NepMed Repository :: Browsing by Author "Ghimire, Jagadishwor"

Browsing by Author "Ghimire, Jagadishwor"

Now showing 1 - 5 of 5

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, Sujan
Background: 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.
Perception of Climate Change Vulnerability and its Impact on Sexual and Reproductive Health and Rights in Khutiya and Banganga River Basins
(Nepal Health Research Council, 2024) Poudel, Khusbu; Karki, Sujan; Lamichhane, Kritee; Timilsina, Amit; Dijkerman, Sally; Ghimire, Jagadishwor
Background: Nepal is one of the most vulnerable countries to climate change. The drivers of climate risk include its topography, ecological diversity, climatic variability, natural resource dependency, under-development, and socioeconomic vulnerabilities. Climate change affects women and girls in unique ways. Research conducted in Asia Pacific region highlight negative sexual and reproductive health outcomes from climate change-related stressors such as droughts, floods, and air pollution, factors also linked to decreased SRH services utilization, increased maternal mortality rates, and repercussions on women’s mental health. Methods: This is a mixed methods study conducted in two river basins including household surveys with 384 females ages 18-49, 12 focus group discussions, and 22 key informant interviews. We conducted descriptive and thematic analysis. Results: More than half relied on agriculture for income (66%). Despite one-third being heads of households, land ownership was low (13%). Climate change perceptions included rising temperatures (88%), increased heat wave (70%), drying water source (99%), and delayed monsoons (83%), impacting agriculture and increasing women's workload (61%) due to displacement and male migration. 64% reported disturbances in antenatal and postnatal care visits . Inaccessible healthcare facilities during the rainy season increased maternal mortality risks. Heavy river flooding hindered female community health volunteers access leading to childbirth complications. 82% of women feared being unable to protect their children post-climate events. Moreover, 21% of women faced gender-based violence during or after climate disasters. Conclusions: Our findings suggest clear impacts of climate change on women and the communities. Thus, climate adaptation efforts must be designed to address the unique impacts of the crisis on women and girls, making space for their increased participation and leadership. Keywords: Climate change; gender based violence; malnutrition; migration; sexual and reproductive health and rights.
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, Bill
Background: 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.
Status of Abortion-Related Stigma in Nepal using Stigmatizing Attitudes, Beliefs, and Actions Scale
(Nepal Health Research Council, 2024) Ghimire, Jagadishwor; Lal, Bibek Kumar; Mehata, Suresh; Joshi, Nisha Kumari; Timilsina, Amit; Lamichhane, Kritee; Phuyal, Parash Prasad; Dotel, Bhogendra Raj; Gautam, Manish; Maharjan, Sanju; Karki, Sujan
Background: Despite substantial improvements in the accessibility of safe abortion services nationwide, a noticeable underutilization of these services persists, primarily attributable to the presence of social stigma. This stigma leads to discrimination, abuse, and poor healthcare. This study aims to understand and address abortion stigma among Nepali women of reproductive age. Methods: This cross-sectional study involved 2286 women of reproductive age across Nepal. SABAS was used to measure abortion stigma, which includes 18 questions. Quantitative data was collected through face-to-face interviews using structured questionnaires on kobo collect. Stata 15.0 software was used for data analysis. Results: The mean SABAS score was 46.5 out of 90, indicating moderate abortion stigma in Nepal. Negative stereotypes and beliefs about abortion were more prevalent, with over 80% believing a woman's health deteriorates after abortion. Discrimination tendencies were lower, with less than 10% endorsing teasing, pointing fingers, or disgrace. Fear of contagion was also relatively low, with less than 20% agreeing that women who had abortions made others ill. Factors such as age, caste/ethnicity, education, marital status, wealth, and provinces were associated with varying levels of stigma, and women of higher age group, Madhesh, Dalit, Muslim, lower education levels, widowed, poor, Madhes province were linked to higher stigma scores. The study found that stigma levels varied among different groups. Conclusions: The stigma level on abortion is higher in upper age group, Madheshi, Dalit, Muslim, lower education levels, widowed, poor, Madhesh province women in Nepal. Similarly, the negative stereotype and discrimination and exclusion is also high while the fear of contagion is low among Nepalese women and girls. Keywords: Abortion-related stigma; attitudes; Nepal.
Trends and Inequities in Use of Abortion Services in Nepal: A Nepal Demographic and Health Survey Data Analysis 1996-2022 A.D.
(Nepal Health Research Council, 2024) Gautam, Manish; Mehata, Suresh; Karki, Sujan; Ghimire, Jagadishwor; Maharjan, Sanju; Dotel, Bhogendra Raj
Background: Despite policy advances and public health initiatives in Nepal to improve access to reproductive healthcare, disparities persist in utilization of abortion services. Grounded in longitudinal data from the Nepal Demographic and Health Survey from 1996 to 2022, this study aims to shed light on evolving patterns in pregnancy outcomes and inequities in use of abortion services across ecological zones and wealth quintiles. Methods: Utilizing six rounds of Nepal Demographic and Health Survey data, pregnancy outcomes were categorized as abortion, delivery, miscarriage, or stillbirth. Income-related inequality in the utilization of abortion services was assessed through the concentration index, ranging from -1 to 1. Trends over time were evaluated using the annual rate of change. Results: The ARC indicated a substantial rise in induced abortion rates, surging from 0.4% in 1996 to 8.8% in 2022. In contrast, live births witnessed a decline from 92.8% to 81.2%. Significant variations were observed across ecological zones and wealth quintiles, with the Mountain zone and the Poorest group experiencing the most pronounced increases in induced abortion rates. By 2022, the concentration index reached a near-zero value, signifying a near-elimination of income-related disparities in the use of induced abortion services. Discussion: The findings suggest that while there has been significant progress in access to and use of abortion services in Nepal, particularly post-2002 policy shifts, challenges remain. Women from lower socio-economic backgrounds continue to face barriers, indicating the need for a multi-pronged approach to address residual challenges. Conclusions: Nepal has made remarkable strides in enhancing equitable access to and use of induced abortion services, but more needs to be done to guarantee equitable access for all women. Future efforts should focus on policy reforms, infrastructural improvements, and societal change to eliminate existing barriers to reproductive healthcare. Keywords: Abortion services; concentration Index; socio-economic disparities.

Browsing by Author "Ghimire, Jagadishwor"

Results Per Page

Sort Options