Unsafe abortion after legalisation in Nepal: a cross‐sectional study of women presenting to hospitals

Objective To investigate abortion practices of N epali women requiring postabortion care. Design Cross‐sectional study. Setting Four tertiary‐care hospitals in urban and rural N epal. Sample 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. Main outcome measures Induction method; uncertified abortion source. Results In all, 234 (44%) women were aware that abortion was legal in N epal. 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 N epal 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 N epal. These findings highlight the need for continued improvements in the provision and awareness of abortion services in N epal.