Post-Abortion Care in Nepal: Disclosure Between Patients and Providers after Legalization

Until 2002, abortion was illegal in Nepal and provision and acquisition of termination services were treated as criminal offenses. Maternal mortality rates were among the highest in the world, owing in part to unsafe abortion. Legal reform and an abortion training and certification program have improved abortion safety. However, women with complications from unsafe induced abortions continue to present to hospitals in the Kathmandu Valley. Despite the fact that patient disclosure of induced abortion may be critical to receiving appropriate medical treatment, many providers note that patients and abortion providers often conceal the details of these complicated abortions. Health care providers' perspectives were examined to explore factors that may influence patient and provider willingness to disclose. 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. Providers believed that patient willingness to disclose was related to awareness of the legal status of abortion, degree of privacy provided during exams, counseling on the importance of disclosure for medical treatment, treatment by the medical staff, and societal stigma of abortion. Interviewees noted that fear of patient party retribution, damage to reputation, and lack of a protected environment for disclosure are reasons providers may conceal their involvement. Identification of these factors can inform interventions to improve patient–provider trust and confidentiality in the context of abortion care.