Browsing by Author "Basnett, I"
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Publication Increasing Access to Safe Abortion Services Through Auxiliary Nurse Midwives Trained as Skilled Birth Attendants(Kathmandu University, 2011) KC, NP; Basnett, I; Sharma, SK; Bhusal, CL; Parajuli, RR; Andersen, KLABSTRACT Background The use of medical abortion methods was approved by Department of Health Services in 2009 and introduced in hospitals and a few primary health centres (PHCs). Access would increase if services were available at health post level and provided by auxiliary nurse midwives trained as skilled birth attendants. Evidence from South Africa, Bangladesh, Nepal and Vietnam show that mid-level health workers can provide medical abortion safely. Objectives To determine the best way to implement the new strategies of medical abortion into the existing health system of Nepal; and to facilitateits full-scale implementation, monitoring and evaluation. Methods An implementation research involving a baseline study, implementation phase and end line study was done in ten districts covering five development regions from July 2010 to June 2011. Both qualitative and quantitative methods were used. Results Of 1,799 medical abortion clients who received service, 46% were disadvantaged Janjati, 14% were Dalit, 42% were upper caste groups and rest were advantaged Janjati (7%), Muslim (1%) and others. 14% were referred by female community health volunteers and 56% were referred by others. Complication rate of 0.3% was well below acceptable levels. Condom use increased from 8% to 28% by the end of study. Use of Pills, Depo, intra uterine devices and Implants also increased, but use of long acting family planning methods was negligible. Conclusions This model should be replicated nationwide at health posts and sub-health posts where auxiliary nurse milwifes are available 24 hours/day. Focus should be given first to those areas where access is difficult, time consuming and costly. KEY WORD medical abortions, safe abortion services, skilled birth attendantPublication Women Having Abortion in Urban Nepal: 2005 and 2010 Compared(Kathmandu University, 2012) Thapa, S; Neupane, S; Basnett, I; Read, EABSTRACT Background The use of abortion services at the Maternity Hospital clinic, the largest public sector abortion clinic in Nepal, has risen over the years. Whether the profile of the clients, reasons for abortion, and contraceptive use have changed are not known and need to be investigated. Objectives This paper evaluates changes between 2005 and 2010 in the socio-demographic profile of abortion users, reasons for seeking abortion, and contraceptive use of two cohorts of women who had first-trimester abortion at the Maternity Hospital. Methods We used data from two similar surveys conducted in 2005 and 2010 among 672 and 392 women, respectively, who obtained first-trimester surgical abortion in a large public sector clinic. We analyzed trend data in service utilization and carried out a cost analysis. Results The number of women having abortions has steadily increased over the years, and cumulatively about 19,800 women have received services. The profile of the clients at this clinic has remained essentially the same between 2005 and 2010. The typical users of abortion services at the clinic were 27 years old with two living children, mostly married, with the majority not wanting to have more children. About half of them used a contraceptive method—mostly condoms, withdrawal, the pill and rhythm—in the month of unintended pregnancy, suggesting failures with these methods. Health concerns, dislike of available methods, and perceived low risk of pregnancy were common reasons for not using a contraceptive method. Conclusion Despite increases in the number of clients, the socio-demographic profile of the abortion clients has remained similar over the years. The linkage between the abortion and family planning clinics needs to be strengthened. KEY WORDS Abortion, client characteristics, family planning, Nepal