Abstract
BackgroundDespite legalization of abortion in Nepal in 2002, many women are still unable to access legal services. This paper examines providers’ views, experiences with abortion denial, and knowledge related to abortion provision, and identifies areas for improvement in quality of care.MethodsWe conducted a structured survey with 106 abortion care providers at 55 government-approved safe abortion facilities across five districts of Nepal in 2017. We assessed reasons for denial of abortion care, knowledge about laws, barriers to provision and attitudes towards abortion.ResultsAlmost all providers (96%) reported that they have ever refused clients for abortion services. Common reasons included beyond 12 weeks gestation (93%), sex selective abortion (86%), and medical contraindications (85%). One in four providers denied abortion for lack of drugs or trained personnel, and one third denied services when they perceived that the woman’s reasons for abortion were insufficient. Only a third of providers knew all three legal indications for abortion -- less than or equal to 12 weeks of pregnancy on request, up to 18 weeks for rape or incest, and any time for maternal or fetal health risk. Overall, providers were in favor of legal abortion but a substantial proportion had mixed or negative attitudes about the service.ConclusionsImprovements in training to address providers’ inadequate knowledge about the abortion law may reduce inappropriate denial of abortion. Establishing referral networks in the case of abortion denial and ensuring regular supply of medical abortion drugs would help more women access abortion care in Nepal.
Highlights
Despite legalization of abortion in Nepal in 2002, many women are still unable to access legal services
We examine providers’ perspectives on abortion denial, reasons for denial of abortion, knowledge about abortion laws and safety, and attitudes about abortion
One third of the providers were aware of all three stipulations of the abortion law in Nepal: 1) a woman may request an abortion up to 12 weeks in pregnancy for any reason, 2) a woman may request an abortion up to 18 weeks in pregnancy for reasons of rape or incest, and 3) a woman may obtain abortion any time in pregnancy for mental or physical health or risks to the fetus
Summary
Despite legalization of abortion in Nepal in 2002, many women are still unable to access legal services. Puri et al Reproductive Health (2018) 15:170 component of reproductive health care, enabling many women to obtain safe, legal services. Any pregnant woman with at least three out of negative mental health conditions is eligible to receive an abortion after weeks of gestation age [2]. Since 2008, nurses, in addition to physicians, have been eligible to receive training in manual vacuum aspiration (MVA) up to 8 weeks gestation. In 2009, medical abortion was introduced (available within 9 weeks of gestation) and by 2017, primary health care centers and health posts located in 45 districts (out of 75) were providing medical abortion services
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