Providers' Interpretations of Abortion Reform in Nepal

Until recently abortion was treated as a criminal offense in Nepal and rates of maternal mortality, owing in large part to unsafe abortion, were among the highest in the world. In 2004 a policy legalizing abortion went into effect permitting elective abortion up to 12 weeks; for rape or incest up to 18 weeks; and for health reasons at later gestations. Health care providers' perspectives were examined in this study to explore interpretation of the abortion law among individuals instrumental in shaping its enactment through patient care, training of providers, and development of institutional practices and policies. Key-informant interviews were conducted with physicians, nurses, and counselors who care for abortion patients and with hospital administrators involved in framing abortion care policy at two major urban hospitals in the Kathmandu Valley (n = 24). Transcripts from semi-structured interviews were coded for content and theme. The majority of providers were aware of legalization, but there was much variation in specific knowledge of the law. Cultural norms related to marital status, family consent, and gender roles were incorrectly believed by many to remain encoded in the abortion law, yet most were aware of a ban on sex selective abortion. Variations in interpretation of gestational age limits among key informants suggest a need to increase knowledge among health care workers, perhaps through targeted interventions. Questions raised by providers about the concept of individual consent highlight a need to consider the challenges of implementing a law that may impose ideas contrary to prevailing cultural norms.