Investigating Contraceptive Use and Continuation among Women Obtaining Legal Abortion Services in Nepal
Following the historic legalization of abortion in Nepal in 2002, descriptive data on the prevalence of legal abortion services are now available, but little is known about access to contraception and method use, or reproductive behaviors and intentions following abortion.
Our mixed-method study examines women's contraceptive use and continuation after obtaining a legal abortion, with attention to method access, the contraceptive counseling experience, and personal and contextual factors influencing contraceptive use and availability in Nepal. We draw on a conceptual framework that considers structural (e.g., health system, family, cultural) and personal level influences on contraceptive use following abortion.
A prospective cohort study of women obtaining abortions at 4 clinics (2 government and 2 private) within the Kathmandu Valley and outside will be conducted. Participants will be interviewed at the clinic on the day of abortion services and at 6 and 12 months. The content and quality of contraceptive counseling, and method choice and continuation will be investigated, as will factors contributing to repeat unintended pregnancy and abortion. In addition, in-depth interviews with abortion service providers, facility managers, and other key stakeholders responsible for contraceptive supplies and provision will be conducted to characterize structural access barriers to contraceptive use.
Our findings will contribute to the scientific literature by examining multiple levels influencing contraceptive use and reproductive health of women seeking legal abortion, and will be useful for advocates working to improve and expand access to contraception and improve the quality of reproductive health care for women in Nepal and in similar countries striving to improve reproductive health policy and services.