Center for Research on Environment, Health and Population Activities (CREHPA), Kathmandu, Nepal.
Advancing New Standards in Reproductive Health, University of California, San Francisco, USA.
Reprod Health. 2018 Oct 11;15(1):170. doi: 10.1186/s12978-018-0619-z.
Despite legalization of abortion in Nepal in 2002, many women are still unable to access legal services. This paper examines providers' views, experiences with abortion denial, and knowledge related to abortion provision, and identifies areas for improvement in quality of care.
We conducted a structured survey with 106 abortion care providers at 55 government-approved safe abortion facilities across five districts of Nepal in 2017. We assessed reasons for denial of abortion care, knowledge about laws, barriers to provision and attitudes towards abortion.
Almost all providers (96%) reported that they have ever refused clients for abortion services. Common reasons included beyond 12 weeks gestation (93%), sex selective abortion (86%), and medical contraindications (85%). One in four providers denied abortion for lack of drugs or trained personnel, and one third denied services when they perceived that the woman's reasons for abortion were insufficient. Only a third of providers knew all three legal indications for abortion -- less than or equal to 12 weeks of pregnancy on request, up to 18 weeks for rape or incest, and any time for maternal or fetal health risk. Overall, providers were in favor of legal abortion but a substantial proportion had mixed or negative attitudes about the service.
Improvements in training to address providers' inadequate knowledge about the abortion law may reduce inappropriate denial of abortion. Establishing referral networks in the case of abortion denial and ensuring regular supply of medical abortion drugs would help more women access abortion care in Nepal.
尽管尼泊尔于 2002 年使堕胎合法化，但仍有许多妇女无法获得合法服务。本文研究了提供者对堕胎的看法、拒绝堕胎的经历以及与堕胎提供相关的知识，并确定了提高护理质量的领域。
我们于 2017 年在尼泊尔五个地区的 55 个政府批准的安全堕胎设施中对 106 名堕胎护理提供者进行了结构化调查。我们评估了拒绝堕胎护理的原因、对法律的了解、提供服务的障碍以及对堕胎的态度。
几乎所有提供者（96%）报告称，他们曾拒绝过客户的堕胎服务。常见的原因包括超过 12 周妊娠（93%）、性别选择性堕胎（86%）和医学禁忌症（85%）。四分之一的提供者因缺乏药物或训练有素的人员而拒绝堕胎，三分之一的提供者在认为妇女堕胎的理由不足时拒绝提供服务。只有三分之一的提供者知道堕胎的所有三个合法指征-请求时怀孕不超过 12 周，强奸或乱伦时怀孕不超过 18 周，以及任何时候因母婴健康风险。总体而言，提供者赞成合法堕胎，但相当一部分对该服务持有混合或负面态度。
改善培训以解决提供者对堕胎法的了解不足的问题，可能会减少不当拒绝堕胎的情况。在堕胎被拒绝的情况下建立转介网络，并确保定期供应药物堕胎药物，将有助于更多的尼泊尔妇女获得堕胎护理。
