Browsing by Author "Lamichhane, Kritee"
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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.Publication 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, JagadishworBackground: 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.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.