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Karki

The Gorkha project was funded by the Safe Abortion Action Fund (SAAF) and the International Planned Parenthood
Federation (IPPF) (London) and was implemented by the Population, Health, and Development Group (PHD Group
– a local NGO). The objectives of the project were to empower women and girls to realize their rights to sexual and
reproductive health and for them to be informed and able to access contraception and safe abortion when needed.
Gorkha District was the epicenter of the 2015 devastating earthquake (NPC, 2015); nearly every house was hit by
the tremor. People suffered and women and girls were impacted the most as a large number of women and girls who
engaged in income-generating activities from their homes, incurred additional losses of home-based economic resources,
and assets essential for their livelihood and well-being (NPC, 2015). The 21,000 women of reproductive age (WRA) in
the three palika of Gorkha District were the project’s main target group. In addition, about 2,000 boys of average age
16.2 years and 2,100 girls of average age 16 years in grades 9 to 12 in the project areas also benefited from basic sexuality
education. This paper examines the association between sociodemographic characteristics (including caste/ethnicity) and
access to safe abortion in young women aged 15 – 24, both nationwide and in the project area.
2.2. Measurements

2.2.1. Dependent variables
This study has three dependent variables that are all dichotomous variables. One dependent variable is whether a participant
was using any of contraception at the time of survey; the second is whether a participant had an abortion within 5 years
preceding the survey, and the third whether such an abortion is a safe abortion. Any respondent using any of the birth
control methods, such as Pill, Intra Uterine Device (IUD), injections (popularly known as Depo Provera), male condom,
female sterilization, male sterilization, periodic abstinence or rhythm method, withdrawal, and implants/Norplant, is
categorized as currently using a contraceptive method. A respondent was classified as having had an abortion if she
obtained such abortion at a government accredited medical facility or at any other health facility, although as a rule, only
government accredited health facilities can provide abortion services. In principle, a government facility that has not been
accredited for safe abortion service by the Ministry of Health and Population cannot perform any abortion service. Any
health facility that is private or non-governmental that has been accredited by the government can provide safe abortion
services. In practice, however, NGO or private health facilities not accredited by the government also provide abortion
services, but such abortions are regarded as “unsafe.” Women performing abortion at home using modern drugs such as
Mifepristone and Misoprostol bought from a pharmacy and abortions performed using crude methods are all regraded as
“unsafe.”

2.2.2. Explanatory variables
Having reviewed the literature earlier on reproductive health including contraception and abortion in the context of Nepal
and elsewhere, a number of factors have been identified that are associated with women’s access to contraception and
abortion. These variables are grouped within three categories: demographic characteristics (age, marital status, caste/
ethnic groups, and number of children ever born), socioeconomic characteristics (residence, ecological region, province,
wealth index, and education), and knowledge (knowledge of legal status of abortion). For abortion models, the type
of contraception (modern methods or traditional methods) currently used is also included as an independent variable.
The traditional methods used by young women in 2016 included rhythm and withdrawal methods (MOH et al., 2017).
Therefore, ten independent variables were used for contraception models and 11 independent variables for abortion
models.
Education is referred to as responsible for turning knowledge into practice (Martin & Juarez, 1995). The household
wealth index is a composite measure of the cumulative living standard of a household (including assets such as the
type of material used for flooring, water, and sanitation facilities and the possession of televisions). The methodology
for construction of the index, based on the principal component analysis, is described in detail elsewhere (Rutstein &
Johnson, 2004). The variable was classified into five categories using quintile (poorest, poor, middle, rich, and richest).
Demographic variables included respondent’s age (15 – 19 years and 20 – 24 years), marital status, and caste/ethnic
groups categorized as Chhetri/Bahun, Janajati, Tarai, and Dalit. In the 2011 census about 81% of the Nepalese reported
their religion as Hindu and thus locating themselves within the caste system (CBS, 2012). In caste hierarchy, Chhetri/
Bahun are ranked the highest followed by Tarai (those aboriginally living in the Tarai area excluding Dalit), Janajati, and
Dalit – the lowest ranked group (Bennet et al., 2008). Socioeconomic variables included urban-rural residence (urban vs.
rural), ecological region (Mountain, Hill, and Tarai area), residence of province (seven provinces), wealth index (poorest,

International Journal of Population Studies | 2021, Volume 7, Issue 1 79