How attitudes and beliefs about abortion stigmatization shape access to safe abortion services among women in Nepal: a qualitative study

Despite the legalization of abortion in Nepal in 2002 and the provision of free, safe abortion services (SAS) since 2016, significant barriers persist. This study explores the nature and extent of abortion stigma and its impact on access to SAS, examining the beliefs and perceptions of key stakeholders in Nepal. A qualitative study was conducted in four districts (Jhapa, Gorkha, Parsa, Surkhet), representing diverse ecological regions and provinces. Data were collected through 20 in-depth interviews (IDIs) with post-abortive women (PAW), 5 key informant interviews (KIIs) with policy representatives, and 16 focus group discussions (FGDs) with community men and women. Purposive and snowball sampling were used. Data were analyzed using thematic analysis guided by the SABAS framework. Key findings indicate widespread lack of clarity about the legal status and availability of SAS. Abortion is highly stigmatized, perceived as immoral, sinful, and equivalent to “killing a child,” leading to guilt, social exclusion, and discrimination, particularly against unmarried women. Findings are organized around four stigma domains: internalized, enacted, perceived, and structural stigma. Stigma is perpetuated by community members, religious adherents, and patriarchal structures, creating barriers to safe access. Abortion stigma remains a profound barrier to realizing legal abortion rights in Nepal. Reducing stigma requires comprehensive strategies including education, provider training, and engaging men, religious leaders, and youth as advocates. Specific policy recommendations and future research directions are outlined.