Improving post-abortion contraceptive services in Nepal

Since Nepal legalized abortion in 2002, safe abortion services have helped reduce high pregnancy-related complications and deaths. This policy change also created new opportunities to offer women contraception, as women presenting for abortion may also have an unmet need for contraception. Despite these new opportunities, contraceptive use in Nepal has plateaued since 2006, with 43% of married women using modern methods of contraception. On average, women have nearly one child more than desired.

Researchers with the UCSF Bixby Center recently examined the contraceptive information and services Nepalese women receive at an abortion visit. They found that:

  • Two-thirds of women reported receiving information on at least one effective method at their abortion visit, most commonly injectables (52%) or pills (45%).
  • Women not currently living with their husband or partner were less likely to receive contraceptive information than women living with husbands (57% vs. 68%).
  • Women who had never given birth were less likely to receive information than women who had (53% vs. 68%).
  • Patients at nongovernmental clinics were more likely to receive contraceptive information than women at public hospitals.
  • Forty-four percent of women received effective contraceptive supplies at their abortion visit, most commonly the injectable (28%) or pills (12%).
  • However, 48% of women choosing long-acting reversible contraception (LARC) and 83% of those selecting sterilization left the abortion visit without an effective method.

Although considerable progress has been made to provide comprehensive family planning services after abortion, challenges remain. Expanding the range of contraceptive methods discussed would allow more women to obtain an acceptable method. Addressing barriers to immediate post-abortion LARC provision would prevent gaps in protection. Legalization of abortion in Nepal presented an unprecedented opportunity to expand contraceptive access—ongoing efforts to improve contraceptive services will continue to reduce the number of women at risk of unintended pregnancy.