Self-rated mobility, physical health, and chronic pain among women seeking abortion in a health facility in Nepal (2019-2024): a prospective cohort study.
4 affiliations
- 1Advancing Standards in Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, 1330 Broadway, Suite 1100, Oakland, CA, 94612, USA.
- 2Department of Epidemiology & Biostatistics, University of California, San Francisco, 550 16th St 2nd Floor, San Francisco, CA, 94158, USA.
- 3Department of Medicine, University of California, San Francisco, 490 Illinois Street, San Francisco, CA, 94158, USA.
- 4Center for Research on Environment Health and Population Activities (CREHPA), Kusunti PO Box 9626, Kathmandu, Nepal.
Abstract
Background
Women may have adverse physical health following abortion denial and childbirth, particularly where maternal morbidity is high. This study aims to investigate mobility, self-rated physical health, and chronic pain associated with unwanted pregnancy among women seeking facility-based abortion services in Nepal.Methods
Women seeking abortion at 22 facilities across Nepal in 2019-2020 completed surveys every six months for five years. This longitudinal cohort study assessed limited mobility, self-rated poor health, and chronic pain using weighted linear and logistic mixed effects regression, including among those seeking abortion for health reasons. We report time-specific marginal predicted probabilities for those denied (who gave birth and did not give birth) and those who obtained abortion.Findings
Of the sample (n = 1742), 51% obtained care (Abortions), 15% gave birth (Turnaway-Births), and 33% were denied but did not give birth (Turnaway-NoBirths). Risk of any limited mobility was 15 percentage points higher (95% CI: 7%, 22%, p = 0.0001) for Turnaway-Births (predicted probability: 47%) versus Abortions (32%), and 2.5 days longer on average (95% CI: 1.42, 3.59, p < 0.0001; 5.3 versus 2.8 days); differences were larger among those seeking abortion for health reasons. Self-rated poor health, pelvic pain, and head pain did not differ for Turnaway-Births versus Abortions overall. Among the subsample, Turnaway-Births had poorer self-rated health at 18 months (0.09, [0.01, 0.16], p = 0.026), more back pain at 24-36 months (maximum risk difference: 0.17 [0.04, 0.31], p = 0.012), and less pelvic pain at 6 months (-0.08, [-0.015, -0.01], p = 0.036) compared to the Abortions.Interpretation
Compared to the Abortions, Turnaway-Births experienced more limited mobility, and, among those who sought abortion for health reasons, poorer self-rated health and more chronic pain. Support for women seeking abortion, especially for health reasons, in obtaining timely care is needed to limit adverse physical health.Funding
This study was supported by the National Institutes of Health and the David and Lucile Packard Foundation.
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BibTeX
@article{raifman2026selfrated,
title = {{Self-rated mobility, physical health, and chronic pain among women seeking abortion in a health facility in Nepal (2019-2024): a prospective cohort study.}},
author = {Sarah Raifman and Rachel Murro and W John Boscardin and Mahesh C Puri and Diana Greene Foster and Corinne H Rocca},
journal = {The Lancet regional health. Southeast Asia},
year = {2026},
month = sep,
doi = {10.1016/j.lansea.2026.100835},
url = {https://europepmc.org/article/MED/42948025},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Self-rated mobility, physical health, and chronic pain among women seeking abortion in a health facility in Nepal (2019-2024): a prospective cohort study.
AU - Sarah Raifman
AU - Rachel Murro
AU - W John Boscardin
AU - Mahesh C Puri
AU - Diana Greene Foster
AU - Corinne H Rocca
PY - 2026
DA - 2026/09/03
JO - The Lancet regional health. Southeast Asia
DO - 10.1016/j.lansea.2026.100835
UR - https://europepmc.org/article/MED/42948025
AB - Background Women may have adverse physical health following abortion denial and childbirth, particularly where maternal morbidity is high. This study aims to investigate mobility, self-rated physical health, and chronic pain associated with unwanted pregnancy among women seeking facility-based abortion services in Nepal.Methods Women seeking abortion at 22 facilities across Nepal in 2019-2020 completed surveys every six months for five years. This longitudinal cohort study assessed limited mobility, self-rated poor health, and chronic pain using weighted linear and logistic mixed effects regression, including among those seeking abortion for health reasons. We report time-specific marginal predicted probabilities for those denied (who gave birth and did not give birth) and those who obtained abortion.Findings Of the sample (n = 1742), 51% obtained care (Abortions), 15% gave birth (Turnaway-Births), and 33% were denied but did not give birth (Turnaway-NoBirths). Risk of any limited mobility was 15 percentage points higher (95% CI: 7%, 22%, p = 0.0001) for Turnaway-Births (predicted probability: 47%) versus Abortions (32%), and 2.5 days longer on average (95% CI: 1.42, 3.59, p < 0.0001; 5.3 versus 2.8 days); differences were larger among those seeking abortion for health reasons. Self-rated poor health, pelvic pain, and head pain did not differ for Turnaway-Births versus Abortions overall. Among the subsample, Turnaway-Births had poorer self-rated health at 18 months (0.09, [0.01, 0.16], p = 0.026), more back pain at 24-36 months (maximum risk difference: 0.17 [0.04, 0.31], p = 0.012), and less pelvic pain at 6 months (-0.08, [-0.015, -0.01], p = 0.036) compared to the Abortions.Interpretation Compared to the Abortions, Turnaway-Births experienced more limited mobility, and, among those who sought abortion for health reasons, poorer self-rated health and more chronic pain. Support for women seeking abortion, especially for health reasons, in obtaining timely care is needed to limit adverse physical health.Funding This study was supported by the National Institutes of Health and the David and Lucile Packard Foundation.
SN - 2772-3682
ER -