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

Background The consequences of abortion denial for women's lives are increasingly recognized, but little is known about the well-being of children born as a result of denied abortion. We compared early childhood outcomes between children born due to abortion denial (index children) and children born from a subsequent pregnancy after their mother received an abortion (subsequent children). Methods Longitudinal data from the five-year prospective cohort Nepal Turnaway Study (2019–2024) include index children and subsequent children. We assessed nutritional status, health, development, and household conditions through maternal report and direct anthropometric measurement. We employed mixed effects models with propensity score weighting to balance differences in maternal characteristics at time of abortion-seeking. Findings Differences between index (n = 274) and subsequent (n = 421) children are to the detriment of index children. Disadvantage starts before birth when their mothers reported more limited diets in terms of green leafy vegetables and sufficient quantity of food. Index children are more likely than subsequent children to be born at home OR=1.91 (95% CI: 1.01–3.61), less than 24 months from an older sibling OR=21.26 (95% CI: 4.39–102.85) and at a birthweight below 2500 g OR=1.92 (95% CI: 1.17–3.16). In their first years of life, index children were more likely than subsequent children to live in households with inadequate income (42.3% vs 31.8% p=0.009), experience acute malnutrition (25.3% vs 17.4% p=0.011); and die (0.7% vs 0.2% p=0.038). Interpretation Being born after abortion denial is associated with economic and nutritional disadvantage in early childhood, underscoring the intergenerational consequences of restricting access to abortion. Funding The U.S. National Institute of Health and the David and Lucile Packard Foundation.