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Under the current law, pregnancy can be terminated up to 12 weeks for any reason and up to 18 weeks for pregnancy
resulting from rape or incest with the pregnant woman’s consent. Recently, a provision has also been made to allow
pregnancy termination as late as 28 weeks (The Kathmandu Post, 03 July, 2019), but this has not been operationalized
(The Kathmandu Post, 27 August, 2019). However, the legalization of abortion does not seem to have much impact; the
proportion of women aged 15 – 49 who are aware that abortion is legal in Nepal increased by only 3% points from 38%
in 2011 (MOHP, 2012) to 41% in 2016 (MOH, et al., 2017). According to the Nepal Demographic and Health Survey
(NDHS) 2016, this knowledge is lower among older women aged 40 – 49 (34%), women living in rural areas (36%),
women with primary (33%) or no education (28%), and poor (38%) and very poor (30%) women (MOH, et al., 2017). By
caste/ethnic groups, this knowledge is highest among the highest ranked group, namely, Chhetri/Bahun (48%), followed
by the second highest ranked group, that is, Janajati ethnic group (40%) and the lowest ranked group – the Dalit (34%).
After Nepal became a federal state in 2015, health care has been devolved to each province. Although safe abortion is
free and legal, 50% of abortions accessed by young women in 2016 were “unsafe,” that is, performed at unauthorized
facilities (MOH et al., 2017). The worrisome situation is that unsafe abortion is reported to be on the rise in the country
due to lockdowns during the COVID-19 pandemic (Gorkhapatra, October 07, 2020).
Gender-biased sex selection (GBSS) in favor of boys is a symptom of pervasive social, cultural, political, and economic
injustices against girls and women. GBSS can be measured using sex ratio at birth (SRB), a comparison of the number
of boys born versus the number of girls born in a given period. According to the WHO, 2011, when many more boys are
born than girls, it is a sign that sex selection is taking place (WHO, 2011). In Nepal, high son preference (Brunson, 2010)
and prevailing discrimination against girls are factors contributable to sex selection (Nanda et al., 2012). Although sex
selective abortion is strictly prohibited by law and punishable, it is also possible that people may take advantage of liberal
abortion to fulfill their wishes. In addition, the situation of stagnant contraceptive prevalence but declining fertility in the
past 10 years may indicate that women are using abortion as a family planning method (Gorkhapatra, August 3, 2019).
Despite the legalization of abortion and the expansion of maternal health services, such as increased access to safe
motherhood services including abortion services, it appears that the sexual and reproductive health needs of women
are not being met. Furthermore, the existing accredited health facilities are not functioning well due to the lack of
sufficient quantity of drugs and equipment, the frequent transfer of trained abortion service providers, and weak abortion
related infrastructure development stand as a serious barrier to women seeking abortion services (Wan-Ju et al., 2017).
Nevertheless, Nepal is committed to Sustainable Development Goal 3 of achieving an MMR of 70 by 2030 (NPC, 2017),
which calls for more focus on reproductive health and rights including safe abortion.

1.2. Factors associated with contraception and abortion

Numerous studies have examined factors associated with the prevalence of contraceptive use and the prevalence of
abortion among young women (Bayer et al., 2011; Munakampe et al., 2018). Studies have revealed that lack of or limited
knowledge, lack of sexuality education and limited access to services, high risk of misperceptions, and harmful social
norms surrounding premarital sexual activity and pregnancy could be major barriers to use contraception and abortion
services (Campbell et al. 2006; Siziya et al. 2008). These obstacles apply equally to adolescents and young people of
Nepal (Thapa et al., 2001). While several efforts have been made to understand young people’s knowledge, attitudes
and practices regarding contraception and safe abortion, systematic research on this matter, and related contexts remain
limited. Increase in couple’s knowledge that they can plan their family size leads them to search for contraceptive methods.
The relationship between contraceptive use and induced abortion is complex due to interactions of several interrelated
factors that range from social, cultural, and economic, from how ideal family size is determined, and from the demand for
contraception and abortion, to another set of variables related to the quality of reproductive health services (Phiri et al.,
2022; Senlet et al., 2001). Modern contraceptives are considered the safest methods to help couples realize better family
planning. Despite the availability of various contraceptive methods, communities in both the developed and developing
countries continue to register high rates of unintended and unwanted pregnancies which contribute to a higher prevalence
of abortions (Haub & Kaneda, 2014).
An analysis of data of women aged 15 – 49 from 2011 Nepal Demographic and Health Survey found that women of
older ages (35 years and above) were less likely to undergo both abortion and unsafe abortion. Educated women were
more likely to undergo an abortion along with those who had no knowledge of legal abortion. Being rich was protective
against unsafe abortion. Child spacing was the most common reason for abortion (Yogi et al., 2018).
The above brief review of contraceptive use and abortion among women aged 15 – 49 shows that, although increases
in contraceptive use ultimately led to decreases in induced abortion rates, trends have been following different paths

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