Chandni

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 Educational status Economic status Occupation

Marital status Religion Parity

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 1.Proposal preparation 2.Proposal presentation 3.Preparation of tools 4.Pretesting of tools 5.Data collection 6.Data analysis 7.Report writing 8.Report presentation 9.Report dissemination 10.Travelling cost 11.Snacks 12.Miscellaneous Total

Amount (NRS) 2,500 500 2,500 500 6,000 1,000 500 500 3,000 1,000 1,000 1,000 20,000