The impact of abortion denial on women's empowerment in Nepal (2019-2024): a prospective cohort study.
- 1Department of Epidemiology & Biostatistics, University of California, San Francisco, 550 16th St 2nd Floor, San Francisco, CA 94158, USA.
- 2University of California, San Francisco, 1330 Broadway, Suite 1100, Oakland, CA 94612, USA.
- 3Center for Research on Environment Health and Population Activities (CREHPA), Kusunti PO Box 9626, Kathmandu, Nepal.
Abstract
Background
There has long been an interest in the association between family planning (contraception and abortion) and women's empowerment, with mixed evidence as to an association and most studies relying on cross sectional data. Within this body of work, less focus has been on how family planning impacts women's empowerment The aim of this study is to understand the impact of abortion denial resulting in having an unwanted birth on women's empowerment, measured by education, mobility and decision-making.Methods
In the Nepal Turnaway Study, we followed women seeking abortions from 2019 to 2020 in Nepal and assessed whether receiving versus being denied an abortion was negatively associated with women's empowerment over five years (longitudinal cohort). We used linear and logistic mixed effects regression models to assess the effects of obtaining an abortion compared to carrying an unwanted pregnancy to term on education, mobility outside the home and household decision-making power.Findings
We followed 1742 for 5 years and find that women who did not give birth were more likely to be in school (Risk Difference (RD) = 0.2 starting 18 months post-abortion seeking) and have greater decision-making power over five years (Risk Difference (RD) = -0.2 starting 12 months post-abortion seeking) and both of these continued for the remainder of the time period. We find no evidence that giving birth affects a woman's freedom to leave her home for shopping or connections to family and friends.Interpretation
These findings suggest that being able to decide the timing and circumstances of childbearing has wide-ranging effects on women's empowerment (as measured by schooling and decision-making).Funding
This study was supported by the National Institute of Health David and Lucile Packard Foundation.
Related
- Antenatal care, birth outcomes, health, development, maternal bonding and nutrition among children of women seeking abortion in a health facility in Nepal (2019-2024): a prospective cohort study.
- Self-rated mobility, physical health, and chronic pain among women seeking abortion in a health facility in Nepal (2019-2024): a prospective cohort study.
- Access to abortion and subsequent fertility preferences and reproductive outcomes in Nepal (2019-2024): a prospective cohort study.
- The impact of schoolbag weight and carrying style on musculoskeletal pain: A 5-year prospective cohort study among schoolchildren in Misrata, Libya
- Evaluation of the Impact of Osteoporosis and Rheumatoid Arthritis on the Outcomes of Nonsurgical Endodontic Therapy: A Prospective Cohort Study
BibTeX
@article{diamondsmith2026impact,
title = {{The impact of abortion denial on women's empowerment in Nepal (2019-2024): a prospective cohort study.}},
author = {Nadia G Diamond-Smith and Diana Greene Foster and Mahesh C Puri and Rachel Murro and Anupama Ale Magar and M Antonia Biggs},
journal = {The Lancet regional health. Southeast Asia},
year = {2026},
month = sep,
doi = {10.1016/j.lansea.2026.100833},
url = {https://europepmc.org/article/MED/42948305},
note = {CC BY},
}
RIS
TY - JOUR
TI - The impact of abortion denial on women's empowerment in Nepal (2019-2024): a prospective cohort study.
AU - Nadia G Diamond-Smith
AU - Diana Greene Foster
AU - Mahesh C Puri
AU - Rachel Murro
AU - Anupama Ale Magar
AU - M Antonia Biggs
PY - 2026
DA - 2026/09/03
JO - The Lancet regional health. Southeast Asia
DO - 10.1016/j.lansea.2026.100833
UR - https://europepmc.org/article/MED/42948305
AB - Background There has long been an interest in the association between family planning (contraception and abortion) and women's empowerment, with mixed evidence as to an association and most studies relying on cross sectional data. Within this body of work, less focus has been on how family planning impacts women's empowerment The aim of this study is to understand the impact of abortion denial resulting in having an unwanted birth on women's empowerment, measured by education, mobility and decision-making.Methods In the Nepal Turnaway Study, we followed women seeking abortions from 2019 to 2020 in Nepal and assessed whether receiving versus being denied an abortion was negatively associated with women's empowerment over five years (longitudinal cohort). We used linear and logistic mixed effects regression models to assess the effects of obtaining an abortion compared to carrying an unwanted pregnancy to term on education, mobility outside the home and household decision-making power.Findings We followed 1742 for 5 years and find that women who did not give birth were more likely to be in school (Risk Difference (RD) = 0.2 starting 18 months post-abortion seeking) and have greater decision-making power over five years (Risk Difference (RD) = -0.2 starting 12 months post-abortion seeking) and both of these continued for the remainder of the time period. We find no evidence that giving birth affects a woman's freedom to leave her home for shopping or connections to family and friends.Interpretation These findings suggest that being able to decide the timing and circumstances of childbearing has wide-ranging effects on women's empowerment (as measured by schooling and decision-making).Funding This study was supported by the National Institute of Health David and Lucile Packard Foundation.
SN - 2772-3682
ER -