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Effects of abortion legalization in Nepal, 2001–2010

Henderson, Jillian T., Puri, Mahesh, Blum, Maya, Harper, Cynthia C., Rana, Ashma, Gurung, Geeta, Pradhan, Neelam, Regmi, Kiran, Malla, Kasturi, Sharma, Sudha, Grossman, Daniel, Bajracharya, Lata, Satyal, Indira, Acharya, Shridhar, Lamichhane, Prabhat and Darney, Philip D. 2013, Effects of abortion legalization in Nepal, 2001–2010, PLoS one, vol. 8, no. 5, doi: 10.1371/journal.pone.0064775.

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Title Effects of abortion legalization in Nepal, 2001–2010
Author(s) Henderson, Jillian T.
Puri, Mahesh
Blum, Maya
Harper, Cynthia C.
Rana, Ashma
Gurung, Geeta
Pradhan, Neelam
Regmi, Kiran
Malla, Kasturi
Sharma, Sudha
Grossman, Daniel
Bajracharya, Lata
Satyal, Indira
Acharya, Shridhar
Lamichhane, PrabhatORCID iD for Lamichhane, Prabhat
Darney, Philip D.
Contributor(s) Kanellopoulos-Langevin, C
Journal name PLoS one
Volume number 8
Issue number 5
Article ID e64775
Total pages 7
Publisher Public Library of Science
Place of publication San Francisco, Calif.
Publication date 2013-05-31
ISSN 1932-6203
Summary Background
Abortion was legalized in Nepal in 2002, following advocacy efforts highlighting high maternal mortality from unsafe abortion. We sought to assess whether legalization led to reductions in the most serious maternal health consequences of unsafe abortion.

We conducted retrospective medical chart review of all gynecological cases presenting at four large public referral hospitals in Nepal. For the years 2001–2010, all cases of spontaneous and induced abortion complications were identified, abstracted, and coded to classify cases of serious infection, injury, and systemic complications. We used segmented Poisson and ordinary logistic regression to test for trend and risks of serious complications for three time periods: before implementation (2001–2003), early implementation (2004–2006), and later implementation (2007–2010).

23,493 cases of abortion complications were identified. A significant downward trend in the proportion of serious infection, injury, and systemic complications was observed for the later implementation period, along with a decline in the risk of serious complications (OR 0.7, 95% CI 0.64, 0.85). Reductions in sepsis occurred sooner, during early implementation (OR 0.6, 95% CI 0.47, 0.75).

Over the study period, health care use and the population of reproductive aged women increased. Total fertility also declined by nearly half, despite relatively low contraceptive prevalence. Greater numbers of women likely obtained abortions and sought hospital care for complications following legalization, yet we observed a significant decline in the rate of serious abortion morbidity. The liberalization of abortion policy in Nepal has benefited women’s health, and likely contributes to falling maternal mortality in the country. The steepest decline was observed after expansion of the safe abortion program to include midlevel providers, second trimester training, and medication abortion, highlighting the importance of concerted efforts to improve access. Other countries contemplating changes to abortion policy can draw on the evidence and implementation strategies observed in Nepal.
Language eng
DOI 10.1371/journal.pone.0064775
Field of Research MD Multidisciplinary
HERDC Research category C1 Refereed article in a scholarly journal
Copyright notice ©2013, Henderson et al.
Free to Read? Yes
Use Rights Creative Commons Attribution licence
Persistent URL

Document type: Journal Article
Collections: Faculty of Health
School of Medicine
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