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. 2018 Oct 11;15(1):170.
doi: 10.1186/s12978-018-0619-z.

Providers' perspectives on denial of abortion care in Nepal: a cross sectional study

Mahesh C Puri  1 , Sarah Raifman  2 , Biddhya Khanal  3 , Dev Chandra Maharjan  3 , Diana Greene Foster  2
Affiliations

Providers' perspectives on denial of abortion care in Nepal: a cross sectional study

Mahesh C Puri et al. Reprod Health. .

Abstract

Background: Despite legalization of abortion in Nepal in 2002, many women are still unable to access legal services. This paper examines providers' views, experiences with abortion denial, and knowledge related to abortion provision, and identifies areas for improvement in quality of care.

Methods: We conducted a structured survey with 106 abortion care providers at 55 government-approved safe abortion facilities across five districts of Nepal in 2017. We assessed reasons for denial of abortion care, knowledge about laws, barriers to provision and attitudes towards abortion.

Results: Almost all providers (96%) reported that they have ever refused clients for abortion services. Common reasons included beyond 12 weeks gestation (93%), sex selective abortion (86%), and medical contraindications (85%). One in four providers denied abortion for lack of drugs or trained personnel, and one third denied services when they perceived that the woman's reasons for abortion were insufficient. Only a third of providers knew all three legal indications for abortion -- less than or equal to 12 weeks of pregnancy on request, up to 18 weeks for rape or incest, and any time for maternal or fetal health risk. Overall, providers were in favor of legal abortion but a substantial proportion had mixed or negative attitudes about the service.

Conclusions: Improvements in training to address providers' inadequate knowledge about the abortion law may reduce inappropriate denial of abortion. Establishing referral networks in the case of abortion denial and ensuring regular supply of medical abortion drugs would help more women access abortion care in Nepal.

Keywords: Abortion; Denial of care; Nepal; Provider training; Providers; Quality of care; Referrals.

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Conflict of interest statement

Ethics approval and consent to participate

The study was approved by the Ethical Review Board of the Nepal Health research Council, Nepal (Reg #152/2017). At the start of each interview, participants were asked to review and sign an informed consent form. They were given the opportunity to ask as many questions as they had regarding the study overall and the interviews specifically. After obtaining signed informed consent, a trained researcher conducted the interview in a private room in each facility and in the Nepali language.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Method of participant’s selection
Fig. 2
Fig. 2
Knowledge about legal provisions of abortion
See this image and copyright information in PMC

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