title: Service provider perspectives on post-abortion contraception in Nepal.
abstract: The government of Nepal has articulated a commitment to the provision of post-abortion contraception since the implementation of a legal safe abortion policy in 2004. Despite this, gaps in services remain. This study examined the perspectives of abortion service providers and administrators regarding strengths and shortcomings of post-abortion contraceptive service provision. In-depth interviews were conducted with 24 abortion providers and administrators at four major health facilities that provide legal abortion in Nepal. Facility factors perceived to impact post-abortion contraceptive services included on-site availability of contraceptive supplies, dedicated and well-trained staff and adequate infrastructure. Cultural norms emerged as influencing contraceptive demand by patients, including method use being unacceptable for women whose husbands migrate and limited decision-making power among women. Service providers described their personal views on appropriate childbearing and the use of specific contraceptive methods that influenced counselling. Findings suggest that improvements to a facility's infrastructure and training to address provider biases and misinformation may improve post-abortion family planning uptake. Adapting services to be sensitive to cultural expectations and norms may help address some barriers to contraceptive use. More research is needed to determine how to best meet the contraceptive needs of women who have infrequent sexual activity or who may face stigma for using family planning, including adolescents, unmarried women and women whose husbands migrate.
authors.affiliation: a Department of Family and Community Medicine , Thomas Jefferson University Hospital, Mazzoni Center , Philadelphia , USA.
authors.forename: Lin-Fan
authors.initials: LF
authors.lastname: Wang
authors.affiliation: b Center for Research on Environment Health and Population Activities , Kathmandu , Nepal.
authors.forename: Mahesh
authors.initials: M
authors.lastname: Puri
authors.affiliation: c Department of Obstetrics, Gynecology & Reproductive Sciences, Bixby Center for Global Reproductive Health , University of California , San Francisco , USA.
authors.forename: Corinne H
authors.initials: CH
authors.lastname: Rocca
authors.affiliation: c Department of Obstetrics, Gynecology & Reproductive Sciences, Bixby Center for Global Reproductive Health , University of California , San Francisco , USA.
authors.forename: Maya
authors.initials: M
authors.lastname: Blum
authors.affiliation: c Department of Obstetrics, Gynecology & Reproductive Sciences, Bixby Center for Global Reproductive Health , University of California , San Francisco , USA.
authors.forename: Jillian T
authors.initials: JT
authors.lastname: Henderson
mesh_terms: D000029:Abortion, Legal; D000328:Adult; D001291:Attitude of Health Personnel; D003267:Contraception / Q000379:methods / Q000523:psychology* / Q000706:statistics & numerical data; D003268:Contraception Behavior; D005193:Family Planning Services; D005260:Female; D066296:Grounded Theory; D006266:Health Education; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009390:Nepal; D010348:Patient Care Team; D011247:Pregnancy
keywords: Nepal; Post-abortion; contraceptive use; service provider views