Understanding factors influencing adverse sex ratios at birth and exploring what works to achieve balance: The situation in selected districts of Nepal

The goal of this study is to identify programs and sociocultural factors underlying disparities in sex ratios at birth in some parts of Nepal, by comparing the situation in districts with high and normal sex ratios at birth and among under-5 children. Findings are expected to inform the design of programs intended to raise the value of girls in general and counter the practice of gender-biased sex selection in particular. The study was conducted in two adjoining hill districts of the western development region of Nepal, namely Kaski (where sex ratios are adverse) and Tanhaun (where sex ratios are normal). The study adopted a mixed method that included a population-based survey of 1,000 married women with at least two children, one of whom was aged 0–5 years, and 29 key informant interviews with district-based public- and private-sector health care providers and program implementers/managers. Data were collected between October and November 2014. This report notes that some background characteristics such as age distribution and religious affiliation of surveyed women were similar, while differences in characteristics and aspects of women’s agency were also observed

Long-term ambient air-stable cubic CsPbBr3 perovskite quantum dots using molecular bromine

We report unprecedented phase stability of cubic CsPbBr3 quantum dots in ambient air obtained by using Br2 as halide precursor. Mechanistic investigation reveals the decisive role of temperature-controlled in situ generated, oleylammonium halide species from molecular halogen and amine for the long term stability and emission tunability of CsPbX3 (X = Br, I) nanocrystals

Factors associated with choice of medical or surgical abortion among women in Nepal

Objective: To investigate factors associated with women's choice of medical abortion (MA) or manual vacuum aspiration (MVA) in Nepal, where the government recently began offering MA services. Methods: Structured exit interviews were conducted between January 19 and May 21, 2010, with women with a pregnancy of 63 days or less who underwent abortions at 7 clinics in 3 districts of Nepal. All those who accepted MA, and 1 in each 4 or 5 of those who underwent MVA, were invited for an interview. Of those interviewed, 499 chose MA and 542 underwent MVA. Results: Many women were not aware of both abortion methods before they came to the clinic. The odds of choosing MA were more than 3 times as high among those who knew about both methods as among those who did not. Of those who had decided on MVA prior to receiving information at the clinic, 29% chose MA. In contrast, only 10% of those who intended to accept MA opted for MVA after receiving information and counseling. Women who had more education, were of the upper Hindu caste, or resided in urban areas were more likely to choose MA. Conclusion: Information and counseling have a large impact on the women's choice of an abortion method. To expand access to MA and to ensure that women can make an informed choice, it is essential that the government of Nepal create positions for trained counselors at all public abortion clinics

Identifying the causal effect of child marriage on unmet needs for modern contraception and unintended pregnancy in Nepal: a cross-sectional study using propensity score matching

Objectives This study aimed to investigate whether child marriage had causal effects on unmet needs for modern contraception, and unintended pregnancy, by estimating the marginal (population-averaged) treatment effect of child marriage.Design This study used secondary data from the Nepal Demographic and Health Survey 2016. Applying one-to-one nearest-neighbour matching with replacement within a calliper range of ±0.01, 15–49 years old women married before the age of 18 were matched with similar women who were married at 18 or above to reduce selection bias.Setting Nationally representative population survey data.Participants The sample consisted of 7833 women aged 15–49 years who were married for more than 5 years.Outcome measures Unmet needs for modern contraception and unintended pregnancy.Results The matching method achieved adequate overlap in the propensity score distributions and balance in measured covariates between treatment and control groups with the same propensity score. Propensity score matching analysis showed that the risk of unmet needs for modern contraception, and unintended pregnancy among women married as children were a 14.3 percentage point (95 % CI 10.3 to 18.2) and a 10.1 percentage point (95 % CI 3.7 to 16.4) higher, respectively, than among women married as adults. Sensitivity analysis indicated that the estimated effects were robust to unmeasured covariates.Conclusions Child marriage appears to increase the risk of unmet needs for modern contraception and unintended pregnancy. These findings call for social development and public health programmes that promote delayed entry into marriage and childbearing to improve reproductive health and rights

Can midlevel health-care providers administer early medical abortion as safely and effectively as doctors? A randomised controlled equivalence trial in Nepal.

BACKGROUND: Medical abortion is under-used in developing countries. We assessed whether early fi rst-trimester medical abortion provided by midlevel providers (government-trained, certified nurses and auxiliary nurse midwives) was as safe and effective as that provided by doctors in Nepal. METHODS: This multicentre randomised controlled equivalence trial was done in fi ve rural district hospitals in Nepal. Women were eligible for medical abortion if their pregnancy was of less than 9 weeks (63 days) and if they resided less than 90 min journey away from the study clinic. Women were ineligible if they had any contraindication to medical abortion. We used a computer-generated randomisation scheme stratified by study centre with a block size of six. Women were randomly assigned to a doctor or a midlevel provider for oral administration of 200 mg mifepristone followed by 800 μg misoprostol vaginally 2 days later, and followed up 10-4 days later. The primary endpoint was complete abortion without manual vacuum aspiration within 30 days of treatment. The study was not masked. Abortions were recorded as complete, incomplete, or failed (continuing pregnancy). Analyses for primary and secondary endpoints were by intention to treat, supplemented by per-protocol analysis of the primary endpoint. This trial is registered with ClinicalTrials.gov, NCT01186302. FINDINGS: Of 1295 women screened, 535 were randomly assigned to a doctor and 542 to a midlevel provider. 514 and 518, respectively, were included in the analyses of the primary endpoint. Abortions were judged complete in 504 (97.3%) women assigned to midlevel providers and in 494 (96.1%) assigned to physicians. The risk difference for complete abortion was 1.24% (95% CI -0.53 to 3.02), which falls within the predefined equivalence range (-5% to 5%). Five cases (1%) were recorded as failed abortion in the doctor cohort and none in the midlevel provider cohort; the remaining cases were recorded as incomplete abortions. No serious complications were noted. INTERPRETATION: The provision of medical abortion up to 9 weeks’ gestation by midlevel providers and doctors was similar in safety and effectiveness. Where permitted by law, appropriately trained midlevel health-care providers can provide safe, low-technology medical abortion services for women independently from doctors. FUNDING: UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research (RHR), World Health Organization