Women's experiences accessing safe induced abortion in Nepal: Lessons for the future

Despite Nepal's 2002 legalization of abortion and safe motherhood efforts, unsafe abortion is still a contributing cause of maternal morbidity and mortality. This descriptive study explores the pathways women use to access safe and legal first trimester induced abortion services and identifies opportunities for community education activities. Data were collected from a cross-sectional sample of women presenting for first trimester induced abortion at three facilities selected to represent urban/rural and public /private variation. Eligible women were recruited during their initial visit and had a follow-up interview approximately 4 weeks later. The response rate was 80% (231/289). Nearly 50% were using modern contraception at conception; over two-thirds received a modern post-abortion contraceptive method. One-quarter reported a previous induced abortion. Overall, 26% of women received medical abortion, the remainder received manual vaccum extraction. Most women (90%) identified themselves as the main decision-maker to have the abortion; 91% reported husband participation. Only 17% of women spoke with a Female Community Health Volunteer (FCHV) before seeking an abortion; however, over half said that they would like to receive abortion-related information from a FCHV. Women often received abortion-related information from healthcare providers, friends/neighbors, and radio; television and FCHVs were desired means of receiving future information. More information concerning abortion methods and providers of safe, legal abortion services was desired. FCHVs appear to be a valuable, though possibly underutilized resource in Nepal. Abortion-related information should be targeted through preferred routes such as television and FCHVs. Increased education on avoiding contraceptive failure is needed.