Cohort Profile: The Nepal Turnaway Study

PurposeThe Nepal Turnaway Study was designed to understand abortion care experiences and the longitudinal wellbeing of abortion-seekers and their families. ParticipantsThe Nepal Turnaway Study is a nation-wide cohort of abortion seekers recruited from public and private facilities across all seven provinces between April 2019 and December 2020. It contains 1,832 abortion seekers followed for up to five years. Repeated measures of socioeconomic status, health and wellbeing--including maternal physical and mental health and child health (under age three)--were collected every six months or annually, alongside detailed pregnancy and abortion-seeking histories. Findings to dateAbortion seekers in this context can be recruited at health facilities (96% participation) and successfully followed for up to five years (87% retention). Nearly half (49%, n=856) of abortion seekers were initially denied their abortion, and 16% (n=275) ultimately carried the pregnancy to term and gave birth. Those who were denied were more likely to be socioeconomically disadvantaged prior to abortion seeking. Future plansThe Nepal Turnaway Study will be used to understand the longitudinal health and socioeconomic effects of receiving a wanted abortion in this setting. Exposure-balancing weights can be applied to ensure rigorous estimation of the effects of abortion denial on longitudinal outcomes. This cohort can also be used more broadly to examine the trajectories of women and their families in the years following abortion-seeking. RegistrationThis study has been registered at clinicaltrials.gov (NCT03930576) STRENGTHS AND LIMITATIONS OF THIS STUDYO_LIThe primary strength of the Nepal Turnaway Study is the recruitment of individuals at the time of abortion seeking, with prospective follow-up. This design ensures accurate measurement of pregnancy outcomes and establishes temporality between abortion receipt and subsequent longitudinal outcomes. C_LIO_LIThe five-year follow-up period enables assessment of both immediate and longer-term health and wellbeing among abortion seekers. It also allows examination of outcomes for children born before and in the years following abortion seeking, capturing broader family-level implications. C_LIO_LIFuture collaborations are welcome, and researchers may rigorously examine the effects of receiving a wanted abortion by applying exposure-balancing weights that have already been derived using propensity score methods C_LIO_LILoss to follow-up and administrative censoring at study end may limit statistical power for some analyses and could introduce bias. C_LIO_LIAlthough the study seeks to emulate a target trial, participants were not randomized to pregnancy outcome groups; therefore, unmeasured or unknown confounding may affect longitudinal analyses. C_LI