International Health Programme, Faculty of Health Sciences, Curtin University, Perth, 6102, Western Australia.
Marie Stopes International, London, UK.
Reprod Health. 2019 Jul 15;16(1):105. doi: 10.1186/s12978-019-0755-0.
Although Nepal legalised abortion in 2002, a significant number of women continue to access unsafe abortions. An estimated 60% of all abortions performed in 2014 were unsafe, with unsafe abortion continuing to be a leading contributor to maternal mortality. Despite medical abortion access being solely permitted through government accredited safe abortion services, medical abortion pills are readily available for illegal purchase at pharmacies throughout the country.
Utilising an Assets Focused Rapid Participatory Appraisal (AFRPA) research methodology, underpinned by a health information pyramid conceptual framework, this qualitative exploratory study collected data from in-depth, open-ended interviews. The study explored the medical abortion and sexual and reproductive health experiences of ten women who accessed medical abortion through an accredited safe abortion service, and ten women who accessed unsafe medical abortion through pharmacies.
Thematic content analysis revealed emerging themes relating to decision-making processes in accessing safe or unsafe medical abortion; knowledge of safe abortion services; and SRH information access and post-abortion contraceptive counselling. Findings emphasised the interconnectivity of sexual and reproductive health and rights; reproductive coercion; education; poverty; spousal separation; and women's personal, social and economic empowerment.
While barriers to safe abortion services persist, so will the continued demand for medical abortion provision through pharmacies. Innovated and effective harm reduction implementations combined with access and information expansion strategies offer the potential to increase access to safe medical abortion while decreasing adverse health outcomes for women.
尽管尼泊尔在 2002 年使堕胎合法化，但仍有大量妇女继续进行不安全的堕胎。据估计，2014 年所有堕胎中有 60%是不安全的，不安全堕胎仍然是导致产妇死亡的主要原因。尽管药物流产仅通过政府认可的安全堕胎服务获得许可，但药物流产药在全国各地的药店都可以非法购买。
本研究采用以资产为重点的快速参与式评估（AFRPA）研究方法，以健康信息金字塔概念框架为基础，从深入的开放式访谈中收集数据。该研究探讨了通过认可的安全堕胎服务接受药物流产的 10 名妇女和通过药店接受不安全药物流产的 10 名妇女的药物流产和性与生殖健康体验。
主题内容分析揭示了与安全或不安全药物流产获取决策过程相关的新出现主题；对安全堕胎服务的了解；以及性与生殖健康信息获取和堕胎后避孕咨询。研究结果强调了性与生殖健康和权利、生殖胁迫、教育、贫困、配偶分离以及妇女的个人、社会和经济赋权之间的相互联系。
尽管安全堕胎服务仍然存在障碍，但通过药店提供药物流产的需求仍将继续。创新和有效的减少伤害实施以及获取和信息扩展策略有可能增加安全药物流产的机会，同时减少妇女的不良健康后果。
