Unsafe abortion after legalisation in Nepal: a cross-sectional study of women presenting to hospitals
Article first published online: 10 APR 2013
© 2013 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2013 RCOG
BJOG: An International Journal of Obstetrics & Gynaecology
Volume 120, Issue 9, pages 1075–1084, August 2013
How to Cite
Unsafe abortion after legalisation in Nepal: a cross-sectional study of women presenting to hospitals. BJOG 2013;120:1075–1084., , , , , , .
- Issue published online: 9 JUL 2013
- Article first published online: 10 APR 2013
- Manuscript Accepted: 24 FEB 2013
- Richard and Rhonda Goldman Fund
- Lucille and David Packard Foundation
- Society of Family Planning
- medical abortion;
- termination of pregnancy;
- unsafe abortion
To investigate abortion practices of Nepali women requiring postabortion care.
Four tertiary-care hospitals in urban and rural Nepal.
A total of 527 women presenting with complications from induced abortion in 2010.
Women completed questionnaires on their awareness of the legal status of abortion and their abortion-seeking experiences. The method of induction and whether the abortion was obtained from an uncertified source was documented. Multivariable logistic regression was used to identify associated factors.
Main outcome measures
Induction method; uncertified abortion source.
In all, 234 (44%) women were aware that abortion was legal in Nepal. Medically induced abortion was used by 359 (68%) women and, of these, 343 (89%) took unsafe, ineffective or unknown substances. Compared with women undergoing surgical abortion, women who had medical abortion were more likely to have obtained information from pharmacists (161/359, 45% versus 11/168, 7%, adjusted odds ratio [aOR] 8.1, 95% confidence interval 4.1–16.0) and to have informed no one about the abortion (28/359, 8% versus 3/168, 2%, aOR 5.5, 95% CI 1.1–26.9). Overall, 291 (81%) medical abortions and 50 (30%) surgical abortions were obtained from uncertified sources; these women were less likely to know that abortion was legal (122/341, 36% versus 112/186, 60%, aOR 0.4, 95% CI 0.2–0.7) and more likely to choose a method because it was available nearby (209/341, 61% versus 62/186, 33%, aOR 2.5, 95% CI 1.5–4.3), compared with women accessing certified sources.
Among women presenting to hospitals in Nepal with complications following induced abortion of pregnancy, the majority had undergone medically induced abortions using unknown substances acquired from uncertified sources. Women using medications and those accessing uncertified providers were less aware that abortion is now legal in Nepal. These findings highlight the need for continued improvements in the provision and awareness of abortion services in Nepal.