Structured Observations of Pre-Abortion Contraceptive Counseling within the Comprehensive Abortion Care Unit of the Paropakar Maternity and Women's Hospital in Kathmandu, Nepal Public

Abstract

Introduction. Nepal's legalization of abortion in 2002 dramatically changed the country's availability and access to safe abortion services. The national framework for comprehensive abortion care is built on three key elements: choice, access, and quality. This study explores the quality of post abortion contraceptive counseling being received by clients of the Comprehensive Abortion Care (CAC) Unit in the Paropakar Maternity and Women's Hospital in Kathmandu, Nepal, by evaluating the current counseling strategies, methods available, and assessing the strengths and weakness of care among first-trimester abortion clients.

Methods. Structured observations of thirty-one pre-abortion family planning provider-client interactions were conducted over a three week period in June, as part of a larger programmatic study to evaluate the quality of contraceptive counseling conducted in the CAC Unit of the Paropakar Maternity and Women's Hospital. The observation checklist used was developed to collect information about the knowledge and skills of reproductive healthcare workers and to assess client-provider interaction. Data was analyzed to assess providers' competencies.

Results. The evaluation identified five areas of interest in the current counseling, representing both strengths and gaps in the current contraceptive counseling. Providers were most successful in their communication with clients, with over 75% of counselors maintaining eye contact, listening attentively, and using appropriate body language and tone of voice while interacting with a client. Areas in the most need of improvement were the frequency of informed choice and availability of a full range of methods, individualized care, and assurance of the clients' understanding of her method and potential need for follow up.

Discussion. These results indicate that the provision of family planning services post abortion needs to be strengthened in order to allow for the integration of high quality, comprehensive family planning services within safe abortion services. The results of this study have already begun to be used by Ipas/Nepal to inform future interventions. Through the promotion of more comprehensive family planning services, these targeted interventions will result in the reduction of method discontinuation and need for repeat abortions.

Table of Contents

Abstract ......................................................................................................................................... iv

Acknowledgements ........................................................................................................................... vi

Table of Contents ............................................................................................................................ vii

List of Tables .................................................................................................................................. viii

Definition of Key Terms ...................................................................................................................... ix

I. INTRODUCTION .............................................................................................................................. 1

Background ...................................................................................................................................... 1

Family Planning in Nepal: A Timeline ...................................................................................................... 3

Nepal's Abortion Law Provisions ............................................................................................................ 9

Abortion Today ................................................................................................................................ 11

Introduction & Rationale .................................................................................................................... 11

II. LITERATURE REVIEW ...................................................................................................................... 25

National Medical Standards: Reproductive Health in Nepal ........................................................................ 30

National Medical Standards: Post-Abortion Care in Nepal ......................................................................... 33

Comprehensive Abortion Care in Nepal ................................................................................................. 34

Literature Limitations ........................................................................................................................ 41

III. MANUSCRIPT ............................................................................................................................. 43

Introduction ................................................................................................................................... 44

Materials & Methods ........................................................................................................................ 53

Results ......................................................................................................................................... 59

Discussion ..................................................................................................................................... 70

Conclusion ..................................................................................................................................... 79

IV. IMPLICATIONS & RECOMMENDATIONS ............................................................................................ 80

Public Health Implications ................................................................................................................. 80

Recommendations ........................................................................................................................... 80

Appendix A: Ipas Counseling Skills Checklist ......................................................................................... 83

Appendix B: Photos of Counseling Environment ..................................................................................... 86

REFERENCES .................................................................................................................................. 90

About this Master's Thesis

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Mot-clé	Abortion Quality of Care Nepal
Committee Chair / Thesis Advisor	Rochat, Roger, Emory University
Partnering Agencies	Emory University schools, faculty or affiliated programs International Non-governmental organization (e.g., CARE, Inc.)

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