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October 11, 2007
CAC Unit
Members of the Kathmandu Maternity Hospital's CAC unit receive their award.
Madhabi Bajracharya
 

In September, one of the largest health-care providers in Kathmandu, Nepal, has recognized its comprehensive abortion care (CAC) unit as the best-performing of 21 units in the hospital. The Kathmandu Maternity Hospital, a specialized hospital for maternity care and a referral hospital for obstetric and gynecological cases, serves about 24,000 patients a year and is one of the main providers of health care in Nepal’s capital and largest city.

Comprehensive abortion care is an approach to providing abortion services that takes into account the various factors that influence a woman’s individual health needs — both physical and mental — as well as her personal circumstances and her ability to access services. It attempts to improve upon traditional abortion services in three dimensions: quality, range of services and access. Ipas worked with the Nepalese government to launch the unit in 2004; Ipas continues to provide guidance to the unit and help it train providers in CAC services.

Kathmandu Maternity Hospital’s CAC unit scored high on rankings of client satisfaction, cleanliness and friendliness. It was also successful in providing the vast majority of its clients with contraceptive counseling (to prevent future abortions), and in quickly and efficiently referring clients with complications to other hospital units. But it was the unit’s efforts to reach women in need that ultimately won it the award, said Dr. Sudha Thapa, an obstetrician-gynecologist and coordinator for the unit.

The unit serves every woman who arrives during service hours, even if this means staying open several hours after the normal closing time. Thapa said that this decision, implemented in 2006, brought the number of women turned away from the clinic from almost 50 percent to zero. Impoverished women, who have difficulty traveling and taking the time to visit health-care providers, may not able to return if turned away. Costs for abortion services are low — typically less than US$15 — and the unit waives fees for women who cannot afford them. To encourage visits from women who would otherwise be reluctant to seek abortion services, the unit allows women to avoid queuing in the general hospital entrance. Instead, they may go directly (and privately) to the CAC unit. Clients can also use unique code numbers instead of their names to seek services confidentially, Thapa said.

Efforts to improve access are especially important in Nepal, which only legalized abortion in 2002. Before that time, women were regularly arrested and sometimes given life sentences for seeking or receiving abortions. Nepal’s maternal mortality rate, which was the second highest in the world during the 1990s, has since fallen by half (it remains high). Government hospitals in Nepal offer affordable, safe abortion services, but abortion’s history as a crime, combined with the strong stigma still attached, make many women reluctant to seek these services.

The CAC unit had to make innovative changes to its human resources and administrative capabilities to make its improvements, Thapa said. The unit had to have staff ready to provide high-quality service on days that could last anywhere from 2 p.m. until after 5. The code-numbering system had to accurately record the number and types of services provided, as well as maintain client confidentiality. 

The CAC unit, along with the other units of the Kathmandu Maternity hospital, is starting to change the way many Nepalis think about health services in addition to providing quality service, Thapa said. “Surprisingly, most women prefer to come to our hospital, not only for CAC, but for all types of obstetric and gynecological services,” Thapa said. “Normally, private hospitals are perceived as better than government [hospitals], but our hospital is considered one of the best.” 


For more information, contact:
Kirsten Sherk
Senior Associate, Media Relations
e-mail: sherkk@ipas.org
phone: 919.960.5612
fax: 919.929.0258