Practices and Perceptions of

Clients availing Safe Abortion

Services
regarding Contraceptive
Acceptance

By Chandni Joshi
Roll no. 273
BPH 3rr year
Abortion was legalized in Nepal in
September 2002
The government of Nepal has been
committed to reducing unsafe abortion
since 1991 under the National Health
Policy and more recently as part of the
Millennium Development Goals
Unsafe abortion is a major public health
concern Women who resort to
unauthorized facilities and/or unskilled
providers put their health and their lives at
risk
Women who have undergone abortion and
are at risk of another unwanted pregnancy
represent an important group with unmet
family planning needs
The best way to prevent unsafe abortions
is to reduce the unmet need for
contraception and make safe abortion
services accessible to women at an
affordable cost.
To improve abortion prevention, the need
for increased use of contraceptives
including emergency contraception is
clearly suggested
CAC includes affordable and accessible
abortion care and other reproductive health
services, eg: counseling and informed
consent for the termination of pregnancy,
informed choice for the post abortion FP,
identification and treatment of STIs/RTIs.
Its components are client’s choice, access
and quality of service
Statement of the problem

Nepal has one of the highest

maternal mortality ratios
(281/100,000 live births) in Asia, a
high unmet need for contraception
and a low contraceptive prevalence
rate of 44% (NDHS, 2006)
Globally, about two out of five
abortion procedures are unsafe and
between 100,000 and 200,000
women die of unsafe abortion every
Death due to abortion complications
in Nepal account for (15-30)% of all
maternal deaths (4000-7000/ year)
In Asia, 9,900,000 unsafe abortions
occur every year. The risk of death
following complications of unsafe
abortion procedures in developing
countries is 1 in 250 procedures as
against 1 in 3750 procedures in
developed countries
unwanted pregnancies occur
because family planning services are
unavailable, inaccessible, ineffective,
or culturally unacceptable to women.
Although women who undergo
abortion are at risk of subsequent
unwanted pregnancies, abortion
services in developing countries are
rarely linked to family planning
services
Rationale
Maternal health is an important component
for the development of the country because
if the mother is healthy, the whole family
will be healthy.
Target of the MDGs is to reduce the
maternal mortality ratio to 114/100,000 live
births. Unwanted pregnancy should be
reduced to achieve this target which will
subsequently reduce maternal mortality
due to abortion.
Promoting family planning (including
emergency contraception) is a sure way to
reduce unsafe abortions; if every woman
who wished to delay or limit births made
use of effective contraception, maternal
mortality would drop, worldwide, by an
estimated 17 to 35 percent.

Several studies have been conducted in

Nepal regarding knowledge of women on
contraception but research needs to focus
on how to increase their voluntary
contraceptive acceptance especially those
seeking abortion
Overall objective

To find out the practices and

perceptions of clients availing safe
abortion service regarding
contraceptive acceptance
Specific objectives
to describe the perceptions of clients
availing safe abortion service towards
contraceptive methods
to find out their contraceptive practice
before the abortion
to find out their choice of contraceptive
method for future use
to document the reasons for their future
contraceptive choice
to find out the factors which impede women
to use contraceptive methods
Research question

What are the practices and

perceptions of clients availing safe
abortion service regarding
contraceptive acceptance?
Independent Variables

Age of woman
Educational status
Economic status
Occupation
Marital status
Religion
Parity
Dependent variables

Contraceptive practice before the

abortion
Contraceptive practice after the
abortion
Perceptions regarding contraceptive
acceptance
Conceptual Framework
Age of the woman Marital status
Educational status Religion
Economic status Parity
Occupation

Contraceptive practice before the procedure

Contraceptive practice after the procedure
Perceptions regarding contraceptive acceptance

Contraceptive acceptance/rejection
Methodology
study design- descriptive, cross sectional and
explorative
study area- Indra Rajya Laxmi Maternity
Hospital, Thapathali, Kathmandu
Study population- CAC clients at the hospital
Sampling design
Sampling method- non probability convenience
sampling
Sample size- all the clients coming to the CAC
service within the 5 days of data collection(75-150)
Sampling frame- total CAC clients visiting the
hospital
Unit of analysis- women attending CAC service
 Data collection method
Interview
Case study

Tools/instruments
Semi structured questionnaire
Checklist for case study

Data collection procedure- from women attending CAC

service

Data management and analysis

Editing- same day to correct errors
Coding- assigning symbols or numbers in the
questionnaire
Entry and analysis- manually as well as using Statistical
Package for Social Sciences (SPSS) 11.5 for windows
Pretesting of the tools- questionnaires will be pre tested
in similar CAC centre and necessary modifications will
be done before carrying out the actual data collection
validity and reliability of the
research
Study proposal preparation and questionnaire
development in the close guidance of supervisor
for ensuring the external validity of the study,
adequate concerned literatures were and will be
reviewed
to reduce the instrumental error
- the set of questionnaire will be checked and
verified by the supervisor and concerned teachers
- Pre testing will be done in similar hospital setting
and validity of the tools in it contents and accuracy
of information will be ensured
the researcher herself will collect the data
Data editing and entry will be done on the same
day of data collection
limitations of the study
this research is limited to women
visiting CAC service at an urban
setting (may not represent rural area
and those who do not visit health
facility at all)
samples purposively selected, so
may not be representative
limited time
 Ethical considerations

Verbal informed consent will be taken from

the participants before the interview
objectives of research will be clarified to
them
they will be assured that the information
they provide will be kept private and
confidential
Written consent will be taken from DCMFH
and Indra RAjya Laxmi Prasuti Griha
Building rapport with the CAC staff and
taking verbal consent from them
Expected outcome of the study
Overall perceptions of CAC clients towards
contraception and abortion will be assessed
Their contraceptive practices before and after
abortion procedure will be determined
The factors that impede them to use contraceptive
devices and ways to increase the contraceptive
acceptance will be identified
The findings can be used as a pilot study for
further research
It will be helpful for local and district level CAC
service planning
It can be used as a guideline for launching
appropriate programs accordingly
Budget
Particulars Amount (NRS)
1.Proposal preparation 2,500
2.Proposal presentation 500
3.Preparation of tools 2,500
4.Pretesting of tools 500
5.Data collection 6,000
6.Data analysis 1,000
7.Report writing 500
8.Report presentation 500
9.Report dissemination 3,000
10.Travelling cost 1,000
11.Snacks 1,000
12.Miscellaneous 1,000
Total 20,000