Consequences of Access to Legal Abortion for Women’s Socioeconomic Wellbeing in Nepal

Mahesh Puri, Center for Research on Environment Health and Population Activities (CREHPA), Nepal
Sunita Karki, CREHPA
Dev Maharjan, Center for Research on Environment Health and Population Activities (CREHPA)
Nadia Diamond-Smith, University of California, San Francisco
Diana Greene Foster, Advancing New Standards in Reproductive Health (ANSIRH), University of California, San Francisco

Nepal has one of the world’s most progressive abortion laws, yet legal, safe services remain inaccessible to many Nepali women, particularly those who are poor, marginalized, or geographically isolated. We assess the effect of being denied a wanted abortion on socioeconomic outcomes among 1841 women who sought an abortion between April 2019 and December 2020 from government-approved health facilities across Nepal and completed semiannual interviews over the next 36 months. We examined the changes in socioeconomic outcomes over time using mixed-effects regression models and propensity score models to distinguish economic disparities that predate abortion denial from hardships that result. Women who were unable to get a wanted abortion showed significant economic hardship with significantly increased prevalence of inadequate household income after the birth of the child and lower labor force participation over three years using mixed effects models. Household economic instability may contribute to the greater incidence of underweight after the birth of the child, as well as the household going days without eating, skipping meals or not affording preferred foods. Lack of equitable abortion access perpetuates and exacerbates household economic and food insecurity.

Keywords: Sexual and Reproductive Health and Rights

See extended abstract.