Browsing by Author "Dangol, Deeb Shrestha"
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Publication A Critical Analysis of Safe Abortion Road Map in Nepal(Nepal Health Research Council, 2024) Ghimire, Jagadishwor; Maharjan, Sanju; Kattel, Pratikshya; Dangol, Deeb Shrestha; Lal, Bibek Kumar; Joshi, Nisha; Shrestha, Gauri Pradhan; Suwal, Archana; Bhattarai, Ojasbi; Shahi, Suruchi; Gautam, Manish; Bhattarai, Navaraj; Mehata, Suresh; Dotel, Bhogendra Raj; Karki, SujanBackground: Abortion was legalized by the 2002 Muluki Ain to combat the surging rates of maternal mortality and morbidity. By 2021, the Maternal Mortality Rate plummeted to 151 from 539 in 1996. The decline in the abortion-related maternal mortality attributes to the implication of progressive abortion policies that includes expanded safe abortion services introduction of medical abortion, constitutional recognition of abortion, the mandates by Safe Motherhood and Reproductive Health Rights Act, and free-of-cost abortion services in government health facilities. This review study delves into exploring the contemporary abortion policies and its implications on women’s access to safe abortion services as well as the factors that affect the access. Methods: This study incorporates findings from extensive desk review of abortion services in Nepal. Results: The 2021 safe abortion services Program Implementation Guideline aims to expand safe abortion sites; however, the Nepal’s challenging geography ensues its inequitable distribution, especially in mountainous area. Policy provisions on information and financial accessibility to abortion are well navigated by the Safe Motherhood and Reproductive Health Rights Act and regulation but consistent to sporadic gaps in its implementation were comprehended in this study. This paper further discussed the Safe Motherhood and Reproductive Health Rights Act’s regressive mandate of 28-week gestational limit at any condition and the role of gender in abortion decision-making under the pretext of factors influencing safe abortion services. Conclusions: The review study recommends strategies: improving capacity for abortion services under federalism, combating stigma, improving the private sector’s readiness, and building a resilient health system. Keywords: Accessibility; availability; legalization; quality; safe abortion.Publication Service Readiness for Safe Abortion Services(Nepal Health Research Council, 2024) Dangol, Deeb Shrestha; Gyawali, Nisha; Lal, Bibek Kumar; Joshi, Nisha Kumari; Karki, Sujan; Lamichhane, Kritee; Phuyal, Parash Prasad; Joshi, Shipra; Ghimire, Jagadishwor; Powell, BillBackground: Health service readiness is a prerequisite to accessing quality services. This study analyzes the readiness of health facilities in Nepal to provide comprehensive abortion services by focusing on the availability and quality of care.? Methods: This is a cross-sectional study, and a multi-stage sampling approach was used to select health facilities. A total of 767 health facilities were surveyed from 30 Municipalities across the country. Results: In a study of 767 health facilities surveyed, only 223 (29%) offered abortion services. Among them, 92% offered medical abortion, 48% provided manual vacuum aspiration, 18% offered dilation and evacuation and 18% offered medical induction. Approximately 7% of health facilities lacked trained providers yet still provided services and 29% of health facilities providing abortion services were not compliant with legal requirements. Interestingly, 13% of these facilities lacked short-acting contraceptives. Conclusions: Most health facilities in Nepal lack readiness for Safe Abortion Services (SAS), failing to meet minimum criteria, including to provide abortion legally. Urgent collaborative efforts among policymakers, administrators, and healthcare providers are needed to align with Nepal's Sustainable Development Goals and address gaps in safe abortion service availability. This includes policy updates, strengthening Public-Private Partnerships (PPPs), and ensuring comprehensive SAS implementation and financing as part of essential health services. Keywords: Health facility; listed facility; post abortion care; safe abortion; service readiness.