s):

Bianca Dias Amaral ◽

Dikaios Sakellariou

Keyword(s):

Scoping Review ◽

Unwanted Pregnancy ◽

Barriers And Facilitators ◽

Unsafe Abortion ◽

Humanitarian Law ◽

Humanitarian Crisis ◽

Safe Abortion ◽

Abortion Care ◽

Humanitarian Crises ◽

Published Research

During humanitarian crises, women are particularly vulnerable to unwanted pregnancy. Unsafe abortion is among the five leading causes of maternal mortality and it is the only one which is entirely preventable. This study aimed to identify the barriers and facilitators to the provision of safe abortion care by humanitarian organisations. We performed a scoping review of the literature in July 2020, covering the years 2010–2020, on the following databases: Medline, Global Health, CINAHL Plus and ReliefWeb. We critically appraised all included articles and we conducted a narrative synthesis of the findings. We retrieved 881 articles. After removing duplicates and excluding articles that did not meet the inclusion criteria, twenty-four articles published between 2015 and 2020 were included in the review. Nine of the included papers were non-research practise items. The findings revealed five main themes: legal environment; context; stigma; economic factors; and service delivery. Restrictive laws, stigma, and lack of funding were reported as the main barriers to safe abortion, while the main facilitators were the fact that abortion is permitted under some circumstances in most countries, humanitarian actors' ability to inform healthcare policies at the onset of a humanitarian crisis, and community engagement. This scoping review revealed a dearth of published research. Increased dissemination of studies on Termination of Pregnancy (ToP) could increase the visibility of unsafe abortion and the need to provide ToP in humanitarian settings. Moreover, humanitarian organisations need to have a clear protocol on safe abortion and an in-depth understanding of relevant legislation, including the International Humanitarian Law, in order to provide this service to the full extent of the law.

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Knowledge and Attitude towards Safe Abortion among Undergraduate Students in Jana Bhawana Campus, Lalitpur, Nepal

International Journal of Health Sciences and Research ◽

10.52403/ijhsr.20210543 ◽

2021 ◽

Vol 11 (5) ◽

pp. 269-277

Author(s):

Nirmala Ghimire ◽

Manju Nepal ◽

Niran Shrestha

Keyword(s):

Undergraduate Students ◽

Living Arrangement ◽

Negative Attitude ◽

Sampling Technique ◽

Cross Sectional Study ◽

Reproductive Age ◽

Unsafe Abortion ◽

Cross Sectional ◽

Safe Abortion ◽

Knowledge And Attitude

Background: Unsafe abortion is one of the health issue of the reproductive age women. In spite of abortion legalization, woman’s access to safe abortion is based on the knowledge related to safe abortion. Knowledge is essential part which equip women to get services and prevent from complications of unsafe abortion. Materials and methods: A descriptive cross sectional study was conducted with the objective to identify the knowledge and attitude on safe abortion among bachelor level student. Non probability total enumerative sampling technique was used to select the sample. Total of 310 respondents were included in the study. The structured pretested questionnaire was used to collect data. Pearson chi-square was used to find out the association between demographic variables and knowledge on safe abortion. Result: The result of the study showed that among the respondents majority 247(79.7%) were ≥20 years of age with mean age 21.4 years with SD 1.9. More than half 173(55.8) of respondents were female. Majority 193(62.3%) of the respondents had fair knowledge and nearly half of the respondents 154(49.7%) had positive attitude regarding safe abortion. Respondents’ knowledge on safe abortion were not significantly associated with their age, gender, marital status, ethnicity, type of family, area of residence and living arrangement. Conclusion: Despite having fair level of knowledge among majority of respondents, it is seen that half of the respondents had negative attitude towards safe abortion. This shows that there is a need for educational intervention among undergraduate students in order to change their attitude. Key words: Attitude, Knowledge, Safe Abortion, Undergraduate Students.

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Global Epidemiology of Induced Abortion

10.1093/acrefore/9780190632366.013.346 ◽

2021 ◽

Author(s):

Suzanne O. Bell ◽

Mridula Shankar ◽

Caroline Moreau

Keyword(s):

Health Care ◽

Reproductive Health ◽

Induced Abortion ◽

World Health ◽

Unsafe Abortion ◽

Safe Procedure ◽

Safe Abortion ◽

Abortion Care ◽

Postabortion Care ◽

Global Epidemiology

Induced abortion is a common reproductive experience, with more than 73 million abortions occurring each year globally. Worldwide, the annual abortion incidence decreased in the 1990s and the early decades of the 21st century, but this decline has been driven by high-resource settings, whereas abortion rates in low- and middle-resource countries have remained stable. Induced abortion is a very safe procedure when performed according to World Health Organization guidelines; however, legal restrictions, stigma, cost, lack of resources, and poor health system accountability limit the availability, accessibility, and use of quality abortion care services. Even as women’s use of safer self-managed medication abortion options becomes more common in some parts of the world, 45% of all abortions annually are unsafe, nearly all of which occur in low- and middle-resource settings, where unsafe abortion remains a primary cause of maternal death. Beyond country-level legal and health care system factors, significant disparities exist in women’s reliance on unsafe abortion. Even among women who receive a safe abortion, quality of care is often poor. Yet abortion’s precarious status as a health care service and its clandestine practice have precluded a systematic focus on quality monitoring and evaluation of service inputs. Improving abortion and postabortion care quality is essential to meeting this reproductive health need, as are efforts to prevent abortion-related mortality and morbidity more broadly. This requires a three-tier approach: primary prevention to reduce unintended pregnancy, secondary prevention to make abortion procedures safer, and tertiary prevention to reduce the negative sequelae of unsafe abortion procedures. Strategies include two complementary approaches: vulnerability reduction and harm reduction, the first focusing on the root causes of unsafe abortion by addressing the determinants of unwanted pregnancy and clandestine abortion, while the latter addresses the harmful consequences of clandestine abortion. Political commitments to extend service coverage of abortion and postabortion care need to be implemented through actions that build the public health system’s capacity. Beyond the model of receiving care exclusively in clinical settings, models of guided self-managed abortion are expanding the capacity of individuals to take evidence-based actions to terminate their pregnancies safely and without the threat of judgment. Research has strived to keep up with the changes in the abortion care landscape, but there remains a continuing need to improve methodologies to generate robust evidence to identify and address inequities in abortion care and its health consequences in a diversified landscape. Doing so will provide information for stakeholders to take actions toward a new era of health care reforms that repositions abortion as an integral component of sexual and reproductive health care.

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Uterine Perforation With Bowel Infarction In a Case of Unsafe Abortion

Journal of Chittagong Medical College Teachers Association ◽

10.3329/jcmcta.v23i2.56840 ◽

2013 ◽

Vol 23 (2) ◽

pp. 50-52

Author(s):

Afroza Ferdous ◽

Shahanara Chowdhury ◽

Rawshan Akter

Keyword(s):

Maternal Mortality ◽

Health Care Providers ◽

World Health ◽

Public Health Issue ◽

Uterine Perforation ◽

Unsafe Abortion ◽

Care Providers ◽

Safe Abortion ◽

Bowel Infarction ◽

Unintended Pregnancies

Every year worldwide about 42 million women with unintended pregnancies choose abortion, and nearly half of these procedures, 19 million, are unsafe. Some 70,000 women die of unsafe abortion annually, making it one of the leading causes of maternal mortality (13%). Of the women who survive unsafe abortion, 5 million will suffer longterm health complications. Unsafe abortion is thus a pressing issue. Both of the primary methods for preventing unsafe abortionless restrictive abortion laws and greater contraceptive useface social, religious, and political obstacles, particularly in developing countries, where most unsafe abortions (97%) occur. Even where these obstacles are overcome, women and health care providers need to be educated about contraception and the availability of legal and safe abortion, and women need better access to safe abortion and post abortion services. Otherwise, desperate women, facing the financial burdens and social stigma of unintended pregnancy and believing they have no other option, will continue to risk their lives by undergoing unsafe abortions. According to the World Health Organization (WHO), every 8 minutes a woman in a developing nation die of complications arising from an unsafe abortion. The fifth United Nations Millennium Development Goal recommends a 75% reduction in maternal mortality by 2015. WHO deems unsafe abortion one of the easiest preventable causes of maternal mortality and a staggering public health issue. We report a case of a 21 years female who presented with uterine perforation with small intestinal prolapse through uterine perforation that required repair of uterine perforation with resection anstomosis of small gut after a unsafe abortion of a 16 weeks pregnancy. JCMCTA 2012 ; 23 (2): 50-52

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Understanding the Abortion Experiences of Young People to Inform Quality Care in Argentina, Bangladesh, Ethiopia, and Nigeria

Youth & Society ◽

10.1177/0044118x211011015 ◽

2021 ◽

pp. 0044118X2110110

Author(s):

Laura E. Jacobson ◽

Ana Maria Ramirez ◽

Chiara Bercu ◽

Anna Katz ◽

Caitlin Gerdts ◽

...

Keyword(s):

Young People ◽

Quality Care ◽

First Trimester ◽

Structural Barriers ◽

Structured Interviews ◽

Safe Abortion ◽

Medication Abortion ◽

Abortion Care ◽

The Mean ◽

Reproductive Healthcare

Young people face social and structural barriers when accessing abortions. High-quality, sexual and reproductive healthcare is needed; however, literature on youth-informed abortion services is limited. This study assesses accounts of youth who obtained an abortion in Argentina, Bangladesh, Ethiopia, and Nigeria and provides recommendations to improve person-centered aspects of abortion quality. We analyzed 48 semi-structured interviews with clients recruited from clinics, safe abortion hotlines, and patent and proprietary medicine vendors. We coded transcripts and conducted a thematic analysis. The mean age was 21 years (range 16–24), and the majority had a first trimester, medication abortion. Prominent themes included access to information; privacy; stigma associated with age or marital status; the decision-making process; and comfort and rapport with providers. Youth-centered abortion care should anticipate the distinct needs of younger clients. Supportive providers have an important role in offering a non-judgmental service that makes young clients feel comfortable and prepared.

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