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Contraception and abortion in Nepalese young women

Dalit, in relative terms, were utilizing the safe abortion service made available in close-by facilities more than their
advantaged counterparts. Furthermore, post-abortion family planning is much higher (87%) in the Gorkha project area
than the national rate of 25% (MOH et al., 2017). Admittedly, the findings in the Gorkha field monitoring data, and those
from Dalit community in particular, were not sufficiently captured in the NDHS of 2016. To understand the complexity
of sexual behavior and abortion among the young age population, more research aiming to capture large sample using
both qualitative and quantitative approaches are needed. Furthermore, more investment is needed in that as evidenced
from the data that even during difficult times of COVID-19 pandemic many women could access the safe abortion service
available nearby.
In sum, findings of this study indicate that the sexual and reproductive health and rights (SRHR) programs including
family planning and safe abortion programs in Nepal have not been satisfactory. For this, not only the family planning
and safe abortion programs need to be strengthened but also the local Female Community Health Volunteers (FCHVs)
have to be encouraged to do their jobs in communities better. The FCHVs should also be asked to hold community
meetings with local women and young girls to spread the knowledge about effective use of modern contraceptive methods,
unreliability of traditional contraceptive methods, legal status of abortion, and availability of free abortion service. The
health infrastructure such as Health Posts, Primary Health Care Centers, local, district, and other hospitals must ensure
that the contraceptives and medical abortion drugs are never in short supply. Family planning program was introduced
in the country more than 50 years ago, and yet, it appears that the program needs an overhaul to increase its efficacy.
Furthermore, abortion was legalized and safe abortion service was introduced for over 12 years, and yet, it is still far from
providing extensive safe and quality abortion service for common women and girls to access it.

4.1. Limitations
This study has several limitations. The NDHS data that have been used here are cross-sectional in nature which does
not permit to establish causal relationships between contraceptive use and abortions. The NDHS data that are regularly
collected in Nepal since 1996 are meant for monitoring progress made in health and demographic dynamics in every
5 years. The issues explored in the surveys do not probe for in-depth understanding of such a causal relationship, although
they are good for program managers and policy makers. For instance, we have learned from the data that a certain
proportion of women had abortion in the recent past, but we do not have information with respect to what made her to go
for abortion nor we know how she felt about the service or how she felt herself after the service.
The monitoring data used in this analysis have limitations too. Because the government categorizes abortion facility
data as highly sensitive and only a few characteristics of abortion clients are collected, it is not possible to understand
deeply about the way a woman decides to opt for abortion service at a facility. Nevertheless, project monitoring data
contain a few basic background characteristics in numerical forms which are helpful to make quantitative analysis.
In addition, the number of young women who had an abortion in the 5 years preceding the survey in this study was
only 83 and when they were further divided into two groups the analyzed sample number became even smaller. It is
thus important that the interpretations presented here must therefore be taken cautiously. Abortion is highly stigmatized
in Nepalese society and people still believe that abortion is a sin (Karki & Magar, 2018). In such a society, collecting
information on abortion from a face-to-face interview in a questionnaire survey is subject to underreporting. There is
evidence that many women just do not report that they have had an abortion. On the basis of the total sample of 12,862
women aged 15 – 49 in 2016 (MOH et al., 2017) and annual abortion rate of 42/1000 women of reproductive age 15 – 49
in 2014 (Puri et al., 2016) of other data sources, approximately 2,700 abortion cases should be captured for the 5-year
period preceding the 2016 NDHS survey. This suggests that only about 20% of abortions were reported in NDHS. As
adolescents face severe social sanctions against premarital pregnancy (Thapa et al., 2001), it is likely that many premarital
pregnancies that ended in abortions were not captured in the survey. The analysis is based on cross-sectional data –
abortions that took place in the past 5 years preceding the survey, which is subject to several limitations. In the absence of
some important variables such as education, residence, and socioeconomic status at the time of abortion, the analysis was
based on data collected at the time of the survey. As education and economic status change over time, they can impact the
results that are presented here.

5. Conclusions

The 2016 Nepal Demographic and Health Survey (NDHS) supplemented by key indicators from several previous waves
of NDHS shows that the prevalence of contraceptive use among women aged 15 – 24 has been stagnant, and their
prevalence of unsafe abortion is high in the last two decades in Nepal. The study also investigated the factors associated

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