Use of Contraceptives among Adolescents: What Does Global Evidence Show and How Can Nepal Learn?

BACKGROUND: Adolescent pregnancy is a global health problem. Early pregnancies among adolescents have major health consequences for adolescent mothers and their babies. Contraceptives can prevent early pregnancy and its consequences. However, there is a low use of contraceptives among adolescents. Global evidence has shown which programmatic approaches are effective to increase the use of contraceptives among adolescents. METHODS: This is not a systematic review. Desk review was done using Google Scholar and PubMed. Different policies, strategies, and reports published by agencies were also reviewed. RESULTS: There is a low use of contraceptives and high unmet need for family planning and high adolescent fertility rate. Various studies conducted in different parts of the world have shown that there are some programmatic approaches implemented which are effective to improve the contraceptives use among adolescents. We have categorized the findings into three parts; i) delivery of services ii) increasing demand for services, and iii) creating an enabling environment. CONCLUSIONS: The use of contraceptives is low among adolescents in low- and middle-income countries including Nepal. So, the current programmatic approaches should be reviewed and the evidence-based practices implemented to bring better results. Ministry of Health and Population and partner agencies in Nepal also need to review the current programmatic approaches and implement them based on the evidence-based practices to improve contraceptives use among adolescents.

Abortion: Still Unfinished Agenda in Nepal.

Unsafe abortion is affecting a lot, in health, socio-economic and health care cost of many countries. Despite invention of simple technology and scientifically approved safe abortion methods, women and girls are still using unsafe abortion practices. Since 2002, Nepal has achieved remarkable progress in developing policies, guidelines, task shifting, training human resources and increasing access to services. However, more than half of abortion in Nepal are performed clandestinely by untrained or unapproved providers or induced by pregnant woman herself. Knowledge on legalization and availability of safe abortion service among women is still very poor. Stigma on abortion still persists among community people, service providers, managers, and policy makers. Access to safe abortion, especially in remote and rural areas, is still far behind as compared to their peers from urban areas. The existing law is not revised in the spirit of current Constitution of Nepal and rights-based approach. The existence of abortion stigma and the shifting of the government structure from unitary system to federalism in absence of a complete clarity on how the safe abortion service gets integrated into the local government structure might create challenge to sustain existing developments. There is, therefore, a need for all stakeholders to make a lot of efforts and allocate adequate resources to sustain current achievements and ensure improvements in creating a supportive social environment for women and girls so that they will be able to make informed decisions and access to safe abortion service in any circumstances.

Expansion of Safe Abortion Services in Nepal Through Auxiliary Nurse-Midwife Provision of Medical Abortion, 2011-2013.

INTRODUCTION: The termination of unwanted pregnancies up to 12 weeks' gestation became legal in Nepal in 2002. Many interventions have taken place to expand access to comprehensive abortion care services. However, comprehensive abortion care services remain out of reach for women in rural and remote areas. This article describes a training and support strategy to train auxiliary nurse-midwives (ANMs), already certified as skilled birth attendants, as medical abortion providers and expand geographic access to safe abortion care to the community level in Nepal. METHODS: This was a descriptive program evaluation. Sites and trainees were selected using standardized assessment tools to determine minimum facility requirements and willingness to provide medical abortion after training. Training was evaluated via posttests and observational checklists. Service statistics were collected through the government's facility logbook for safe abortion services (HMIS-11). RESULTS: By the end of June 2014, medical abortion service had been expanded to 25 districts through 463 listed ANMs at 290 listed primary-level facilities and served 25,187 women. Providers report a high level of confidence in their medical abortion skills and considerable clinical knowledge and capacity in medical abortion. DISCUSSION: The Nepali experience demonstrates that safe induced abortion care can be provided by ANMs, even in remote primary-level health facilities. Post-training support for providers is critical in helping ANMs handle potential barriers to medical abortion service provision and build lasting capacity in medical abortion.