title: Unsafe abortion after legalisation in Nepal: a cross-sectional study of women presenting to hospitals.
abstract: OBJECTIVE
  To investigate abortion practices of Nepali women requiring postabortion care.
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  Four tertiary-care hospitals in urban and rural Nepal.
  
  
  METHODS
  A total of 527 women presenting with complications from induced abortion in 2010.
  
  
  METHODS
  Women completed questionnaires on their awareness of the legal status of abortion and their abortion-seeking experiences. The method of induction and whether the abortion was obtained from an uncertified source was documented. Multivariable logistic regression was used to identify associated factors.
  
  
  METHODS
  Induction method; uncertified abortion source.
  
  
  RESULTS
  In all, 234 (44%) women were aware that abortion was legal in Nepal. Medically induced abortion was used by 359 (68%) women and, of these, 343 (89%) took unsafe, ineffective or unknown substances. Compared with women undergoing surgical abortion, women who had medical abortion were more likely to have obtained information from pharmacists (161/359, 45% versus 11/168, 7%, adjusted odds ratio [aOR] 8.1, 95% confidence interval 4.1-16.0) and to have informed no one about the abortion (28/359, 8% versus 3/168, 2%, aOR 5.5, 95% CI 1.1-26.9). Overall, 291 (81%) medical abortions and 50 (30%) surgical abortions were obtained from uncertified sources; these women were less likely to know that abortion was legal (122/341, 36% versus 112/186, 60%, aOR 0.4, 95% CI 0.2-0.7) and more likely to choose a method because it was available nearby (209/341, 61% versus 62/186, 33%, aOR 2.5, 95% CI 1.5-4.3), compared with women accessing certified sources.
  
  
  CONCLUSIONS
  Among women presenting to hospitals in Nepal with complications following induced abortion of pregnancy, the majority had undergone medically induced abortions using unknown substances acquired from uncertified sources. Women using medications and those accessing uncertified providers were less aware that abortion is now legal in Nepal. These findings highlight the need for continued improvements in the provision and awareness of abortion services in Nepal.
authors.affiliation: Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, School of Medicine, University of California, San Francisco, CA, USA. roccac@obgyn.ucsf.edu
authors.forename: C H
authors.initials: CH
authors.lastname: Rocca
authors.forename: M
authors.initials: M
authors.lastname: Puri
authors.forename: B
authors.initials: B
authors.lastname: Dulal
authors.forename: L
authors.initials: L
authors.lastname: Bajracharya
authors.forename: C C
authors.initials: CC
authors.lastname: Harper
authors.forename: M
authors.initials: M
authors.lastname: Blum
authors.forename: J T
authors.initials: JT
authors.lastname: Henderson
mesh_terms: D015746:Abdominal Pain / Q000453:epidemiology; D000029:Abortion, Legal / Q000009:adverse effects / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*; D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D004715:Endometriosis / Q000453:epidemiology; D005260:Female; D005334:Fever / Q000453:epidemiology; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D006760:Hospitalization / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D009390:Nepal / Q000453:epidemiology; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011182:Postoperative Care / Q000592:standards / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology*; D011247:Pregnancy; D018805:Sepsis / Q000453:epidemiology; D012769:Shock / Q000453:epidemiology; D011795:Surveys and Questionnaires; D014592:Uterine Hemorrhage / Q000453:epidemiology
keywords: Abortion; Nepal; medical abortion; termination of pregnancy; unsafe abortion