We declare that none of the authors have any competing interests regarding this work.
MP, DV, CG and DF contributed to the study design, survey development, drafting the paper and reviewing versions of the paper. MP was responsible for study implementation and drafting the paper. DV was responsible for data analysis and drafting the paper. CG and DF were responsible for overall study design and reviewing versions of the paper. All authors read and approved the final manuscript.
Although abortion was legalized in Nepal in 2002, many women are not able to obtain legal services. Using qualitative data from women who were denied legal abortion services, we examined reasons for seeking an abortion, options considered and pursued after being denied an abortion, reasons for delaying seeking care, as well as complications experienced among women who were denied legal abortion.
After obtaining authorization from two health facilities in Nepal, we requested informed consent from all women who were seeking abortion services to complete a case report form to determine their eligibility for the study. We then recruited all eligible and interested women in to the study. Two months after recruitment, we conducted in-depth interviews with 25 women who were denied abortion services from the two recruitment facilities due to advanced gestational age (>12 weeks). Interviews were translated and transcribed, and the transcripts were analyzed through an iterative process grounded in thematic analysis, involving both a priori and emergent codes.
Eleven women were recruited from the government hospital and 14 from an NGO facility. The majority of women (15 women or 60 %) were living rural settings, ranged in age from 18 to 40 years and had an average of 2 children. None had completed any post-secondary education. Women most commonly cited financial concerns and health concerns as reasons for seeking termination. Not recognizing pregnancy, uncertainty about how to proceed, needing time to coordinate the trip to the facility or raise money, and waiting to know the sex of fetus were the commonly cited delays. Among the women interviewed, 12 decided to continue their pregnancies following denial, 12 terminated their pregnancies elsewhere, and one self-induced using medication. At least two women experienced significant complications after obtaining an abortion. Most women who continued their pregnancies anticipated negative consequences for their health, family relationships, and wellbeing.
Barriers to seeking early abortion need to be addressed in order to reduce utilization of abortion services that may be unsafe and to improve women's health and wellbeing in Nepal.
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Puri M, Regmi S, Tamang A, Shrestha P. Road map to scaling-up: translating operations research study’s results into actions for expanding medical abortion services in rural health facilities in Nepal. Health Res Policy Syst BioMed Central. 2014;12:24. CrossRef
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Frost MD, Puri M, Hinde PR: Falling sex ratios and emerging evidence of sex-selective abortion in Nepal: evidence from nationally representative survey data. BMJ open 2013, 3(5). doi: 10.1136/bmjopen-2013-002612
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- “I need to terminate this pregnancy even if it will take my life”: a qualitative study of the effect of being denied legal abortion on women’s lives in Nepal
Diana Greene Foster
- BioMed Central
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