“I don’t have the right to decide by myself, as it is his child too.” Exploring the process of abortion decision-making among women in Nepal

Background In Nepal, the legalization and expansion of safe abortion services have significantly reduced severe abortion-related complications. However, despite the availability of safe abortion care, many individuals face challenges in accessing these services. This study aims to explore the complexities of abortion decision-making among women seeking abortion care in Nepal, focusing on the socio-cultural, economic, and interpersonal dynamics that influence their decisions. Methods As part of a longitudinal cohort study, we conducted 43 in-depth interviews with women accessing abortion services in 2022. Among these women, 19 received abortion services, while 24 were denied abortions and continued their pregnancies. Using the socio-ecological model (SEM) as the analytical framework, we employed thematic analysis to examine how individual characteristics, interpersonal relationship, community norms and health system factors influenced abortion decision-making. Results Our findings reveal a complex interplay of factors, including individual health concerns, financial limitations, partner influence, family dynamics, and societal norms, such as gender preference for sons that influence abortion decision-making. Among these, societal norms and partner influence had the most significant impact while making decisions. Conclusion This study underscores the urgent need for targeted interventions to enhance access to reproductive health information, empower women to advocate for their reproductive rights, guide family engagement, and challenge cultural biases at the individual, interpersonal, and community levels.