Peer-reviewed article
Understanding awareness of abortion legality and barriers to service access among adolescent girls in Karnali Province, Nepal: evidence from a mixed methods study.
Singh Thakuri D, Bhandari R, Moen HL ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study examined adolescent girls' awareness of abortion legality and barriers to accessing safe abortion services in Karnali Province, Nepal. Although 89% of girls aged 12-19 had heard about abortion, only 50% knew it is legal in Nepal. The research identified major barriers including social stigma, misinformation, lack of confidentiality at health facilities, and health worker attitudes. The study found that older girls, those with sexuality education, and girls from certain districts were more likely to know about abortion legality.
Key points
- Only 49.8% of adolescent girls aged 12-19 were aware that abortion is legal in Nepal, despite 89.2% having heard about abortion
- Adolescents aged 15-19, those with comprehensive sexuality education, and girls from Jajarkot and Jumla districts had significantly higher awareness of abortion legality
- Major barriers to service access included social stigma, limited information, misinformation about consequences, distrust in services, and lack of confidentiality
- Health worker attitudes and behaviours, poor service availability, and teachers' limited knowledge of abortion legality compounded access challenges
- Study recommends multi-level approaches including social and behaviour change initiatives and strengthening adolescent-friendly abortion services
Limitations
The study provides cross-sectional data from one province, so findings may not be generalizable to all of Nepal. The research identifies barriers and awareness levels but does not evaluate the effectiveness of any specific intervention to improve access or knowledge.
Abstract
Background Although abortion has been legal in Nepal since 2002, the utilization of safe abortion services has not been universally adopted, especially among adolescents. Adolescent girls disproportionately experience barriers in accessing these services due to a lack of awareness and stigma. This study assessed awareness of abortion legality and barriers to accessing services among adolescents aged 12-19 years in Karnali Province, Nepal. Methods This study used a cross-sectional mixed-methods approach. A survey assessed the awareness about the legality of abortion, and focus group discussions, key informant interviews, and in-depth interviews were conducted to explore the barriers to accessing abortion services. We performed a binomial logistic regression analysis to identify the determinants of awareness of abortion legality. A thematic analysis was conducted for the qualitative data, and the findings were triangulated with the quantitative results. Results Nearly 9 out of 10 (89.2%) respondents had heard about abortion. However, only 49.8% knew that abortion is legal in Nepal. Adolescents aged 15-19 years (aOR = 1.976, 95% CI: 1.266, 3.084), who lived in Jajarkot (aOR = 2.784, 95% CI:1.529, 5.067) or Jumla (aOR = 2.419, 95% CI: 1.204, 4.860), and who had awareness on comprehensive sexuality education (aOR = 1.991, 95% CI: 1.175, 3.374) were more likely to be aware of the legality of abortion services. Key barriers to abortion services included social stigma, limited information, misinformation about consequences, distrust in available services, and a lack of confidentiality at health facilities. These challenges were further compounded by health workers' behaviors and attitudes, poor service availability, and schoolteachers' limited knowledge of abortion legality. Conclusion Overall, adolescent girls had limited awareness of the legality of abortion and faced multiple demand- and supply-side barriers to accessing services. Addressing these challenges requires a multi-level approach, including social and behavior change initiatives to raise awareness of abortion legality among adolescents and teachers and reduce social stigma. In addition, abortion services should be strengthened by expanding service sites and ensuring that services are adolescent-friendly.