Academic journal article International Perspectives on Sexual and Reproductive Health

Abortion Incidence and Unintended Pregnancy in Nepal

Academic journal article International Perspectives on Sexual and Reproductive Health

Abortion Incidence and Unintended Pregnancy in Nepal

Article excerpt

CONTEXT: Although abortion has been legal under broad criteria in Nepal since 2002, a significant proportion of women continue to obtain illegal, unsafe abortions, and no national estimates exist of the incidence of safe and unsafe abortions.

METHODS: Data were collected in 2014 from a nationally representative sample of 386 facilities that provide legal abortions or postabortion care and a survey of 134 health professionals knowledgeable about abortion service provision. Facility caseloads and indirect estimation techniques were used to calculate the national and regional incidence of legal and illegal abortion. National and regional levels of abortion complications and unintended pregnancy were also estimated.

RESULTS: In 2014, women in Nepal had 323, 100 abortions, of which 137,000 were legal, and 63,200 women were treated for abortion complications. The abortion rate was 42 per 1,000 women aged 15-49, and the abortion ratio was 56 per 100 live births. The abortion rate in the Central region (59 per 1,000) was substantially higher than the national average. Overall, 50% of pregnancies were unintended, and the unintended pregnancy rate was 68 per 1,000 women of reproductive age.

CONCLUSIONS: Despite legalization of abortion and expansion of services in Nepal, unsafe abortion is still common and exacts a heavy toll on women. Programs and policies to reduce rates of unintended pregnancy and unsafe abortion, increase access to high-quality contraceptive care and expand safe abortion services are warranted.

International Perspectives on Sexual and Reproductive Health, 2016, 42(4): 197-209.

Prior to its amendment in 2002, the abortion law in Nepal was highly restrictive: Abortion was permitted only to save a woman's life. (1) Moreover, unsafe abortion was common, and deaths from abortion-related complications accounted for more than half of maternal deaths that occurred in major hospitals. (2) In 2002, the Country Code of Nepal (Muluki Ain) was amended to grant all women the right to terminate a pregnancy at up to 12 weeks' gestation on demand, at up to 18 weeks' gestation if the pregnancy resulted from rape or incest, and at any gestational age with a doctor's recommendation if the pregnancy poses a danger to the woman's life or her physical or mental health or if there is a risk of fetal abnormality or impairment. (1) In addition, the revised law prohibits sex-selective abortions and abortions done without the consent of the woman.

During the past decade, the Ministry of Health has developed strategies for implementing the law and expanding access to safe and legal services. These strategies include training clinicians to perform abortions, providing them with necessary equipment, and certifying providers and health facilities (3) (both of which need government approval to provide abortion services). (4,5) All health facilities that have official approval to provide abortions are expected to perform first-trimester abortions. A few lower-level facilities, such as health posts, are approved only to provide medical abortion up to nine weeks' gestation. To provide abortions after the first trimester, facilities need separate approval and are required to have staff members trained and certified to provide such abortions. Abortion legalization has led to a decrease in the number of women presenting with severe abortion complications, (6,7) and it has contributed to a decline in the country's maternal mortality ratio, which fell from 580 maternal deaths per 100,000 live births in 1995 to 190 deaths per 100,000 live births in 2013. (8)

Nonetheless, unsafe abortions--that is, procedures carried out by an unapproved provider in an unapproved facility, potentially under unsafe conditions and using unsafe methods--remain a concern in Nepal. According to the 2011 Nepal Demographic and Health Survey (DHS), a quarter of the women who reported having had an abortion in the past five years had had postabortion complications. …

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