Abortion in Nepal: emerging insights.

Abstract

The collection of data from multiple sources facilitated new insight into the nature, extent, and consequences of illegal abortion in rural Nepal. These sources included a baseline household survey of the 13,229 reproductive age women in the seven study sites, six-month (July-December 1985) follow-up of the 1313 pregnancies identified through the baseline survey, interviews with abortion providers, and record reviews at the four closest district hospitals. During the study period, 22 of the index pregnancies (1.7%) were terminated through induced abortion; however, the pregnant respondents acknowledged an additional 87 abortions in the two years preceding the survey. Compared to women in the population survey, aborters were older (mean age, 29.8 years) and more likely to be married (90.9%) and to have three or more living children (50.0%). The economic burden of a large family was cited by 68% as the reason for induced abortion; another 10% identified poor health and 8% wanted to space their next birth. The most common methods of abortion induction were oral herbal preparations (19%), modern oral medicine (16%), insertion of foreign objects into the vagina (13%), and vaginal ointment (11%). 30% used the services of a traditional birth attendant (TBA), while 25% consulted a doctor and another 25% self-induced. In about one-third of cases, a second or third attempt at abortion was required. Over the six-month study period, the district hospitals recorded 276 cases of abortion-related complications, 48 (17.4%) of which were judged to involve induction; there were two deaths. The TBAs were older (mean age, 56 years) than other abortion providers, trained informally through apprenticeship, and yet were more willing to abort a second trimester pregnancy. TBAs relied entirely on traditional methods, while doctors used menstrual regulation or dilatation and curettage Only 24.6% of village women in the broader sample approved of abortion, compared to 53.9% of women who underwent abortion and 65.4% of abortion providers. Given the central role TBAs play in reproductive health care in rural Nepal, steps should be taken to integrate TBAs into the primary health care system. Through such a strategy, the TBA's role could be expanded to include menstrual regulation and family planning services.