Policy change to improve access to safe abortion care in federal Nepal.

In Nepal's constitution, safe abortion care is recognized as an essential component of a comprehensive approach to fulfill individuals' sexual and reproductive health and rights. In the current context of transition to a three-level governance (federal, provincial, and local), there are opportunities to accelerate decentralization and devolution of decision-making power, increase access to and coverage of safe abortion services, and improve health outcomes. This article documents the processes and results of the policy change undertaken by the Ministry of Health and Population in collaboration with development partners to decentralize the approval process of safe abortion sites and providers with the objective to increase access to and coverage of safe abortion services. With the decentralization of certification, the approval process for safe abortion service sites and providers has become simpler, less time consuming, and less expensive by reducing cost of traveling to Kathmandu or approaching authorities at the federal level. This has resulted in expanding safe abortion services across the country including remote areas with marginalized populations. Evidence-based advocacy enabled policy change for decentralization of the approval process. Collaboration among stakeholders has been vital for implementing the policy change, including issuing directives from the federal to provincial levels and capacity strengthening of provincial level officials in understanding the requirements for approval of sites and providers.

Moving from maternal death review to surveillance and response: A paradigm shift.

In the era of the sustainable development goals, India is committed to reduce its maternal mortality ratio to less than 70 per one lakh live births by 2030. An important strategy that was adopted in the Reproductive and Child Health Programme in 2010 was maternal death review. Analysis of the progress so far has brought to light certain gaps which have prompted the paradigm shift toward Maternal Death Surveillance and Response (MDSR), which focuses on taking action on information obtained from every maternal death so as to prevent further maternal deaths. The new guidelines on MDSR were released by the Ministry of Health and Family Welfare in 2017.

Reasons for not practicing contraception in a rural population of Dehradun District.

This study was undertaken to find out the reasons for not using the contraception among Ever Married Women aged 15-49 years in rural population of Dehradun District and to study the factors for discontinuation of contraceptive methods among women who had everusedany method. A Cross-sectional descriptive study was conducted among 2278 Ever Married Women aged 15-49 years in 20 villages from Doiwala block of Dehradun District, Uttaranchal. A multistage sampling technique was used for the selection of villages. Personal interview method with house-to-house visit was adopted as the study method. In this study, Knowledge of any method of contraception was almost universal (96.9%) among ever-married women but 61.81% of the couples had ever used while only 49.9% were currently using any method of contraception. Most common reasons for not using contraception were the desire for more children (21.5%) or particularly a male child (5.4%) followed by religious reasons (9.1%) and opposition by husband or family members (3.3%). Present study revealed that awareness about contraceptive methods is almost universal but counseling of eligible couples on importance of small families and assisting them in making informed choice is needed to remove the obstacles in practicing contraception.