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Contraception and abortion in Nepalese young women

in individual country settings. Abortion rates and contraceptive practice often rise simultaneously because they are
affected by the same underlying social and demographic factors (Noble & Potts, 1996). Similarly, women who practice
contraception are often those who are more likely than others to undergo abortions, again due to bidirectional causality.
In these situations, increases in contraceptive use may reduce reliance on abortion by keeping abortion rates stable or by
preventing an even more rapid increase in abortion rates.
1.3. Objectives of the present study

Research studies on abortion in Nepal are very limited. NDHS is carried out every 5 years and the survey started including
abortion section since 2011 which provide basic quantitative indicators. Data on abortion incidence in Nepal are hardly
available except for one study by Puri et al. (2016) that show 42/1000 women of reproductive ages 15 – 49 in 2014
based on Nepal’s National Health Facilities Survey and Health Professionals Survey. Another important limitation in
the existing literature is the paucity of research on how women accessed family planning services during the crisis. This
is extremely important and closely relevant given the current situation of the ongoing COVID-19 pandemic. A recent
estimate shows the contraceptive prevalence rate in Nepal among currently married women declined from 53% in 2016
(MOH et al., 2017) to 33% in 2020 due to disturbance in supply of contraceptives (Global Financing Facility-GFF: https://
www.globalfinancingfacility.org/CoVid19/).
Although no studies on the theme were available by far, it is fortunate that Nepal implemented the GSA project
during mid-2018 to June 2020 (including the first period of the COVID-19 pandemic, April-June 2020) in three palika
(subdistrict) in Gorkha district that aims to empower women to access safe abortion services (see Map of Gorkha in
Figure A1). The data collected in this GSA project enable researchers to investigate how family planning services were
delivered to the most vulnerable populations in the area. Research using such data would have added value to the existing
literature and have important policy implications on how to improve family planning services on the general as well as in
crises, such as in this ongoing pandemic.
Based on the above reviews and consideration, this paper is written with three objectives in mind to fill the research
gap. First, using national data from NDHS of different years, it attempts to show different family planning practices by
sociodemographic characteristics of adolescents and youth. Second, it examines factors associated with abortion and safe
abortion, and third, using the Gorkha project monitoring data on abortion, it investigates how increasing access to functioning
safe abortion services could pay off even in difficult times such as in the COVID-19 pandemic lockdown periods.
2. Data and methods

2.1. Data sources
For national level data analysis on family planning and abortion, nationally representative sample survey data from the
Nepal Demographic and Health Survey (NDHS) 2016 (MOH et al., 2017) were the main source, but for comparison
purposes, NDHS data from 1996 (Pradhan et al., 1997), 2001 (MOHP et al., 2002), 2006 (MOHP et al., 2007), and 2011
(MOHP et al., 2012) were also used. In all, 12,862 women of reproductive age 15 – 49 were interviewed in 2016 and
the corresponding figures were 12,674 in 2011 and 10,793 in 2006. Interviews were conducted with only ever-married
women in 2001 and 1996 and the numbers of women interviewed were 8,429 in 2001 and 8,726 in 1996, respectively.
However, only the NDHS 2016 collected information about the residence of province because when the earlier surveys
were conducted that the country was not divided into federal provinces. There are seven provinces in Nepal (Province
No.1, Madhesh Province, Bagmati Province, Gandaki Province, Lumbini Province, Karnali Province, and Sudurpashchim
Province; see Appendix). Therefore, for analyses of relationships between contraception, abortion, and sociodemographic
variables, only the NDHS 2016 data were used with 4,568 women aged 15 – 24.
NDHSs deal with a number of topics, including but not limited to fertility, family planning, infant and child health
and mortality, maternal health, and HIV/AIDS-related knowledge and behaviors and mass media exposure. Only NDHS
reports of 2011 and 2016 contain separate section on abortion although induced abortion rate as a component of pregnancy
outcomes is reported in all NDHS reports. Some details about sampling designs, field work, and data quality of NDHSs
can be found at https://dhsprogram.com
In addition to five national NDHS datasets, regularly collected abortion monitoring data from the project Empowering
women to access safe abortion services in Gorkha implemented in three palika (subdistrict) in Gorkha district of Nepal
(see Map in Figure A1) during mid-2018 to June 2020 (including the first few months of the COVID-19 pandemic, April-
June 2020) are also used to augment the analysis.

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