Browsing by Author "Joshi, Nisha Kumari"
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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.Publication 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, SujanBackground: 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.