Sharad Sharma

Women's knowledge of abortion law and availability of services in Nepal.

This paper assesses womens awareness of the liberalization of abortion law and their knowledge of a place for obtaining abortion services in Nepal. The data are from the 2011 Nepal Demographic and Health Survey. The results are compared with data from a similar survey conducted in 2006. Variations in the two measures among several population sub-groups are analysed by performing logistic regression. Among women aged 15-44, 38.7% (CI: 37.8, 39.6) were aware of the legal status of abortion and 59.8% (CI: 58.9, 60.7) knew of a place to have an abortion. The percentages of both measures varied considerably by various population sub-groups. Over a 5-year period, knowledge of the legality of abortion increased by 6.4 percentage points, and awareness of service delivery sites increased by 3.3 percentage points. The increases in both measures were, however, largely limited to higher wealth quintiles and those with higher educational attainment. The results suggest the need to intensify efforts to educate women in Nepal, particularly the most disadvantaged women, about abortion law, including the conditions under which abortion is permitted, and where to access safe abortion services.

Marital status and abortion among young women in Rupandehi, Nepal

BackgroundDespite liberalization of the Nepal abortion law, young women continue to experience barriers to safe abortion services. We hypothesize that marital status may differentially impact such barriers, given the societal context of Nepal.MethodsWe evaluated differences in reproductive knowledge and attitudes by marital status with a probability-based, cross-sectional survey of young women in Rupandehi district, Nepal. Participants (N = 600) were surveyed in 2012 on demographics, romantic experiences, media habits, reproductive information, and abortion knowledge and attitudes. We used logistic regression to assess differences by marital status, controlling for age.ResultsParticipants, who comprised never-married (54%) and ever-married women (45%), reported good access to basic reproductive health and abortion information. Social desirability bias might have prevented reporting of premarital romantic and sexual activity given that participants reported more premarital activities for their friends than for themselves. Only 45% knew that abortion was legal, and fewer ever-married women were aware of abortion legality. Never-married women expected more negative responses from having an abortion than ever-married women.ConclusionsFindings highlight the need for providing sexual and reproductive health care information and services to young women regardless of marital status.

Women's awareness of liberalization of abortion law and knowledge of place for obtaining services in Nepal.

In Nepal, following the liberalization of the abortion law, expansion and scaling up of services proceeded in parallel with efforts to create awareness of the legalization status of abortion and provide women with information about where services are available. This article assesses the effectiveness of these programmatic interventions in the early years of the country’s abortion program. Data from a 2006 national survey are analyzed with 2 outcome measures—awareness of the legal status of abortion and knowledge of places to obtain abortion services among women ages 15 to 44 years. The variations in the outcomes are analyzed by ecological–development subregion, residence, education, household wealth quintile, age, and number of living children. Bivariate and multivariate logistic regression techniques are used. Overall 32.3% (95% confidence interval = 31.4% to 33.2%) of the respondents were aware of the legal status of abortion and 56.5% (95% confidence interval = 55.5% to 57.4%) knew of a place where they could obtain an abortion. Both outcome measures showed considerable variations by the covariates. Women with secondary or higher level of education had the highest odds ratio of being aware of the law and having knowledge of a source for abortion services. Ecological–development subregions showed the second highest levels of odds ratios. Significant disparities among the population subgroups existed in the diffusion of awareness of the legal status of abortion and having knowledge of a place for abortion services in Nepal. The results point to which population subgroups to focus on and also serve as a baseline for assessing future progress in the diffusion process.

Contextual Influences on Obstetric Morbidity and Related Care Seeking Behaviour in Thailand

This study examines the association of individual and community-level characteristics with obstetric morbidity and care seeking behaviour in Thailand. Community characteristics have been recognized to shape individual health, but there have been only a few studies explaining their influence on obstetric morbidity. Multi-level logistic regression analysis among 930 women, living in 86 villages indicated that not the community social and health infrastructure but community impoverishment was associated with the likelihood of reporting the morbidity and seeking appropriate care. The findings suggest that community factors should be taken into consideration while implementing programmes to improve maternal health.

Determination of medical abortion eligibility by women and community health volunteers in Nepal: A toolkit evaluation

Objective To determine if pregnant, literate women and female community health volunteers (FCHVs) in Nepal can accurately determine a woman’s eligibility for medical abortion (MA) using a toolkit, compared to comprehensive abortion care (CAC) trained providers. Study design We conducted a prospective diagnostic accuracy study in which women presenting for first trimester abortion, and FCHVs, independently assessed each woman’s eligibility for MA using a modified gestational dating wheel to determine gestational age and a nine-point checklist of MA contraindications or cautions. Ability to determine MA eligibility was compared to experienced CAC-providers using Nepali standard of care. Results Both women (n = 3131) and FCHVs (n = 165) accurately interpreted the wheel 96% of the time, and the eligibility checklist 72% and 95% of the time, respectively. Of the 649 women who reported potential contraindications or cautions on the checklist, 88% misidentified as eligible. Positive predictive value (PPV) of women’s assessment of eligibility based on gestational age was 93% (95% CI 92, 94) compared to CAC-providers’ (n = 47); PPV of the medical contraindications checklist and overall (90% [95% CI 88, 91] and 93% [95% CI 92, 94] respectively) must be interpreted with caution given women’s difficulty using the checklist. PPV of FCHVs’ determinations were 93% (95% CI 92, 94), 90% (95% CI 89,91), and 93% (95% CI 91, 94) respectively. Conclusion Although a promising strategy to assist women and FCHVs to assess MA eligibility, further refinement of the eligibility tools, particularly the checklist, is needed before their widespread use.

Monitoring and Evaluation (M&E) of Development Projects: Issues Facing Nepal

M&E are, perhaps the least emphasized areas in development programs/projects implementation of Nepal, as reflected in the continuous low performance of the periodic plans themselves. This paper attempts to present an analysis of the methodologies used in whatever scanty exercise done in the area in the recent past and highlights their limitations due to the differences in the techniques of surveys and studies. Following this, an effort is made by the author to develop a comprehensive framework for an effective M&E of development projects. Particular emphasis is placed on the M&E of poverty reduction projects as the basic goals of the Tenth Plan as well as development of a methodology for the active role of local government in the process. Basic issues such as income measurement and other indicators to development are discussed along with highlights on the specific desirable characteristics and the robustness of the indicators. A proposed M&E arrangement for poverty reduction is presented from the central to the grassroots level. Relevant critical issues in data generation and use in M&E are discussed with specific emphasis on poverty reduction focused development projects including pro-poor strategies. An analytical framework is also presented on critical development performance issues, in general and for the meaningful public participation in M&E. Economic Journal of Nepal Vol.28(3) 2005 pp.127-148