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Denial of legal abortion in Nepal

PloS one, 2023-03, Vol.18 (3), p.e0282886-e0282886 [Peer Reviewed Journal]

Copyright: © 2023 Puri et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. ;COPYRIGHT 2023 Public Library of Science ;2023 Puri et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License. ;2023 Puri et al 2023 Puri et al ;2023 Puri et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License. ;ISSN: 1932-6203 ;EISSN: 1932-6203 ;DOI: 10.1371/journal.pone.0282886 ;PMID: 36943824

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  • Title:
    Denial of legal abortion in Nepal
  • Author: Puri, Mahesh C ; Raifman, Sarah ; Daniel, Sara ; Karki, Sunita ; Maharjan, Dev Chandra ; Ahlbach, Chris ; Diamond-Smith, Nadia ; Foster, Diana Greene
  • Thapa, Kanchan
  • Subjects: Abortion ; Abortion services ; Abortion, Induced ; Abortion, Legal ; Age ; Clustering ; Coronaviruses ; COVID-19 ; Female ; Gestation ; Gestational age ; Health aspects ; Health facilities ; Humans ; Infant, Newborn ; Longitudinal Studies ; Management ; Medicine and Health Sciences ; Mental disorders ; Mental health ; Nepal ; Nurses ; People and Places ; Political aspects ; Pregnancy ; Prospective Studies ; Regression analysis ; Regression models ; Social Sciences ; Socioeconomics ; Women ; Womens health
  • Is Part Of: PloS one, 2023-03, Vol.18 (3), p.e0282886-e0282886
  • Description: In Nepal, abortion is legal on request through 12 weeks of pregnancy and up to 28 weeks for health and other reasons. Abortion is available at public facilities at no cost and by trained private providers. Yet, over half of abortions are provided outside this legal system. We sought to investigate the extent to which patients are denied an abortion at clinics legally able to provide services and factors associated with presenting late for care, being denied, and receiving an abortion after being denied. We used data from a prospective longitudinal study with 1835 women aged 15-45. Between April 2019 and December 2020, we recruited 1,835 women seeking abortions at 22 sites across Nepal, including those seeking care at any gestational age (n = 537) and then only those seeking care at or after 10 weeks of gestation or do not know their gestational age (n = 1,298). We conducted interviewer-led surveys with these women at the time they were seeking abortion service (n = 1,835), at six weeks after abortion-seeking (n = 1523) and six-month intervals for three years. Using descriptive and multivariable logistic regression models, we examined factors associated with presenting for abortion before versus after 10 weeks gestation, with receiving versus being denied an abortion, and with continuing the pregnancy after being denied care. We also described reasons for the denial of care and how and where participants sought abortion care subsequent to being denied. Mixed-effects models was used to accounting clustering effect at the facility level. Among those recruited when eligibility included seeking abortion at any gestational age, four in ten women sought abortion care beyond 10 weeks or did not know their gestation and just over one in ten was denied care. Of the full sample, 73% were at or beyond 10 weeks gestation, 44% were denied care, and 60% of those denied continued to seek care after denial. Nearly three-quarters of those denied care were legally eligible for abortion, based on their gestation and pre-existing conditions. Women with lower socioeconomic status, including those who were younger, less educated, and less wealthy, were more likely to present later for abortion, more likely to be turned away, and more likely to continue the pregnancy after denial of care. Denial of legal abortion care in Nepal is common, particularly among those with fewer resources. The majority of those denied in the sample should have been able to obtain care according to Nepal's abortion law. Abortion denial could have significant potential implications for the health and well-being of women and their families in Nepal.
  • Publisher: United States: Public Library of Science
  • Language: English
  • Identifier: ISSN: 1932-6203
    EISSN: 1932-6203
    DOI: 10.1371/journal.pone.0282886
    PMID: 36943824
  • Source: PLoS (Open access)
    Geneva Foundation Free Medical Journals at publisher websites
    MEDLINE
    PubMed Central（OA）
    Coronavirus Research Database
    ProQuest Central
    DOAJ Directory of Open Access Journals
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