{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,6]],"date-time":"2026-09-06T18:18:01Z","timestamp":1788718681497,"version":"build-2803163510"},"reference-count":38,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2024,2,22]],"date-time":"2024-02-22T00:00:00Z","timestamp":1708560000000},"content-version":"vor","delay-in-days":21,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2024,2,1]],"date-time":"2024-02-01T00:00:00Z","timestamp":1706745600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Health Science Reports"],"published-print":{"date-parts":[[2024,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and Aims<\/jats:title>\n                    <jats:p>Despite the decriminalization of abortion in Nepal in 2002, unsafe abortion is still a significant contributor to maternal morbidity and mortality. Nepal has witnessed a significant drop in abortion\u2010related severe complications and maternal deaths owing to the legalization of abortion laws, lowered financial costs, and wider accessibility of safe abortion services (SAS). However, various factors such as sociocultural beliefs, financial constraints, geographical difficulties, and stigma act as barriers to the liberal accessibility of SAS. This review aimed to determine key barriers obstructing women's access to lawful, safe abortion care and identify facilitators that have improved access to and quality of abortion services.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A systematic search strategy utilizing the databases PubMed, CINAHL, Scopus, and Embase was used to include studies on the accessibility and safety of abortion services in Nepal. Data were extracted from included studies through close reading. Barriers and facilitators were then categorized into various themes and analyzed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 223 studies, 112 were duplicates, 73 did not meet the inclusion criteria, and 18 did not align with the research question; thus, 20 studies were included in the review. Various barriers to SAS in Nepal were categorized as economic, geographic, societal, legal\/policy, socio\u2010cultural, health systems, and other factors. Facilitators improving access were categorized as economic\/geographic\/societal, legal\/policy, socio\u2010cultural, and health systems factors. The patterns and trends of barriers and facilitators were analyzed, grouping them under legal\/policy, socio\u2010cultural, geographic\/accessibility, and health systems factors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The review identifies financial constraints, unfavorable geography, lack of infrastructure, and social stigmatization as major barriers to SAS. Economics and geography, legalization, improved access, reduced cost and active involvement of auxiliary nurse\u2010midwives and community health volunteers are key facilitators.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/hsr2.1877","type":"journal-article","created":{"date-parts":[[2024,2,22]],"date-time":"2024-02-22T08:43:01Z","timestamp":1708591381000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Striving toward\u00a0safe abortion services in Nepal: A review of barriers and facilitators"],"prefix":"10.1002","volume":"7","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6657-7871","authenticated-orcid":false,"given":"Alok","family":"Atreya","sequence":"first","affiliation":[{"name":"Department of Forensic Medicine Lumbini Medical College Palpa Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kishor","family":"Adhikari","sequence":"additional","affiliation":[{"name":"Department of Community Medicine, School of Public Health Chitwan Medical College  Bharatpur Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samata","family":"Nepal","sequence":"additional","affiliation":[{"name":"Department of Community Medicine Lumbini Medical College Palpa Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Milan","family":"Bhusal","sequence":"additional","affiliation":[{"name":"Medical Officer Gulmi Hospital  Tamghas, Gulmi Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2135-4161","authenticated-orcid":false,"given":"Ritesh G.","family":"Menezes","sequence":"additional","affiliation":[{"name":"Department of Pathology, College of Medicine Imam Abdulrahman Bin Faisal University  Dammam Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8121-083X","authenticated-orcid":false,"given":"Dhan B.","family":"Shrestha","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Mount Sinai Hospital  Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deepak","family":"Shrestha","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology Lumbini Medical College  Palpa Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,2,22]]},"reference":[{"key":"e_1_2_10_2_1","volume-title":"The Safety and Quality of Abortion Care in the United States","author":"National Academies of Sciences, Engineering, and Medicine;\u00a0Health and Medicine Division;\u00a0Board on Health Care Services;\u00a0Board on Population Health and Public Health Practice;\u00a0Committee on Reproductive Health 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G","year":"2012","journal-title":"Reprod Health"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.3126\/tuj.v37i1.48210"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1177\/0025817218822009"},{"key":"e_1_2_10_17_1","unstructured":"The Right to Safe Motherhood and Reproductive Health Act 2075 (2018).2018."},{"key":"e_1_2_10_18_1","unstructured":"Annual Report 2077\/78 (2020\/21). 2022."},{"key":"e_1_2_10_19_1","volume-title":"Improvements in maternal health in Nepal: Further analysis of the 2006 Nepal Demographic and Health Survey","author":"Pant PD","year":"2008"},{"key":"e_1_2_10_20_1","unstructured":"Ministry of Health and Population National Statistics Office. 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