A study on factors associated with comprehensive abortion care & post abortion care services in the reproductive age group women in Lumbini zone of Nepal.

Thesis Report.

ABSTRACT: Abortion, play a significant role in reproductive life of the women. Women are facing abortion related health complication. Either induced or spontaneous abortion under various medico-social circumstances may results abortion complications & consequences to women health. Reproductive health, safe abortion services and easily accessible to appropriate contraceptive care at the time of abortion will prevent these women from the risk of yet another unwanted pregnancy and abortion which plays a significant role in substantial reduction of maternal mortality and morbidity associated with abortions. Prior to abortion was legalized, induced abortion was taken as crime and sin as well as social stigma as a result of the reasons women who need abortion services used to seek clandestine abortion which always put women's life in higher risk of life threatening either temporary or permanent disability to death. Because of the all these reasons abortion is legalized to reduce, abortion complications and maternal mortality. Safe abortion services introduced under Comprehensive Abortion Care (CAC) & Post Abortion Care (PAC) services. CAC refers to safe and legal abortion services under hygienic condition by trained health personnel. It offers couple counseling, use Manual Vacuum Aspiration (MVA), use of oral and vaginal medication to terminate pregnancies, provide post-CAC contraceptive methods and other reproductive health services, and affordable services. Post Abortion Care (PAC) refers to post abortion complication management services whether the complications result from either induced or spontaneous abortion. It includes post abortion counseling and temporary and permanent method for contraception. Emphasis will be on providing quality and affordable services. Study was conducted to access the medico-social factors associated with Comprehensive Abortion Care and Post Abortion Care (CAC/PAC) services in six districts of Lumbini Zone of Nepal. Hospital based cross sectional study was undertaken among the reproductive age group (15-19 years) who had received CAC/PAC services under the abortion law of Nepal. Multi-staged sampling technique was adopted to get the required study sample. A total number of 1476 respondents were selected till sample size was met. Chi- square, mean age, standard deviation, co-efficient of variance, ANOVA, statistical test was used for testing the significant of analyzed data. The results revels that abortion under CAC/PAC services was used by mostly reproductive age group between 21-30 years (60.8%), unplanned early age pregnancy (10.0%) from rural back ground and illiterate respondents with less than 50000/- annual family income (68.8%) etc.; Social reasons identified were unwanted pregnancy (89.2%) keeping small and complete family (44.9%), method for birth spacing (8.4%), family pressure (1.7%), Medical circumstances such as temporary/permanent family planning method failure (58.5%), medical condition of the respondents (21.6%), congenital deformity of the foetus (6.7%) etc.. Respondents (1.6%) suffered from complications immediate and after few days of abortion procedure /CAC/PAC (MVA, D&C and MA procedure) done and 0.3 per cent respondents were hospitalized for treatment. Complications related CAC/PAC services were per vaginal bleeding, R'POC or incomplete abortion , lower abdomen pain, retention of urine and no stool pass, fever, headache, nausea, loss of appetite, neurogenic shock, MVA failed & pregnancy continue, cervical tear, uterus perforation and severe anemia. Approximately Seventy Nine per cent respondents were counseled after CAC/PAC services and only 63.6 per cent respondent were using contraceptive method after CAC/PAC procedure. Study, recommends Family Life Education, awareness regarding proper usage of contraceptive to the reproductive age group couples.