Browsing by Author "Joshi, Nisha"
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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 An Estimate of Abortion Incidence and Unintended Pregnancies(Nepal Health Research Council, 2024) Ghimire, Agadishwor; Lal, Bibek Kumar; Karki, Sujan; Mehata, Suresh; Dotel, Bhogendra Raj; Joshi, Nisha; Pradhan, Gauri Shrestha; Gautam, Manish; Dangol, Deeb Shrestha; Phuyal, Parash Prasad; Lamichhane, Kritee; Bhattarai, Navaraj; Lynam, AnnaBackground: After the legalization of abortion in Nepal, there has been remarkable changes in policies and service delivery. However, even after two decades of legalization, access to and use of safe abortion services remains limited. The objective of this study is to estimate the incidence of abortion and unintended pregnancies in Nepal. Methods: A cross sectional study was conducted in 767 health facilities using structured questionnaires to assess the availability of abortion services, and 231 key informant interviews were conducted. Information on medical abortion drugs was collected from distributors and pharmacies. Abortion estimations were segmented into categories: those performed within healthcare facilities, those conducted outside healthcare facilities, and those using other traditional methods. To estimate pregnancy outcomes, we utilized secondary data from national censuses and health surveys. Results: The total incidence of induced abortion cases in Nepal was estimated to be 333,343 for the year 2021. Only 48 percent of abortion services were provided from the listed (legal) sites and providers. The estimates showed that total facility based induced abortion in Nepal was 176,216 in 2021, more than half were medical abortions. The highest and lowest abortion cases were in Bagmati and Karnali province respectively. The result showed that more than half of the pregnancies were unintended (53.3%). Conclusions: Despite a relatively liberal legal environment, more than half of all abortions are extra-legal in Nepal. Unintended pregnancies are also common, resulting in induced abortion. This demands for increasing access to information and services on contraception and safe abortion among women and girls. Keywords: Abortion incidence; legal abortion; unintended pregnancy.