Nepal offers free abortion services in public health facilities. Excerpt from www.ipas.org/news/2015/August/nepal-to-provide-free-abortion-services-at-public-health-facilities. Retrieved 20 October 2018. Our findings document how women seek safe or unsafe abortion services based on positive personal experiences or advice from positive experiences from family and friends, where easy access to services, concerns about confidentiality, and economic burden also play a role. Despite permissive laws and the government`s commitment to providing free safe abortion services, several Nepalese studies show that awareness of the legal status of abortions and awareness of safe abortion services remains low [8, 66,67,68]. Combined with a lack of knowledge, barriers to accessing and using safe abortion services will continue to facilitate the demand for PA services by pharmacies in Nepal [11]. It is important that SRH policymakers recognize the role pharmacies continue to play in the provision of PAs and develop practical strategies to reduce negative health outcomes for women and improve access to and referrals to safe PAs [20, 61, 69]. If the pregnancy is not terminated by attempted abortion and the child is born alive, but dies immediately after birth as a result of such an act, this act is considered a crime of abortion. Using an Assets Focused Rapid Participatory Appraisal (AFRPA) research methodology supported by a conceptual framework of the health information pyramid, this qualitative exploratory study collected data from in-depth and open-ended interviews. The study examined the medical abortion and sexual and reproductive health experiences of ten women who had medical abortion through an accredited safe abortion service and ten women who had unsafe medical abortion through pharmacies. Although Nepal legalized abortion in 2002, a significant number of women continue to have access to unsafe abortions. An estimated 60% of all abortions performed in 2014 were unsafe, with unsafe abortions continuing to be one of the largest contributors to maternal mortality. Although access to medical abortions is only allowed through state-approved safe abortion services, medical abortion pills are readily available for illegal purchase in pharmacies across the country.
According to the law, women have access to legal abortion only under the following conditions. Nepal legalized abortion in March 2002 under the 11th Amendment to the Civil Code. The legal opinion was successfully implemented on 25 December 2003. [1] The high maternal mortality rate in Nepal led the government to legalize it. More than 500,000 women requested abortions between 2004 and 2014. [2] In 2014, 323,100 women in Nepal had abortions; Of these, only 42% of abortions were legal and 19% were treated for abortion complications. A similar study found that the rate of unwanted pregnancies was 50%. [3] There is ample evidence to suggest that involving additional health workers in abortion care can help improve the delivery of abortion services. Access to medical abortions may increase with the inclusion of pharmacists as legal providers of medicines. Authorizing the role of pharmacists will also facilitate the government`s ability to regulate, train and ensure quality. As many women prefer to seek care in private clinics, the involvement of private auxiliary midwives as medical abortion providers will be crucial. Community health workers could also play an important role in raising awareness about legal abortion and the location of safe services, as well as combating stigma around this issue.
In contrast, other CP respondents reported receiving information about SRH at the time of MA purchase, such as administration of MAID, what to expect from PA and possible side effects, and what to do if the abortion is incomplete (e.g., return to the pharmacy, visit a clinic or hospital, or call the pharmacy). However, only two participants discussed contraceptive use after abortion with the pharmacy staff who provided their MA. The effective and safe administration of PA by non-physician clinicians is well documented [56,57,58,59,60,61]. Puri et al. (2018) and Rocca et al. (2018) show in their study of nursing assistant midwives provided to PAs by pharmacies that effective and safe administration of PA can be achieved without compromising contraceptive care [53]. With many medium-sized healthcare providers (nurses and nursing assistant midwives) owning pharmacies in Nepal, their study shows another promising pathway for safe and convenient delivery of PA and expansion into pharmacies [53, 61]. While none of the respondents based their personal abortion process on learning about fetal sex through ultrasound technology, several participants shared stories of sex-selective abortions in their communities or extended families. Puri M, Raifman S, Khanal B, Maharjan DC, Foster DG.
Provider perspectives on abortion denial in Nepal: a cross-sectional study. Reprod Health. 2018;15:170. The overhaul of the framework and methodology for estimating unsafe abortions has further divided the WHO classification of unsafe abortion into two categories: less safe and less safe [5]. In their 2017 study, Ganatra et al. classified abortions as less safe if only one of the two criteria was met: (1) the abortion was performed by a qualified provider, but an outdated or unsafe method (e.g., sharp curettage) was used, or (2) a safe abortion method (e.g., mifepristone and/or misoprostol) was used. but administered without adequate information or assistance from a qualified supplier. The least safe abortions are classified as abortions performed by untrained people who use dangerous methods such as ingesting corrosive substances, introducing foreign bodies, and using traditional herbal mixtures or tonics [5].
Of the 25 million unsafe abortions (45% of all abortions) that took place each year between 2010 and 2014, an estimated 17 million (31%) were considered less safe and 8 million (14%) were considered the least safe [2, 5]. Effective culturally safe contraceptive counseling is an integral part of CAP, helping women give birth in space, prevent future unwanted pregnancies, and avoid unsafe abortions [22, 23]. It also plays a critical role in ensuring that women`s concerns about contraceptive use are addressed so that women can make informed decisions about which method is best for them [51].