BackgroundAbortion was legalized in Nepal in 2002, following advocacy efforts highlighting high maternal mortality from unsafe abortion. We sought to assess whether legalization led to reductions in the most serious maternal health consequences of unsafe abortion.MethodsWe conducted retrospective medical chart review of all gynecological cases presenting at four large public referral hospitals in Nepal. For the years 2001–2010, all cases of spontaneous and induced abortion complications were identified, abstracted, and coded to classify cases of serious infection, injury, and systemic complications. We used segmented Poisson and ordinary logistic regression to test for trend and risks of serious complications for three time periods: before implementation (2001–2003), early implementation (2004–2006), and later implementation (2007–2010).Results23,493 cases of abortion complications were identified. A significant downward trend in the proportion of serious infection, injury, and systemic complications was observed for the later implementation period, along with a decline in the risk of serious complications (OR 0.7, 95% CI 0.64, 0.85). Reductions in sepsis occurred sooner, during early implementation (OR 0.6, 95% CI 0.47, 0.75).ConclusionOver the study period, health care use and the population of reproductive aged women increased. Total fertility also declined by nearly half, despite relatively low contraceptive prevalence. Greater numbers of women likely obtained abortions and sought hospital care for complications following legalization, yet we observed a significant decline in the rate of serious abortion morbidity. The liberalization of abortion policy in Nepal has benefited women’s health, and likely contributes to falling maternal mortality in the country. The steepest decline was observed after expansion of the safe abortion program to include midlevel providers, second trimester training, and medication abortion, highlighting the importance of concerted efforts to improve access. Other countries contemplating changes to abortion policy can draw on the evidence and implementation strategies observed in Nepal.

Background Learning environment is an important base for learning processes of students and for preferences of future workplaces. It is considered as an essential factor in determining the success of an effective curriculum and the students’ academic achievements. This study attempts to assess the perception of learning environment among the nursing students. Methods A descriptive cross-sectional study design was used to conduct the study among 122 nursing students studying at B.P. Koirala Institute of Health Science. Data were collected following total enumerative sampling method using a self-administered questionnaire. Dundee Ready Educational Environment Measure (DREEM) inventory tool was used to assess the perception of learning environment. Descriptive statistics (frequency, percentage, mean and standard deviation) was used to describe the demographic and other related variables. One way Analysis of Variance (ANOVA) was used to find out the difference in the overall scale score and its subscales across the selected socio-demographic variables (age, ethnicity, residence, year of enrollment) of the respondents. Results The mean age of the students was 21 ± 1.46 years. Majority of the students were from Province no. 1 (57.4%) and largely from Sunsari district (25.4%). First year students were found to be more satisfied (68.23%) with the educational environment (136.45 ± 16.93) compared to student of other years. Academic self-perception (21.94 ± 3.42) was the highest scoring subscale (68.57%) while the social self-perception (16.43 ± 2.96) was the lowest (58.66%). The overall DREEM score (131.25 ± 15.82 out of 200) indicated that perception of learning environment among the students was positive. Despite overall positive perception, students perceived that the teachers were authoritative and there is lack of good support system for the students at the time of stress. The total DREEM score varied significantly between the years of enrollment (p < 0.05). Conclusion The current study showed positive perception of learning environment which varied significantly according to the year of enrollment. However improvements are required across all the five domains for the high quality educational environment. Future qualitative studies are recommended to confirm and to have in-depth understanding of this finding.

An education program along with routine iron supplementation can improve hemoglobin levels and reduce anemia prevalence in pregnant women. Pill count as a measure of compliance has no additional effect on improving hemoglobin status.

: Induced abortion was proven to be a major detrimental factor for maternal mortality. Morbidity was four times higher than mortality to the extent that patients suffered hemiplegia and forced barrenness.

BackgroundIn some developing countries a woman’s decision to utilize maternal health care services is not made by the woman herself but by other family members. The perception of family members regarding who is the most influential person for making the decision to utilize these services is inconclusive. Hence, this study aimed to determine the perceived influential person on utilization of antenatal care (ANC) and delivery care services among teen, young adult and adult pregnant women from the perspective of the woman themselves, their husband and their mother-in-law, identify the factors associated with the woman being the most influential person, and assess the level of agreement between the woman’s and her husband’s response to the woman being the most influential person.MethodsA cross-sectional study was conducted at Paropakar Maternity and Women’s Hospital and Tribhuvan University Teaching Hospital. Purposive sampling technique was used to select 315 women of which 105 were from each age group and their accompanied husbands (n = 315) and mothers-in-law (n = 315). The proportion of perceived influential person and mean priority score of the perceived influence with its 95% confidence interval was calculated. The factors associated with the woman perceived as the most influential person were analyzed by multivariate logistic regression model. The agreement was analyzed using kappa statistic.ResultsAmong teens and young adults and their husband and mother-in-law, the woman’s husband was perceived as the most influential person. Among adults, the most influential person for ANC was the woman herself but for delivery care was the woman’s husband. A woman of adult age, having a non-indigenous ethnicity or who was not referred was more likely to perceive herself as the most influential person in the decision to utilize delivery care. A fair to poor level of agreement was found on the perception of the most influential person for ANC and delivery care utilization.ConclusionsBoth women and their husbands influenced the decision to utilize ANC and delivery care but husbands were more influential, especially in teens and young adults. Thus, husband’s involvement is crucial as a strategy to improve maternal health care utilization in Nepal.Electronic supplementary materialThe online version of this article (doi:10.1186/1742-4755-11-92) contains supplementary material, which is available to authorized users.