NepMed Repository :: Browsing by Author "Lal, Bibek Kumar"

Browsing by Author "Lal, Bibek Kumar"

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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.
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, Anna
Background: 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.
Cervical Cancer Screening Services in Nepal: A Descriptive Crosssectional Study
(Nepal Medical Association, 2024) Lal, Bibek Kumar; Bhatta, Ghanshyam Kumar; Adhikari, Ramesh; Karn, Abhishek; K.C, Ranju; Nyaupane, Sujata; Adhikari, Anuska; Shrestha, Binita; Shrestha, Merina; Bhattarai, Pankaj; Sah, Sujit; Shrestha, Bijaya
Abstract Introduction: Cervical cancer, the most prevalent cancer among women, is also the primary cause of cancer-related deaths in reproductive age women in Nepal. The study aims to assess the situation of cervical cancer screening services in Nepal. Methods: This cross-sectional study used quantitative methods to understand the situation of cervical cancer screening in 572 health facilities of Nepal. The research was conducted to assess screening facilities, the allocation of separate screening rooms, the availability of screening services on a routine basis throughout the week, screening facilities that are free of charge, human resources, and the availability of treatment. It was conducted in October to December 2022. Results: The research was carried out among 572 healthcare facilities, out of which 134 (23.42%) had provision for cervical cancer screening services. Ethical approval was obtained from the Nepal Health Research Council (NHRC) under reference number 397/2022 P. Amongst those 134, 72 (53.73%) healthcare facilities had assigned separate rooms for screening intentions. One hundred and two (76.12%) healthcare facilities provided regular screening services throughout the week, while 112 (83.58 %) had free-of-charge screening services. Concerning trained personnel, 121 (90.30%) health facilities had personnel trained in visual inspection with Acetic acid, 9 (6.72%) had personnel trained in use of colposcopy, and 5 (3.73%) had personnel trained in use of Loop Electrosurgical Excision Procedure (LEEP). Lastly, 31 (23.13%) healthcare facilities offered treatment choices for cervical cancer. Conclusions: Most of the health care facilities did not have provision of cervical screening. Amongst those who had the provision, personnel trained in loop electrosurgical excision procedure colposcopy.
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.

Browsing by Author "Lal, Bibek Kumar"

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