Deciding to abort: what factors influence young couples in Nepal?

The government of Nepal legalised abortion in 2002 and services became operational in 2004. Since then, thousands of women have used the legal abortion services. How do young couples reach the decision to terminate an unintended pregnancy?

Earlymarriage and early childbearing is the social custom in Nepal, with one in sixwomen having at least one child between the ages of fifteen to nineteen. By age24, 66 percent of women have had at least one child. Although most are informedabout modern contraceptive methods, only nine percent of fifteen to nineteenyear olds use them.

Untilabortion was legalised, Nepal had one of the worst maternal death ratios inAsia (539 per 100,000 live births). Unsafe abortions contributed significantlyto this, with the Ministry of Health reporting that 54 percent of all maternaldeaths in hospital resulted from unsafe abortions. By December 2006, 151government-approved abortion facilities were operating and 85,000 women had hadlegal abortions. 

Astudy by the Centre for Research on Environment Health and PopulationActivities in Kathmandu and the University of Southampton in the UK considersdata from a 2003 study examining the factors influencing young couples’decisions to abort unintended pregnancies in Nepal. Most unintended pregnanciesin this study probably occurred prior to the legalisation of abortion, or whenabortion services were still poorly developed.

Thestudy found that: 

• A high number of pregnancies among young married couples were unintended,yet relatively few couples had actually had abortions or had attempted them.
• Multiple factors affected the decision to abort unintended pregnancies,including husbands views, health service providers, family and social networks,and socio-economic circumstances. Women were more likely to make an independentdecision to abort if they had experienced a short interval between births, iftheir husband suspected them of infidelity, or if they faced other hardships.
• While some young women discussed their options with theirmothers-in-law, friends and close relatives, this had little effect on theirfinal decision.
• Factors central to the decision-making process included economic issues,cultural and religious beliefs, fear of social stigmatisation, and fear ofbecoming sterile or suffering ill-health.   
• Incorrect information about abortion law and services was being providedto young couples by some medical staff.

Thestudy makes the following recommendations:

• scale up access to family planning and abortion services, in particulartargeting young couples
• educate communities about family planning and legalabortion services through  socialmarketing and private-public partnerships
• work towards ensuring  the pricingof services is transparent and affordable to overcome barriers to access
• assist husbands in playing a more important role in decision-making and includethem in reproductive health and rights programmes
• provide extensive professional training for medical staff  to ensure they provide abortion information tocouples
• update the health service training curricula in line with the legalstatus of abortion
• devise extensive education programmes for the public