Adolescent sexual and reproductive health outcomes following legalized abortion in Nepal: a comparison with the global experience

Background: Unsafe abortion and its consequences are a major global health problem especially in LMIC. In Nepal, despite legalized abortion being available for more than two decades, illegal abortion is still prevalent, with a dipropionate impact on adoles-cent girls. This study reviews how legalizing abortion services has contributed to sexu-al and reproductive health outcomes of Nepali adolescent girls by comparing with the reported experiences of other LMIC.Methods: A documentary review was conducted using mixed-method analysis. Twen-ty-three documents were selected for analysis using the PRISMA screening method. Data was processed using data matrixes.Findings: Abortion has been legal in Nepal since 2002, and since then, services have been expanded and decentralized. However, adolescent girls still face geographical, socio-cultural, economic and structural barriers to accessing legal abortion services, which contributes to high rates of unsafe abortion and significant numbers of un-planned births. In other LMIC, politically and/or socially conservative countries have the most restrictions and barriers to safe abortion care, which contributes to significant maternal morbidity and mortality.Discussion: According to the findings from other LMIC, the abortion policy of Nepal needs to review its policies on gestational limit for accessing late abortion and on the legal role of pharmacies in prescribing for medical abortion. The decentralization of SRH services has been successful, but still suffers from inconsistent functionality of public facilities, lack of policy clarity on the eligibility of SRH care providers to advise abortion, especially in rural areas, and the low proficiency of front-line health care staff in SRH care. There is insufficient effort to improve awareness of women and girls of the legal status of abortion and to reduce community stigmatization of those who seek abortions. The policies of some foreign aid agencies put limitations on the ability of government to use donor funds for reproductive health programs. These bar-riers disproportionally impact socially and economically marginalized adolescents, contributing to poor SRH outcomes such as unsafe abortion and unplanned births. Although efforts have been made to reduce barriers to access to legal abortion ser-vices, high unmet need of modern contraception among adolescents needs to be also prioritized to reduce unintended pregnancy, which can be addressed by improving evidence-based decision and policy making. Conclusion: Despite contributing to positive SRH outcomes of adolescents by liberal-izing abortion services, the issues of unintended pregnancy, unsafe abortion and un-planned birth remains problematic in Nepal. The government needs to take additional measures to ensure more equitable legal abortion services, to improve the coverage and effectiveness of services and to reduce the barriers facing adolescent girls in accessing safe SRH services.