Effects of Abortion Legalization in Nepal, 2001-2010

Jillian T. Henderson, University of California, San Francisco
Sudha Sharma, Ministry of Health and Population, Nepal
Ashma Rana, Tribhuvan University
Mahesh Puri, Center for Research on Environment Health and Population Activities (CREHPA)
Cynthia C. Harper, University of California, San Francisco
Maya Blum, University of California, San Francisco
Prabhat Lamichhane, Center for Research on Environment Health and Population Activities (CREHPA)
Dolmaya Thogra, Bixby Center for Global Reproductive Health
Philip Darney, University of California, San Francisco

The status of induced abortion in Nepal shifted dramatically in 2002 - from a crime for which women were imprisoned to broadly legal. To monitor effects of abortion legalization and service expansion, we abstracted all abortion complication cases (spontaneous and induced) presenting at four public, tertiary care hospitals (2001-2010, n = 18,205). High severity cases were those with serious infection (n=965), injury (n=94), systemic complications (n=595), and death (n=11). Interrupted time series analysis for trends in the proportion of severe complications at different stages of safe abortion implementation showed a significant decline in the most severe complications, beginning in 2007 (IRR 0.85, p<.001). Despite secular trends increasing overall cases (expansion of free health care, more induced abortion), fewer women suffered harmful health consequences of abortion, especially after second trimester care and medication abortion services became more available. Abortion legalization in Nepal has contributed to improved maternal health.