#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#

Factors associated with unsafe abortion practices in Nepal: Pooled analysis of the 2011 and 2016 Nepal Demographic and Health Surveys


Autoři: Resham Bahadur Khatri aff001;  Samikshya Poudel aff002;  Pramesh Raj Ghimire aff003
Působiště autorů: Center for Research and Development, Surkhet, Nepal aff001;  Ujyalo Nepal, Ratnanagar Municipality, Chitwan, Nepal aff002;  School of Science and Health, Western Sydney University, Sydney, Australia aff003
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article
doi: https://doi.org/10.1371/journal.pone.0223385

Souhrn

Background

Unsafe abortion contributes to maternal morbidities, mortalities as well as social and financial costs to women, families, and the health system. This study aimed to examine the factors associated with unsafe abortion practices in Nepal.

Methods

Data were derived from the 2011 and 2016 Nepal Demographic and Health Surveys (NDHS). A total of 911 women aged 15–49 years who aborted five years prior to surveys were included in the analysis. The multivariate logistic regression analysis was employed to determine factors associated with unsafe abortion.

Results

Unsafe abortion rate was seven per 1000 women aged 15–49 years. This research found that women living in the Mountains (adjusted Odds Ratio (aOR) 2.36; 95% CI 1.21, 4.60), or those who were urban residents (aOR 2.11; 95% CI 1.37, 3.24) were more likely to have unsafe abortion. The odds of unsafe abortion were higher amongst women of poor households (aOR 2.16; 95% CI 1.18, 3.94); Dalit women (aOR 1.89; 95% CI 1.02, 3.52), husband with no education background (aOR 2.12; 95%CI 1.06, 4.22), or women who reported agriculture occupation (aOR 1.82; 95% CI 1.16, 2.86) compared to their reference’s group. Regardless of knowledge on legal conditions of abortion, the probability of having unsafe abortion was significantly higher (aOR 5.13; 95% CI 2.64, 9.98) amongst women who did not know the location of safe abortion sites. Finally, women who wanted to delay or space childbirth (aOR 2.71; 95% CI 1.39, 5.28) or those who reported unwanted birth (aOR = 2.33; 95% CI 1.19, 4.56) were at higher risk of unsafe abortion.

Conclusion

Going forward, increasing the availability of safe abortion facilities and strengthening family planning services can help reduce unsafe abortion in Nepal. These programmatic efforts should be targeted to women of poor households, disadvantaged ethnicities, and those who reside in mountainous region.

Klíčová slova:

Birth – Ethnicities – Global health – Children – Labor and delivery – Mass media – Nepal – Termination of pregnancy


Zdroje

1. World Health Organization. Safe abortion: technical and policy guidance for health systems: World Health Organization; 2012.

2. Ganatra B, Gerdts C, Rossier C, Johnson BR Jr, Tunçalp Ö, Assifi A, et al. Global, regional, and subregional classification of abortions by safety, 2010–14: estimates from a Bayesian hierarchical model. The Lancet. 2017;390(10110):2372–81.

3. World Health Organization. Unsafe abortion incidence and mortality: global and regional levels in 2008 and trends during 1990–2008. 2012.

4. Haddad LB, Nour NM. Unsafe abortion: unnecessary maternal mortality. Reviews in obstetrics and gynecology. 2009;2(2):122. 19609407

5. Sedgh G, Bearak J, Singh S, Bankole A, Popinchalk A, Ganatra B, et al. Abortion incidence between 1990 and 2014: global, regional, and subregional levels and trends. The Lancet. 2016;388(10041):258–67. https://doi.org/10.1016/S0140-6736(16)30380-4.

6. World Health Organization. Safe abortion: technical and policy guidance for health systems: World Health Organization; 2003.

7. World Health Organization. Reproductive health strategy to accelerate progress towards the attainment of international development goals and targets. 2004.

8. Amo-Adjei J, Darteh EK. Unmet/met need for contraception and self-reported abortion in Ghana. Sexual & Reproductive Healthcare. 2017;13:118–24.

9. Faúndes A, Shah IH. Evidence supporting broader access to safe legal abortion. International Journal of Gynecology & Obstetrics. 2015;131:S56–S9. https://doi.org/10.1016/j.ijgo.2015.03.018.

10. Adjei G, Enuameh Y, Asante KP, Baiden F, A Nettey OE, Abubakari S, et al. Predictors of abortions in Rural Ghana: a cross-sectional study. BMC Public Health. 2015;15(1):202. doi: 10.1186/s12889-015-1572-1 25885483

11. Sousa A, Lozano R, Gakidou E. Exploring the determinants of unsafe abortion: improving the evidence base in Mexico. Health Policy and Planning. 2009;25(4):300–10. doi: 10.1093/heapol/czp061 20008904

12. Tesfaye G, Hambisa MT, Semahegn A. Induced abortion and associated factors in health facilities of Guraghe Zone, southern Ethiopia. Journal of pregnancy. 2014;2014.

13. Samandari G, Wolf M, Basnett I, Hyman A, Andersen K. Implementation of legal abortion in Nepal: a model for rapid scale-up of high-quality care. Reproductive Health. 2012;9(1):7. doi: 10.1186/1742-4755-9-7 22475782

14. Thapa S. Abortion law in Nepal: the road to reform. Reproductive Health Matters. 2004;12(sup24):85–94.

15. Andersen KL, Basnett I, Shrestha DR, Shrestha MK, Shah M, Aryal S, et al. Expansion of Safe Abortion Services in Nepal Through Auxiliary Nurse-Midwife Provision of Medical Abortion, 2011–2013. J Jom 2016;61(2):177–84.

16. Puri M, Regmi S, Tamang A, Shrestha P. Road map to scaling-up: translating operations research study’s results into actions for expanding medical abortion services in rural health facilities in Nepal. Health Research Policy and Systems. 2014;12(1):24. doi: 10.1186/1478-4505-12-24 24886393

17. Tamang A, Puri M, Masud S, Karki DK, Khadka D, Singh M, et al. Medical abortion can be provided safely and effectively by pharmacy workers trained within a harm reduction framework: Nepal. Contraception. 2018;97(2):137–43. doi: 10.1016/j.contraception.2017.09.004 28935219

18. Puri MC, Raifman S, Khanal B, Maharjan DC, Foster DG. Providers’ perspectives on denial of abortion care in Nepal: a cross sectional study. Reproductive health. 2018;15(1):170. doi: 10.1186/s12978-018-0619-z 30305079

19. Shrestha DR, Regmi SC, Dangal G. Abortion: Still Unfinished Agenda in Nepal. Journal of Nepal Health Research Council. 2018;16(1):93–8. 29717298

20. Wu W-J, Maru S, Regmi K, Basnett I. Abortion Care in Nepal, 15 Years after Legalization: Gaps in Access, Equity, and Quality. Health and human rights. 2017;19(1):221. 28630554

21. Ministry of Health and Population (MOHP) [Nepal] NE, ICF International Inc,. Nepal Demographic and Health Survey 2016. Kathmandu,Nepal: Ministry of Health and Population, New ERA, and ICF International, Calverton, Maryland: 2017.

22. Puri M, Vohra D, Gerdts C, Foster DG. “I need to terminate this pregnancy even if it will take my life”: a qualitative study of the effect of being denied legal abortion on women’s lives in Nepal. BMC Women’s Health. 2015;15(1):85. doi: 10.1186/s12905-015-0241-y 26466784

23. Thapa S, Sharma SK, Khatiwada N. Women’s knowledge of abortion law and availability of services in Nepal. Journal of biosocial science. 2014;46(2):266–77. doi: 10.1017/S0021932013000461 23953960

24. Tuladhar H, Risal A. Level of awareness about legalization of abortion in Nepal: A study at Nepal Medical College Teaching Hospital. Nepal Med Coll J. 2010;12(2):76–80. 21222401

25. Rocca C, Puri M, Dulal B, Bajracharya L, Harper C, Blum M, et al. Unsafe abortion after legalisation in Nepal: a cross-sectional study of women presenting to hospitals. BJOG: An International Journal of Obstetrics & Gynaecology. 2013;120(9):1075–84.

26. Thapa S, Sharma SK. Women’s awareness of liberalization of abortion law and knowledge of place for obtaining services in Nepal. Asia Pacific Journal of Public Health. 2015;27(2):208–16. doi: 10.1177/1010539512454165 23000795

27. Yogi A, Prakash K, Neupane SJ. Prevalence and factors associated with abortion and unsafe abortion in Nepal: a nationwide cross-sectional study. Bp, childbirth 2018;18(1):376.

28. World Health Organization, UNICEF. Managing complications in pregnancy and childbirth: a guide for midwives and doctors. 2017.

29. Ministry of Health and Population (MOHP) [Nepal] NE, ICF International Inc,. Nepal Demographic and Health Survey 2011. Kathmandu,Nepal: Ministry of Health and Population, New ERA, and ICF International, Calverton, Maryland: 2012.

30. National Planning Commission, 2015: Sustainable Development Goals, 2016–2030, National Report. Government of Nepal, National Planning Commission, Kathmandu, Nepal

31. Ministry of Health and Population (MOHP) [Nepal], New ERA, ICF International Inc. Nepal Demographic Health Survey 2006. Kathmandu,Nepal:Ministry of Health and Population, New ERA, and ICF International, Calverton, Maryland: 2007.

32. Ministry of Health and Population (MOHP) [Nepal]. Annual Report 2073/74 (2016/2017). Kathmandu,Nepal.

33. Shahabuddin A, De Brouwere V, Adhikari R, Delamou A, Bardaj A, Delvaux T. Determinants of institutional delivery among young married women in Nepal: Evidence from the Nepal Demographic and Health Survey, 2011. J Bo 2017;7(4):e012446.

34. Poudel S, Upadhaya N, Khatri RB, Ghimire PR. Trends and factors associated with pregnancies among adolescent women in Nepal: Pooled analysis of Nepal Demographic and Health Surveys (2006, 2011 and 2016). J Po 2018;13(8):e0202107.

35. Ghimire PR, Agho KE, Renzaho AM, Dibley M, Raynes-Greenow C. Association between health service use and diarrhoea management approach among caregivers of under-five children in Nepal. PloS one. 2018;13(3):e0191988. doi: 10.1371/journal.pone.0191988 29494611

36. Ghimire PR, Agho KE, Renzaho A, Christou A, Nisha MK, Dibley M, et al. Socio-economic predictors of stillbirths in Nepal (2001–2011). PloS one. 2017;12(7):e0181332. doi: 10.1371/journal.pone.0181332 28704548

37. Anderson R, Davidson P. Improving access to care in America: individual and contextual factors. Changing the US Health Care System San Francisco: Jossey-Bass. 2001:3–30.

38. Karkee R, Lee AH, Khanal V. Need factors for utilisation of institutional delivery services in Nepal: an analysis from Nepal Demographic and Health Survey, 2011. BMJ Open. 2014;4(3). doi: 10.1136/bmjopen-2013-004372 24650803

39. Babitsch B, Gohl D, von Lengerke T. Re-revisiting Andersen’s Behavioral Model of Health Services Use: a systematic review of studies from 1998–2011. GMS Psycho-Social-Medicine. 2012;9:Doc11. doi: 10.3205/psm000089 23133505

40. Khanal V, Adhikari M, Karkee R, Gavidia T. Factors associated with the utilisation of postnatal care services among the mothers of Nepal: analysis of Nepal Demographic and Health Survey 2011. BMC Women’s Health. 2014;14(1):19. doi: 10.1186/1472-6874-14-19 24484933

41. Victora CG, Huttly SR, Fuchs SC, Olinto MT. The role of conceptual frameworks in epidemiological analysis: a hierarchical approach. International Journal of Epidemiology. 1997;26(1):224–7. doi: 10.1093/ije/26.1.224 9126524

42. Khanal V, da Cruz JLNB, Mishra SR, Karkee R, Lee AH. Under-utilization of antenatal care services in Timor-Leste: results from Demographic and Health Survey 2009–2010. JBp, childbirth. 2015;15(1):211.

43. Craney TA, Surles JG. Model-dependent variance inflation factor cutoff values. JQE 2002;14(3):391–403.

44. West BT. Statistical and methodological issues in the analysis of complex sample survey data: practical guidance for trauma researchers. JJots 2008;21(5):440–7.

45. Rogers C, Sapkota S, Paudel R, Dantas JA. Medical abortion in Nepal: a qualitative study on women’s experiences at safe abortion services and pharmacies. JRh 2019;16(1):105.

46. Mehata S, Paudel YR, Mehta R, Dariang M, Poudel P, Barnett S. Unmet need for family planning in Nepal during the first two years postpartum. BioMed research international. 2014;2014.

47. Fusco CLB. Unsafe Abortion: a serious public health issue in a poverty stricken population. Reprodução & Climatério. 2013;28(1):2–9. https://doi.org/10.1016/j.recli.2013.04.001.

48. Kulczycki A. Abortion in Latin America: changes in practice, growing conflict, and recent policy developments. Studies in family planning. 2011;42(3):199–220. 21972673

49. Mehata S, Paudel YR, Dotel BR, Singh DR, Poudel P, Barnett S. Inequalities in the use of family planning in rural Nepal. BioMed research international. 2014;2014.

50. Bell SO, Zimmerman L, Choi Y, Hindin MJ. Legal but limited? Abortion service availability and readiness assessment in Nepal. Health policy and planning. 2017;33(1):99–106.

51. Bingham A, Drake JK, Goodyear L, Gopinath C, Kaufman A, Bhattarai S. The role of interpersonal communication in preventing unsafe abortion in communities: the dialogues for life project in Nepal. JJohc 2011;16(3):245–63.

52. Thapa S, Sharma SK. Women’s awareness of liberalization of abortion law and knowledge of place for obtaining services in Nepal. JAPJoPH 2015;27(2):208–16. doi: 10.1177/1010539512454165 23000795


Článek vyšel v časopise

PLOS One


2019 Číslo 10
Nejčtenější tento týden
Nejčtenější v tomto čísle
Kurzy

Zvyšte si kvalifikaci online z pohodlí domova

plice
INSIGHTS from European Respiratory Congress
nový kurz

Současné pohledy na riziko v parodontologii
Autoři: MUDr. Ladislav Korábek, CSc., MBA

Svět praktické medicíny 3/2024 (znalostní test z časopisu)

Kardiologické projevy hypereozinofilií
Autoři: prof. MUDr. Petr Němec, Ph.D.

Střevní příprava před kolonoskopií
Autoři: MUDr. Klára Kmochová, Ph.D.

Všechny kurzy
Kurzy Podcasty Doporučená témata Časopisy
Přihlášení
Zapomenuté heslo

Zadejte e-mailovou adresu, se kterou jste vytvářel(a) účet, budou Vám na ni zaslány informace k nastavení nového hesla.

Přihlášení

Nemáte účet?  Registrujte se

#ADS_BOTTOM_SCRIPTS#