||Reproductive Health Research
Number 9, February 2004
Opinion Poll on Abortion Law and Service - III
CREHPA has been carrying out annual public
opinion polls since abortion was legalized in the country
in 2002. Annual public opinion polls reflect public
perceptions and attitudes towards the abortion law that
safeguards women’s reproductive rights. Opinion
polls also echoes public awareness about and acceptance
of the policies and programs related to legal and safe
abortion services. The Poll results are relevant in
designing appropriate IEC and advocacy strategies and
behavior change communication (BCC) messages to enable
women and couples to make informed decisions about their
fertility without fear of social stigma and discrimination.
The Public Opinion Poll III was conducted
in 10 towns viz., Kathmandu, Bhaktapur, Bharatpur, Pokhara,
Biratnanar, Dharan, Birgunj, Janakpur, Bhairahwa and
Ilam bazar. 2,665 adult urban residents (1332 male &
1333 female) aged 18-60 years were interviewed between
November 22 and December 12, 2004.
Population proportionate to size (PPS)
technique was used for the allocations the sample in
each urban municipalities. Depending upon the size of
the urban population of a municipality, a minimum of
3 and a maximum of 11 urban wards were selected randomly.
Cluster sampling technique was used to interview the
desired number of adult male and female respondents
in each sampled ward. The published voters' lists of
each ward were used for the selection of the principal
It has been more than 2 years since abortion
was legalized in Nepal. Abortion is legally permitted
on request during first 12 weeks of pregnancy for any
reason, and up to 18 weeks of pregnancy in case of rape
or incest and up to any gestation period in case of
fetal deformity or disability or risk of woman’s
Preventing unsafe abortion practices and
increasing access to safe and affordable abortion care
to women especially in rural area are some of the major
post-legalization challenges. Currently, government
approved comprehensive abortion care (CAC) services
are limited to public (government) hospitals and selected
non-government clinics located in the urban/peri-urban
areas or at the district headquarters of approximately
a third of the country’s 75 districts.
However, many of the government hospitals
approved for CAC services are unable to provide full
time CAC services due to the limited number of doctors
serving in these hospitals. Few approved hospitals had
not started CAC services despite receiving government
Abortion Care (CAC) in Nepal
Since March 2004, selected government
hospitals, non-governmental organizations and medical
institutions began providing comprehensive abortion
care (CAC) services. As of December 2004, there were
26 government hospitals and 13 non-governmental health
clinics, which received government approval for providing
CAC services. These government hospitals began charging
fees for abortion (each hospital can independently decide
the abortion fee) and the fee ranged from Rs. 900 (approx.
US $ 13) to Rs. 1500 (approx. US $ 21). In non-governmental
organizations and medical institutions, the abortion
fee ranges from Rs. 950 to Rs. 3000 or more.
of the public opinion poll III
The objectives of the Annual Public Opinion
Poll III (2004) are as follows:
• To assess the level of awareness
among urban public about the legalization of abortion
in the country;
• To understand whether or not
the urban public perceived that legalization helps to
decrease maternal mortality and unsafe abortion practices
and increase the demand for abortion in the country;
• To assess the extent the urban
public are aware of the 'approved' safe abortion service
• To explore what the urban public
think about the amount of fee currently being charged
by government hospitals for abortion and also solicit
their views regarding the reasons or advantages of charging
high abortion fee.
of the urban public are still ignorant about legalization
Even after 2 years, only 42% of the urban
public mentioned that abortion is now legal in the country.
The proportions of the respondents who said that abortion
is not legalized (30%) or have no idea (28%) comprise
a formidable percentage of the total urban respondents
when combined (chart 1).
Is abortion legal in our country or not?
Comparison of the three successive opinion
poll results (2002, 2003 & 2004) reveal that there
has been a remarkable increase in awareness level about
the legal reform. For example, in 2002, only 22% were
aware about legalization, this percentage increased
only marginally in 2003 (26%) and increased by approximately
one and a half times in 2004 (42%) (Chart 2).
Chart 2: Trend in awareness
on legalization of abortion: 2002, 2003 & 2004
A higher proportion of the adult males
(47%) than the adult females (37%) are aware about the
legalization. Likewise, urban public who are 'high literates'
(59%), read newspaper regularly (55%) or are exposed
to radio (47%), or TV (45%) regularly, are more aware
of legalization than those who are low literates (25%),
never read newspapers (21%) or never listen to the radio
(24%) or TV (23%).These differences are significant.
about the three legal conditions for abortion is still
Among the urban public who are aware of
legalizations, only a third of them (37%) are aware
that abortion is permitted on request during first 12
weeks of pregnancy. Very few repondents (7%) are aware
that abortion is permitted up to 18 weeks in case of
rape or incest and just one fifth (20%) are aware that
it is permitted if pregnancy affects the health of mother
or the fetus.
viewed that maternal mortality ratio (MMR) and Unsafe
abortion will decrease
The large majority of the respondents
(81%) believed that MMR will decrease because of the
legalization. Only 15% mentioned that it will increase
and 3% said that it will remain same (Chart 3).
In your opinion, would the maternal mortality ratio
of our country increase or decrease because of legalization?
Likewise, most of the respondents (81%)
viewed that illegal and unsafe abortion practices will
decrease because of legalization. Only a tenth of the
respondents felt that it will increase (Chart4).
Would illegal and unsafe abortion practices increase
or decrease because of the legalization?
believed that demand of abortion will increase
Three fifths (61%) of the urban public
believed that the number of women seeking abortion service
will increase because of legalization. Less than a fifth
of the respondents opined that the demand for abortion
will decrease (19%) or remain the same (18%) (chart
Would the number of women seeking abortion service increase
or decrease because of legalization?
Over a half
of the respondents are unaware about CAC services
In districts having government approved
CAC centers, more than half of the urban public (except
Kathmandu; 72%) are still unaware about their district
hospitals having approved safe abortion service centers.
Even in districts not having CAC centers, a considerable
proportion (25%-49%) of the urban public have the misconceptions
that their district hospitals provide safe abortion
Nearly a half of the urban
public approves hospitals charging Abortion Fee
Nearly half of the respondents (49%) mentioned
that it is right for the government hospitals to charge
some fees for abortion. On the other hand, less than
a half (45%) of the respondents felt that abortion services
should be provided free of cost in government hospitals.
majority of the urban public desired modest abortion
Two fifths of the urban public (44%) suggested
that the government hospitals in their districts should
charge abortion fees ranging between Rs. 250 (approx.
$4) and Rs. 500 ($8). Another about one third (34%)
suggested Rs. 250 or less. About a sixth (18%) suggested
the fee between Rs 501-Rs. 1000 and only 4% suggested
that the fee should be more than Rs. 1100 (Average=
Rs.517) (Chart 6).
How much should the government hospital in your district
charge clients for abortion care?
Average= Rs. 517
hospitals highly preferred for safe abortion care
Around three quarter (74%) of the urban
public would prefer visiting a government hospital than
other facilties for safe abortion services. Only 18%
mentioned that they prefer private nursing homes and
clinics (Chart 7).
7: Where would you like to obtain safe abortion care
if you wish to have one in the future?
Inexpensive service (82%) was the main
reason for prefering a government hospital. Other reasons
for preference are trustworthy (40%), good care (32%),
proximity (28%) and presence of skilled doctor (14%).
Only 8% cited 'service available all the time' and 2%
mentioned 'privacy' for prefering a government hospital
Why do you prefer government hospital?
of the urban residents rated current abortion fee in
certain government hospitals as 'Low'
Two in three urban respondents (67%) considered
Rs 900 as fee currently being charged by some government
for CAC service as 'moderate' or 'low'. Only 3% rated
this amount as 'high'.
disagrees with the view that high abortion fee would
ensure quality services and that women are ready to
pay any amount
More than two third of the urban public
(68%) have rejected the views that high abortion fee
(more than Rs.1000) would ensure quality service in
hospitals. Likewise, roughly two thirds (63%) disagreed
with the views that women are ready to pay any amount
of fee for abortion.
On the other hand, almost all (92%) accepted
the view that high abortion fee would encourage clients
to be careful next time and adopt FP method. While over
two thirds (68%) agreed that a high abortion fee would
minimise client flow in the hospital (Chart 9).
Do you agree or disagree that a high abortion fee (above
Rs. 1000) will help in the following ?
and Policy Implications
· Though there is a remarkable
increase on awareness about the legalization, more IEC/public
awareness efforts are essential to impart correct knowledge
about abortion rights, legal provision and safe abortion
· The higher public preference
for government hospitals for safe abortion care is highly
noteworthy. However, presently, CAC services are confined
to some districts only and hence it is imperative to
expand CAC centers in the remaining districts and at
PHC levels to increase safe abortion access to rural
· In view of the urban public stressing
for a lower abortion fee and endorsing Rs. 900 charged
by few hospitals, government and concerned NGOs should
ensure that govt. hospitals do not charge abortion fee
above this limit and also make honest provision to provide
free CAC service to poor women.
· Opinion polls and KAP surveys
on abortion in the rural areas are necessary to document
and compare the attitudes and perceptions of rural communities
on the above key issues.
CREHPA, 2002. Public Opinion Poll on Abortion
and Abortion Law -I 2002
CREHPA, 2003. Public Opinion Poll on Abortion
Law and Rights- II 2003
HMG/MoH, 2003. Safe Abortion Service Procedure
HMG/MoH/FHD, 2003. National Safe Abortion
Policy 2060 (B.S.)
Press conference by CREHPA disseminating
Opinion Poll 2004 Results;
Hotel Himalaya, Jan. 5, 2005