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Contraception and abortion in Nepalese young women

need for contraception is not addressed, increasing number of youths will end up in taking recourse to unsafe abortion.
Unsafe abortion is a pressing public health concern and is a major contributing factor to high maternal mortality in Nepal
(Thapa & Padhye, 2001). The government’s aim of reducing maternal mortality ratio (MMR) to <70/100,000 live births
by 2030 (NPC, 2017) will not be achieved when unsafe abortion persists among the youth population. As per the past
2016 survey, women aged 15 – 24 contribute 55% to age specific fertility (MOH et al., 2017), and therefore, it is important
to pay special attention to unmet need for contraception among the youth so that the maximum number of youths are
prevented from practicing unsafe abortion. This motivates the present research.
Below in the remaining of this introduction section, some background information about contraceptive use and abortion
in Nepal is briefed, followed by reviews on factors associated with contraceptive use and abortion, an introduction of the
Gorkha Safe Abortion (GSA) project aiming to help young Nepali women to get safe abortion services, and the objectives
of the present research. Subsequently, data sources and methods used for fulfilling the research goals in the data and
method section are described, followed by the results, discussion, and conclusion sections.
1.1. Brief background on contraceptive use and abortion in Nepal

In Nepal, contraceptive use has increased markedly since 1996. The prevalence rate of using any contraceptive method
among currently married women was 32% in 1996 (Pradhan et al., 1997) and increased to 39% in 2001 (MOHP et al.,
2002), 50% in 2006 (MOHP et al., 2007), and 53% in 2016 (MOH et al., 2017). Along with the increase in the use of
modern contraceptive methods, increase in the use of traditional methods is also seen in Nepal. In 2006, the proportion of
currently married women using traditional methods comprising mainly withdrawal and rhythm methods was 4% (MOHP
et al., 2007), which increased to 7% in 2011 (MOHP et al., 2012) and further to 10% by 2016 (MOH et al., 2017).
However, any method can fail, and some are more dependable than others. Research has shown that the chance of an
unexpected pregnancy is almost non-existent for couples who rely on sterilization and very low for users of IUD, injectables,
or implants. It is moderate for pill and condom users and very high if couples rely on periodic abstinence, withdrawal, or
spermicides (The Alan Guttmacher Institute, 1999). This means that increasingly more couples might end up with unwanted
pregnancies and thus demand more abortion services. However, despite a steady increase in contraceptive use, the unmet
need for family planning is still high in Nepal. For all women aged 15 – 49, the total unmet need for family planning was
estimated at 18% for 2016, higher for limiting methods (12%) than for spacing methods (6%) (MOH et al., 2017).
Abortion was legalized in Nepal in 2002 (MOH, 2004), and Safe Abortion Policy 2002 and Procedural Process
developed and implemented since 2004 (MOH, 2005). The policy called for an expansion of quality comprehensive
abortion care services in the country with appropriate numbers of trained and skilled service providers, adequate
equipment, and essential drugs. Under this policy, safe abortion services were charged at Nepalese Rupees 1,000/- or
US$10, which was out of reach for many women, especially in rural areas, but these services were made free of charge
nationwide in 2016 (MOH, 2016).
Before 2002, abortions were totally illegal in Nepal. The Legal Code 1963 (Muluki Ain) of Nepal did not permit the
termination of pregnancies even if they were the result of rape or incest or threatened the woman’s life. In effect, it equated
abortion with infanticide (Ministry of Law and Justice, 1963). Physicians and other medical practitioners were prohibited
from recommending abortion or performing abortion without exceptions (Thapa, 2004). In this context, both women
sought abortions and providers provided necessary abortion services clandestinely. Most of the abortions that took place
were unsafe; only a very small proportion of women, mostly those living in urban or semi-urban areas and able to afford
the cost, had access to trained medical practitioners and safe procedures (Thapa & Padhye, 2001).
As a result of the illegal and criminal status of abortion in Nepal before 2002, the conditions under which poor women
obtained abortion services were often extremely unsafe. High unintended pregnancy makes women look for means to
terminate it and in the absence of readily available safe abortion facility women who are likely to seek unsafe methods
of abortion. This situation is likely to contribute to high maternal morbidity and mortality. Many are still dying during or
shortly after pregnancy due to unsafe abortion (The Kathmandu Post, March 31, 2022). MMR in Nepal was estimated
at 790 deaths/100,000 live births in 1990 (WHO, 2014). In a hospital-based study of abortion in Nepal pre-legalization,
deaths from abortion-related complications accounted for over half of all maternal deaths (Thapa et al., 1992). The
recognition that illegal abortions were unsafe and contributed to Nepal’s high maternal mortality was instrumental in
the advocacy efforts to legalize abortion (Shakya et al., 2004). Indeed, MMR had improved and gone down to 239
deaths/100,000 live births for several years before the 2016 survey (MOH et al., 2017). However, MMR of 186/10000
live births still remains among the highest worldwide (WHO, 2022), and unintended pregnancy was around 19% in 2016
(MOH et al., 2017).

76 International Journal of Population Studies | 2021, Volume 7, Issue 1