Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Ste W4041, 615 N. Wolfe Street, Baltimore, MD 21205, USA.
The Population Council, 1 Dag Hammarskjold Plaza New York, NY 10017.
Health Policy Plan. 2018 Jan 1;33(1):99-106. doi: 10.1093/heapol/czx149.
The government of Nepal revised its law in 2002 to allow women to terminate a pregnancy up to 12 weeks gestation for any indication on request, and up to 18 weeks if certain conditions are met. We evaluated the readiness of facilities in Nepal to provide three abortion services, manual vacuum aspiration (MVA), medication abortion (MA) and post-abortion care (PAC), using the service availability and readiness assessment (SARA) framework. The framework consists broadly of three domains; service availability, general service readiness and service readiness specific to individual services (i.e. service-specific readiness). We applied the framework to data from the Nepal Health Facility Survey 2015, a nationally representative survey of 992 health facilities. Overall, we find that access to safe abortion remains limited in Nepal. Of the facilities that reported offering delivery services and were thus eligible to provide safe abortion services, 44.5, 36.0 and 25.6% had provided any MVA, MA or PAC services, respectively, in the 3 months prior to the survey, and <2% were 'ready' to provide any abortion service based on our application of the SARA criteria for service-specific readiness. Among only the facilities that reported providing an abortion service in the 3 months prior to the survey, 3.2% of facilities that provided MVA, 1.5% of facilities that provided MA and 1.1% of the facilities that provided PAC had all the components of care required. Although the private sector conducted approximately half of all abortion services provided in the 3 months prior to the survey, no private sector facilities had all the abortion service-specific readiness components. Results suggest that accessing safe abortion services remains a significant challenge for Nepalese women, despite a set of permissive laws.
尼泊尔政府于 2002 年修订了法律，允许妇女在怀孕 12 周内以任何理由要求终止妊娠，在满足某些条件的情况下，怀孕 18 周内也可以终止妊娠。我们使用服务可用性和准备情况评估（SARA）框架评估了尼泊尔提供三种堕胎服务（手动真空抽吸（MVA）、药物流产（MA）和流产后护理（PAC））的设施的准备情况。该框架大致包括三个领域：服务可用性、一般服务准备情况以及针对特定服务的服务准备情况（即服务特定准备情况）。我们将该框架应用于 2015 年尼泊尔卫生设施调查的数据，这是一项针对 992 个卫生设施的全国代表性调查。总的来说，我们发现尼泊尔获取安全堕胎的机会仍然有限。在报告提供分娩服务并因此有资格提供安全堕胎服务的设施中，分别有 44.5%、36.0%和 25.6%在调查前 3 个月提供了任何 MVA、MA 或 PAC 服务，根据我们对 SARA 标准的应用，只有不到 2%的设施在服务特定准备方面“准备好”提供任何堕胎服务。在仅报告在调查前 3 个月提供堕胎服务的设施中，提供 MVA 的设施中有 3.2%、提供 MA 的设施中有 1.5%、提供 PAC 的设施中有 1.1%具备所需护理的所有组成部分。尽管私营部门在调查前 3 个月提供了大约一半的堕胎服务，但没有一家私营部门的设施具备所有的堕胎服务特定准备组件。结果表明，尽管有一系列许可性法律，但尼泊尔妇女获得安全堕胎服务仍然是一项重大挑战。
