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Effects of Abortion Legalization in Nepal, 2001–2010
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. METHODS: We conducted retrospecti...
Autores principales: | , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2013
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3669364/ https://www.ncbi.nlm.nih.gov/pubmed/23741391 http://dx.doi.org/10.1371/journal.pone.0064775 |
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author | 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 Darney, Philip D. |
author_facet | 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 Darney, Philip D. |
author_sort | Henderson, Jillian T. |
collection | PubMed |
description | 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. METHODS: 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). RESULTS: 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). CONCLUSION: 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. |
format | Online Article Text |
id | pubmed-3669364 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2013 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-36693642013-06-05 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 Darney, Philip D. PLoS One Research Article 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. METHODS: 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). RESULTS: 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). CONCLUSION: 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. Public Library of Science 2013-05-31 /pmc/articles/PMC3669364/ /pubmed/23741391 http://dx.doi.org/10.1371/journal.pone.0064775 Text en © 2013 Henderson et al http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited. |
spellingShingle | Research Article 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 Darney, Philip D. Effects of Abortion Legalization in Nepal, 2001–2010 |
title | Effects of Abortion Legalization in Nepal, 2001–2010 |
title_full | Effects of Abortion Legalization in Nepal, 2001–2010 |
title_fullStr | Effects of Abortion Legalization in Nepal, 2001–2010 |
title_full_unstemmed | Effects of Abortion Legalization in Nepal, 2001–2010 |
title_short | Effects of Abortion Legalization in Nepal, 2001–2010 |
title_sort | effects of abortion legalization in nepal, 2001–2010 |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3669364/ https://www.ncbi.nlm.nih.gov/pubmed/23741391 http://dx.doi.org/10.1371/journal.pone.0064775 |
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