Browsing by Author "Timilsina, Amit"
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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 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.Publication Understanding the Knowledge, Attitude, Practice and Intention regarding Abortion among Federal and Provincial Policymakers(Nepal Health Research Council, 2024) Bajracharya, Madhabi; Gyawali, Nisha; Bhattarai, Tejaswee; Joshi, Shipra; Devkota, Jivan; Devkota, Bishnu; Rai, Jayashree; Tandukar, Samasti; Timilsina, Amit; Shrestha Dangol, DeebBackground: For more than two decades abortion is legalized in Nepal, recognizing unsafe abortion as one of the leading but preventable cause of maternal morbidity and mortality. To safeguard safe abortion as women’s rights, several policies, guidelines, training manuals have been developed along with training human resources and increasing access to abortion services across Nepal. However, access to safe abortion services remains a challenge. Hence, to unravel the possible reasons behind these challenges, this study explored the knowledge, attitudes, practices and intentions of policymakers of Nepal towards abortion. Methods: Mixed methodology was used incorporating self-administered questionnaire for quantitative data collection and semi-structured interview guidelines to interview twenty local leaders from federal and provincial level, identified through purposive sampling. The ethical approval was taken from Nepal Health Research Council prior to data collection. After transcription and translation to English, Dedoose application was used for qualitative thematic analysis while the quantitative data was analysed using SPSS version.  Results: 70% understand that international health and human rights frameworks support abortion. Also, a majority (85%) believe that policies limiting abortion access create negative attitudes toward abortion. All the participants mentioned that they possess a good knowledge of safe abortion services. Majority of the participants had good attitude, confident in advocating, and had positive intention towards safe abortion services. However, existing socio-cultural barriers, lack of awareness, legal barriers and maintaining privacy were identified challenges to seek safe abortion and related services. Conclusions: Despite strong positive intentions, policy implementation gaps and lack of accountability have resulted in poor awareness, access, and acceptability of abortion related services. Further budget allocation, safe abortion prioritization, continuous advocacy, integration of abortion in preservice curriculum and community engagement and awareness will bridge these gaps – to ensure equitable access to quality services including women and girls from marginalized community and adolescents. Keywords: Intention; knowledge; policy gaps; policymakers; safe abortion.