Rural Nepal and Women’s Health

Khotang is the nearest remote district to Kathmandu located Northeastern Nepal. This is a hilly region with very limited access to any road or any infrastructure. It has a population of 206,312, 53% being women and women with 5,000 pregnancies per year. The rate of childbirth with a skilled birth attendant, the single most effective intervention to reduce maternal mortality, is less than 25%. Most facilities lack power, running water and are under-staffed. Estimates of maternal and neonatal mortality are twice the national average. There is gender imbalance in the districts with high rates of seasonal migration.

Khotang has one District Hospital, 2 primary health centres, 10 health posts and 63 sub-health posts. health facilities are meant to be staffed by 333 personnel, but over a third of these posts (126) are vacant. The District Health Officer and Family Planning Office in district health office (DHO), Khotang are also vacant. The district has a low contraceptive prevalence rate (44%). Only Disctrict Hospital provides free Safe Abortion Service (MVA+MA). However, recently service providers from two PHCs and  seven health posts have been trained on Comprehensive Safe Abortion. But, the services have not started yet from those PHCs and health posts.

Recently, an incident occurred resulting death of a woman due to severe complications from abortion service. A mother of seven children from rural Khotang accessed  MVA from district hospital. The hospital was not able to immediately send/refer the client to Kathmandu or nearest districts for further treatment. The women died. This is due to inaccessible road. The district has three airports but due to bad weather the client was not able to be chartered in plane or helicopter. The situation is worse as women in Khotang use traditional methods and herbal remedies for terminating their pregnancy. Also, the district has unregistered providers providing abortion service through pharmacies and selling unauthorized drugs to women. There are more PAC (Post Abortion Care) cases in district hospital. 

According to Surendra Budhathoki, focal person from DHO- Khotang shared that there is prevalence of child marriage, high number of rape cases and the district is one of the top ranked when it comes to suicide. He also shared that the people are not aware of importance of family planning. Because of when women have to suffer and continue her pregnancy for 10th or 12th times. Married and unmarried, both access abortion service from district hospital. There is limited knowledge among villagers on legality of abortion and availability of family planning. Myths and misconception is the barrier for women to use family planning devices. Modern methods are still stigmatized. On asking him about stigma associated with abortion in the village, he shared that the community is not sensitize in abortion issue therefore people think it is a sin. However, people are also positive about free services available in health facilities and if needed they do visit and access service.

Surendra Budhathiki continued sharing about Christianity influencing villagers. There was only 2% of Christian residing in the village as per 2011 data. The trend is converting poor villagers into Christianity and its being challenge for health workers to convince the community to use contraceptives and access safe abortion services. Health workers are not allowed to conduct awareness campaigns regarding family planning and abortion in those communities. He said that last year, services providers from health posts were selected for Comprehensive Abortion Care training organized by Government of Nepal. One of the female service providers back out from the training as she is a Christain. She shared she is not allowed to even talk about abortion in her religion. Even if she wants her family won’t except her. She was afraid to be boycotted from her community.

The only reliable health workers to reach women in rural communities of Khotang with information on family planning and safe abortion are Female Community Health Workers (FCHVs). The DHO is under staffed and the team is not able to mobilize FCHVs in the communities. The team was only able to conduct 1 sensitization session for 40 people from different communities on “Free SA” service. “This is not enough”- said Surendra Buddhathoki. The district is also politically sensitive. Political pressure and influence are the biggest barriers for organizations and projects to implement programs effectively. Organization like PLAN International Nepal and project like SAAFAL were prohibited to continue their work in the district. The political instability, inaccessible road, under-staffed health facilities and religious beliefs are affecting the health of women. Women have to continue their pregnancy and give birth to more than 5 children degrading their health.

Nepal just conducted its district level election and all new bodies are on the board. The agenda for each and every rural municipalities must be advocating for women’s sexual and reproductive health rights. The priorities for health agenda could be meeting unmet need of family planning and accessible safe plus legal abortion service. The Government should give importance to mobilizing local qualified people as the district is under staffed. People outside of districts hesitate to travel and work in rural areas therefore, local human resources should be empowered.

 

 

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Take on MA pills over the counter in Nepal

“It’s a culture.” I answered to one of the freelance journalists. “When you have a headache or something you don’t rush to the hospital. You go directly to the pharmacist.” This article talks about the clandestine procedures are still common in Nepal even if abortion is legal. The abortion law in Nepal does not permit pharmacies to sell any abortion pills without prescription. However, thousands of women are easily accessing MA pills via medical shops/pharmacies nearby. I had causally discussed the reasons behind accessing MA pills in pharmacies rather than authorized health facilities with the women who used self administrative drugs. Most of them shared that pharmacies are convenient as they do not have to go through paper works; no forms, no personal information referring to easily accessible and the other reason is privacy.

Even if it is mentioned strictly that abortion should be performed within a standard health protocol; authorized/certified health facilities and by trained medical professionals, women are accessing services through unregistered medical shops and untrained medical professionals. The study done by CREHPA mentioned that nationwide, fewer than half (42%) of all abortions were provided legally in government-approved facilities. The remainder (58%) were clandestine procedures provided by untrained or unapproved providers or induced by the pregnant woman herself. When taken correctly, self-inducing abortions using misoprostol and mifepristone can safely terminate a pregnancy.

The studies also have shown that women prefer visiting pharmacies rather than any Government authorized health facilities for abortion service. However, the Government of Nepal does not have strong action against pharmacies selling various medical abortion pills and resulting to clandestine procedures. An estimated 80,000 women were treated in health facilities in 2014 for complications related to abortion and miscarriage. Sixty-eight percent of these women had complications that resulted from a clandestine abortion. Forty-four percent of women receiving post abortion care were treated in private facilities, 41% in public facilities and 15% in NGO facilities. Nepal’s pharmaceutical industry is difficult to regulate. Only four brands of misoprostol and mifepristone abortion kits are legal in the country, but at least 20 different brands are smuggled across its porous border with India. The pharmacists have a high incentive to sell them since they can pocket hundreds of rupees each time they sell medical abortion kits. This shows that cost is not barrier for women to access MA pills. They can pay for huge amount buying it from pharmacies rather than visiting government facilities which provides safe abortion free of cost.

Recently Government of Nepal has provided free abortion service in Government health facilities- District Hospitals, Primary Health Care and via Health/sub-health posts. This is in deed great progress while recognizing women’s health and prioritizing abortion to be safe, legal and accessible. However, to measure the impact of free safe abortion services and number of women accessing abortion without stigma in health facilities resulting in reducing clandestine abortion should be performed. This will give us clear picture whether “cost” is what women take in account when they have to access abortion service.

Various organization like Marie Stopes Nepal and PSI Nepal have recognized working in partnership with pharmacies could result in providing self administration drugs to women with accurate information and instruction to reduce complications. Marie Stopes Nepal has been closely working with pharmacists and orientating them about their mhealth program “Mero Swastha Mero Haath ma”.  The pharmacists provides stickers and wallet cards to the client accessing medical abortion pills over the counter. The client has to register in mobile health platform; type MA and send to 35565 and they receive 19 SMS for 8 days. The SMS are free of cost. It has clear instruction on how to use medical abortion pills step wise mentioning expected results and call to action for any complication. The SMS also provides information on Contact Centre number for emergency and complications (Contact Centre is toll free number and available every day from 7:00 am to 12:00 am). The SMS has information on post abortion family planning and information on Marie Stopes’ clinics.

The Government of Nepal should realize the fact that the pharmacies are more accessible for women that health facilities and they are buying abortion pills in medical shops. To reduce the complications after accessing MA pills over the counter and improve women’s health, government should reform its policy either resulting into strict actions for pharmacies selling unauthorized medical abortion pills (beside four registered MA drugs) or working in coordination with Druggists and Chemists Association to regulate the drugs and making abortion pills accessible to women all over  Nepal with clear instruction plus reasonable price. The restricted law for pharmacies selling MA drugs over the counter has created barrier for pharmacists and among women accessing the drugs. The pharmacists are afraid to be exposed and doing this under the table which has limited the women to get accurate information on usage leading to complications. Also, women have been cheated with high price. They would have accessed service free of cost. However, lack of information about free SA service and stigma associated with abortion is leading women to seek drugs from pharmacists and black market. This needs to be regulated by government of Nepal to reduce complication incidence and improve reproductive health of women.

Religious Belief – A hindrance for women to access SRHR

Traveling and meeting real people in the communities provide you a sense of satisfaction regarding your work in the field of sexual and reproductive health rights. It is always easy to assume the situation of women and young girls in rural Nepal and describe the barriers they face to access their right to choose. There is always a curtain between me and reality when it comes to discuss a situation of a woman living in remote areas and embrace her circumstances to access her sexual and reproductive health rights.

This year I decided to travel to meet women and young girls. Not only them, also have an informal interaction with service providers to analyze whether they are capable enough to provide services to young girls and boys. Meanwhile I travel;ed to western region of Nepal.

Kapilvastu

Kapilvastu is well connected via the East-West highway to the eastern and western part of Nepal and via feeder blacktop road to India in the south. Kapilvastu received reports of 568 cases of violation of women’s rights in 2011, 52% of which referred to domestic violence, 8% to property related disputes, 6% to social violence, 5% to citizenship-related problems and 3% to polygamy. Social and gender-based exclusionary and discriminatory practices continue to hamper the well-being of women in Kapilvastu. Women face unequal power relations due to a patriarchal social structure and the exploitative nature of the socio-cultural system, particularly in Madheshi and Muslim communities. Caste-based discrimination is also prevalent in Kapilvastu district. Seasonal migration to India is a means for households in Kapilvastu to increase their income. Kapilvastu is one of the districts with very low contraceptive prevalence rates (31%), less than half the government target for 2015.

There are discussion surrounding family planning in the Muslim community. I recently read a book prepared by UNFPA-  Islamic interpretation on sexuality, reproductive health and family planning. The book is prepared by Islamic religious leaders to present religiously sound interpretations (fatwa) on the subject. I always had questions like how is family planning & safe abortion perceived within the Muslim community? Does Islam address the issue of family planning & safe abortion? Is it permissible? Do young women have right to discuss about their sexual and reproductive health choices?

In this regard, I got an opportunity to speak with District Public Health Officer to put light on religious beliefs shaping people’s attitudes within the Muslim community. The level of awareness remains low, and there are many misconceptions related to family planning. Side effects of contraceptive methods and opposition from family members, particularly husbands are the main barrier for resistance to family planning. However, the book which I referred says Islam allows short term methods like oral pills and injectables if the methods do not have any effect on the woman’s body. It is clearly mentioned that wife should compulsorily consult with husband before using any contraceptive methods; discussion should be taken mutually. The DPHO, Kapilvastu also mentioned long acting family planning methods like IUCD/Implant is taken as foreign object, which could harm a woman’s body. The religious leaders shared the permanent birth control method is considered ‘Haram’ in Islam as it causes anatomical/physiological changes in the human body.

The Muslim religious leaders were gathered in Kathmandu to discuss about implementing program on family planning in their districts. One of the religious leaders shared that he is father of seven children. He is not using any family planning methods. He said its all Allah’s grace bestowed to his family and he does not know how many children he will have in the future. The religious leaders talked about exclusive breast feeding stating it is impossible for a woman to fall pregnant while she is breast feeding.  The religious leaders are against abortion. Even the organizer were not confident to talk about safe and legal abortion with them.

The DPHO further added to change the terminology परिवार नियोजन to खुसाल परिवार. He encouraged us to initiate discussion related to uterine prolapse before talking about family planning if I am thinking about sessions in Muslim communities. As he had really bad experience and was nearly beaten up by Muslim men when he had facilitated session on family planning in one of the Muslim communities in Nepaljung.

Similarly I met some service providers in Kapilvastu districts. As per service providers, they mentioned there is no such stigma related to women from Muslim community using short term or long term family planning methods. They shared that women are mostly accompanied by her husband or mother-in-law when they come for service uptake. Similarly, they mentioned that women come and access safe abortion service as well. However, the uptake of family planning after safe abortion is less. The women come for the service but they do not prefer to be counselled. The women always mention about limited time and always seek for privacy and confidentiality. The service providers shared that there are still few communities in rural side where the awareness is limited and it is very difficult to intervene the community with information on family planning. The community is conservative and they have strong religious belief. Women in those areas are suffering more as they have to give birth number of children without birth spacing.

In conversation with FCHVs, they are reliable source for Muslim women when it comes to family planning and safe abortion. They had shared about Muslim families limiting their family size and using modern contraceptives like oral pills and injectables. One of the FCHVs said it is difficult for her to convince women to use long acting methods like IUCD and Implant as the women think these methods affecting women’s body. They also talked about migration rate among men of Muslim community. Migration is another reason for women avoiding family planning methods. Muslim community is rooted with patriarchal ideologies women discussion is influenced by their husbands. Most of FCHVs had claimed that they had accompanied women to health facilities for safe abortion services.

The religion itself is not restricting women for accessing their right to access SRH services and rights. However, the translation of religious belief is male dominating where power relation exhibits clearly. I always wonder why religious leaders are only men. The religions put forward the concept of men and women being equal but when it comes to continuing generation only son is preferred. This has resulted to continue unintended pregnancy even if women want; they are not allowed to seek abortion service. The religious text books/beliefs/values need to be revised with gender lens and eradicate those terms which hindrance all gender to access their SRH rights and services.

Sept 28: Pro-Choice vs Pro-Life

Today going through all those events which had great impact on me and people around in 2016 I scroll on one of the most interesting talk series organized by Marie Stopes Nepal in co-ordination with CREASION Nepal- Debunking Myths.

Debunking Myths is a series devoted towards bringing into light the myths that have taken a hold of our society’s image of the world around it. With our focus primarily on instilling the desire to test society’s behavior towards specific problems in young people, Debunking Myths works with experienced, yet ever-curious keynote speakers and a committed audience, this program hopes to achieve the change that CREASION always speaks of. Change that is self-sustainable and positive for all parties committed.

The episode on Pro-Choice vs Pro-Life  was all focused on different kind of myths related to Abortion. Being a neutral person participants in the hall listened to view of both pro-lifers and pro-choisers and later raised their questions. “All we want is people to know different angle of taking same thing and judge themselves about right and wrong”-Organizer. 

Every time I spoke in favor of safe abortion being woman’s SRHR, I have been hearing about pro-life organization’s existence in Nepal which has different views. I had this amazing vibe in 2016 to meet the focal person of the pro-life organization. I had known their work when they placed this annoying exhibition booth in “Children and Education” related program saying “Abortion is a crime” and their wall painting in Thapathali denoting “Abortion means killing a baby.” The debunking episode also invited representative from pro-life organization. Similarly, the event had keynote speakers from Youth Champion Advocacy Network Nepal (YouthCANN), Marie Stopes Nepal and guest speaker from Centre for Reproductive Rights- Nepal (CRR).

This person from pro-life organization is HUMAN. Yes, he is however talking totally opposite and abstract on “life in fetus”. He also handed me a sample of fetus- the sponge baby shaped miniature saying this is how the fetus looks like and feel when it is within 12 weeks in the uterus. This is ridiculous. This conversation didn’t end here. He quoted name of various researchers and acclaimed that the researches on “Life in Fetus” are evidence based and scientific. However, I had never heard of those philosophers/academic researchers name ever. These were all unauthentic I believe. The research which pissed me off was on “Rape & Pregnancy”. The presentation showed only 1% of pregnancy is resulted by rape/incest. He stressed on saying every rape/incest does not reciprocate to pregnancy- indicating rape/incest is not an excuse for terminating pregnancy. He then referred abortion is crime as it has been trend/fashion. On asking where he got all these data, he did not have any answer and started yelling on us claiming pro-choice supporters are here in group to demoralize him and his team. I did not know our presence and our questions could make him frustrated out of nothing. His arguments were baseless. Comparing to other pro-lifers he also talked about morals however, he presented pointless discussions.

The discussion on Pro-Choice vs Pro-Life was really intense. Almost all participants were young people. Most of them were bombarded with the terminologies for the first time. Each one of them had different views. However, they all supported safe & legal abortion as the young woman’s sexual and reproductive health rights. The participants raised questions when the pro-life presenter spoke about adoption even if a woman does not want to continue her pregnancy. To convince the audiences he shared the woman who has unwanted pregnancy will be totally taken care by his organization in a shelter home. Once, she delivers her child will be given for adoption. People talk about women terminating their pregnancy regret, what about a woman who does not want to deliver is forced/manipulated to and given for adoption.

I got hyper when he was talking about these nonsense. The best thing I observed during the episode was a young girl, facilitating the discussion was sharing her abortion experience. Hats off to her. I have never meet young woman as bold as her.

A woman’s decisions are her own, and it is women who live with the outcomes of reproductive choices, not the society.

 She also referred to Safe Abortion Law of Nepal being liberal and allowing young woman like her to take her own decision about her bodily integrity and autonomy. She also said that the decision she took few years back was the best decision which helped her to continue her education and career plus facilitate the very session.

We always try to compete with our competitors. We never think about getting their back or side for our cause. Here, pro-lifers and pro-choisers are trying their best to improve the woman’s life. They both believe on sexual and reproductive health rights. However, we a part when it comes to abortion. Have we ever tried to pull them in our side and make them jell with our ideology and cause? At least I don’t. I was really pissed off when the representative from pro-life organization talked about anti-choice and highlighted pro-life philosophy. Ms. Purna Shrestha- Senior Program Officer/ Advocate from CRR Nepal remind me of how our argument should be effective in terms of convincing our opponents with reasons and backing up our points with scientific evidences. This has been the best learning and will be implementing same in 2017.

 

FEMALE MIGRANT WORKERS AND THEIR SRHR

A rapid globalization in the world has a permanent facet in migration and population mobility, Nepal is no exception. Economic migration or migration for employment has dominated the movement of people in Nepal. Labour migration trends are influenced by gender dynamics. In 2011, there were over 237,000 Nepali women working outside of Nepal, about 12 percent of the total number of the 2.2 million Nepali migrants. According to the Kathmandu-based Center for the Study of Labour and Mobility, Nepali female labor migrants work in countries such as India, Kuwait, Malaysia, Qatar, and the United Arab Emirates, primarily as domestic workers and caregivers. Only smaller percentage of women travel abroad for skilled work, most of these immigrants leave Nepal to do unskilled work at cheaper rated, such as domestic help, construction site labourers, factory workers, etc. Some of the women travel as legal immigrants and others often take a risk and entry without a permit.

While migration can provide new opportunities to improve women’s lives and change oppressive gender relations, it can also perpetuate and entrench traditional roles and inequalities and expose women to new vulnerabilities. The vulnerabilities are more sever and acute among women migrants in unsupervised and unregulated sectors like domestic work which includes violence, exploitation, abuse leading to labour rights violations.

SRHR of women migrant workers are subject to regulation by both countries of origin and destination. These regulations begin even before their deployment, with the requirement of medical screening for various conditions and diseases including pregnancy, HIV and other sexually transmitted infections. About 60 governments have established pre-departure and post arrival medical screening of migrant workers. On the other hands, not all countries have done the same for providing health and rights information and education to migrants. Female migrants who are classified as semi-skilled or unskilled workers often have limited access to health services and information. They face multiple barriers in accessing SRH services including language. Also, they have to deal with the negative attitude of employers towards ill or pregnant workers and with fear to termination from the job due to illness and pregnancy.

Currently, there are no sustainable pre-departure, post-arrival and reintegration programs in Nepal that address SRHR of women migrant workers. These information are provided by few organization. Once, they migrate to other countries, they have even less or no access to SRHR information. International agreements like International Conference on Population and Development (ICPD)  which has comprehensive coverage of SRHR commitments and has an entire separate section on migration, it actually does not provide specific recommendations to address SRHR of female migrant workers. However, CEDAW has mentioned the health of women migrant workers and urges countries or origin to “deliver or facilitate free or affordable gender and rights-based pre-departure information and training programs which includes information on general reproductive health including HIV & AIDS prevention.

In 2015, a Nepali migrant worker- Nirmala Thapa was retried in Malaysia for getting an illegal abortion. Nirmala Thapa was 24 years old, who worked as an operator at a Sony factory, terminated her 6 week pregnancy  in Oct-24. She was arrested along with her doctor, while she was recovering post operation at a clinic. Abortion is allowed in Malaysia since 1989 but only when the pregnancy threatens the mother’s life or her physical and mental health. Nirmala was sentenced to a year in prison but has since been out on bail and living at a migrant workers’ shelter. Now, she has returned to Nepal. However, she is facing difficulties to re-establish in her community and sustain daily life.

In order to ensure SRHR of women migrant workers, origin and destination countries must ensure the provision of comprehensive SRH services and education at all phases of the migration cycle and facilitate the establishment linkages and referral networks with migrant friendly SRH service providers. To achieve this, governments from origin and destination countries must work together with civil society and other stakeholders in creating an enabling environment for female migrant workers to make life choices and exercise their Sexual Reproductive Rights.

New Bill ignoring SRHR of women with disabilities

We all believe that Sexual and Reproductive Health Rights are fundamental HUMAN RIGHTS. So does, Nepal. However, a new bill to protect the rights of people living with disabilities had ignored the reproductive health rights of women living with disabilities. Does this mean women living with disabilities are not HUMAN??

Rights of the people living with disabilities 2072 Bill, which has tabled in the Cabinet for discussion, briefly touches upon the reproductive right but is silent on reproductive health rights. The laws have always respected the rights of women in Nepal. For example, Nepal legalized abortion in 2002 allowing women to terminate pregnancies of up to 12 weeks on the consent of women. However, the policy makers in Nepal are insensitive. The recent decision had proved this where the constitution which has always enshrined the reproductive health rights of all Nepali women, this time ignored the reproductive health rights of women living with disabilities to have the right to their own body.

There is always a myth related to sexual rights of people living with disabilities. Women and girls with disability often face violence, discrimination and prejudice that affects their sexual and reproductive rights. These attitudes and practices, which pervade many of our communities and institutions, result in multiple and extreme abuses of the sexual and reproductive rights of women and girls with disability, including through state-sanctioned violence including forced sterilization, forced abortion, and forced contraception. These very severe and cruel forms of sexual violence – perpetrated largely against women and girls with disability, and which qualify as torture or inhuman treatment, have no place in our world.

The sexual and reproductive rights of all people, including women and girls with disability, are contained in many human rights instruments, including the Convention on the Rights of Persons with Disabilities (CRPD) and the Convention on the Elimination of all forms of Discrimination Against Women (CEDAW). Nepal had even signed the CEDAW with promise to protect SRH rights of all human including people living with disabilities.

After a country formally agrees to a UN convention, they have a legal obligation to respect, protect, and fulfill the rights set out in the particular Convention.

RESPECT: Governments must not deprive people of a right or interfere with people exercising their rights. For example, governments must not perform medical treatments on people with disability without their consent, or exclude a child from school on the basis of disability.

PROTECT: Governments must prevent ‘third parties’ (such as police) from abusing the human rights of others. For example, governments must protect people with disability from violence and abuse in institutions.

FULFILL: Governments must take positive steps to make sure people can enjoy their human rights. For example, governments must make or change laws and policies so that people with disability can enjoy their human rights the same as everyone else.

I wonder if there is any treaty committee which plays a role of watchdog in respective countries which implement the particular treaty to which they have formally agreed. The violation of the agreed treaty should have a form of penalty for ignoring any relevant agreement in the treaty. The so called WATCHDOG committee should make sure the respective countries follows all the required details to implement agreed treaty in the country.

Follow the link to get the insight news on new bill in Nepal ignoring SRH rights of women living with disabilities. 

Young People and Unsafe Abortion

Recently the National Daily Newspaper- Kantipur published an article with heading “Abortion Among Teenagers On the Rise”. The article shares, “A 17 year teen girl arrived at Lamjung Model Hospital situated at Beshisahar. The girl who had come from rural part of the district did not agree on continuing her pregnancy and demanded to terminate her pregnancy.”  Don’t you think this is a good news. I am really proud that young people are being vocal about their unwanted pregnancies and taking their own decisions  whether or not to continue with their unwanted pregnancies. The headline of the news should have been “AWESOME TEEN GIRLS CALMING THEIR ABORTION RIGHT AND ACCESSING SAFE ABORTION” – simple !!

The article continues and says “It is clear that underage as well as illicit sexual relationships are increasing along with abortions.” Lamjung Model Hospital is the only authorized abortion centre in the district. Dr. Tilak Babu Ghimire said, “Even the teenage girls of 17-18 years are coming for abortion. We try to convince them not to terminate their pregnancy as far as possible, but they are adamant.” I believe that service providers should be non-judgement and maintain confidentiality. The doctor should be proud on providing safe abortion to young girls, else they would have opt unsafe abortion which could have risk their lives. The article also talks about young women visiting neighboring district to access abortion. This clearly indicates that women do not trust the nearest health facilities- the reason might be service providers being judgmental and the facility does not maintain privacy and confidentiality. In Nepal even if abortion has been legalized and government health facilities provide safe abortion, women still have to travel different places to seek abortion. Another reason could be stigma. Stigma related to abortion has forced women to terminate their unwanted pregnancy seeking service from quack doctors or using herbal products.

For young women, complications from pregnancy and childbirth are the leading cause of death, and unsafe abortion is a major contributor to this mortality. Unsafe abortion can also result in lasting and devastating consequences, including, sepsis, peroration of the uterus or intestines, hemorrhage, chronic pelvic infections, and infertility. (1)

Deaths due to unsafe abortion are on the decline, but the proportion of women dying from unsafe abortion globally remains the same. 

• According to the World Health Organization, deaths from unsafe abortion worldwide have dropped from 69,000 in 1990 to 47,000 in 2008.(2)
• Parallel to this decline, there has also been a one-third decline in maternal mortality from 546,000 deaths in 1990 to 358,000 in 2008. (2)
• Despite the decline in the number of deaths due to unsafe abortion, the proportion of women dying from unsafe abortion has remained the same at approximately 13% of all maternal deaths.(2)
• The number of unsafe abortions increased from 19.7 million in 2003 to 21.6 million in 2008 while the unsafe abortions per 1,000 women aged 15-44 years. (2)
• This increase in the number of unsafe abortions without a corresponding increase in the rate is mainly due to the growing population for women for reproductive age.(2)

Young women account for a significant proportion of unsafe abortion worldwide. However, the article reflects that most of the teenagers are seeking services from safe places like, Lamjung Model Hospital and Marie Stopes Centres. This is commendable that young girls in rural areas of Nepal who are stigmatized for being a girl and getting pregnant before marriage accessing safe and legal abortion services. Without projecting this as a success story of Government of Nepal after making history for legalizing abortion 14 years back, our media is only sensationalizing the reality and reinforcing stigma around abortion.

According to the most recent data available from 2003, almost 14% of all unsafe abortions in developing countries were among women under 20 years of age. 

In developing countries, 2 in 5 unsafe abortions occur among women under age 25, and about 1 in 7 women who have unsafe abortion is under 20. Similarly, in Asia 30% of unsafe abortions are among women under 25 years of age and 60% are in women under 30. 

This is a request to all media personnel to analysis on the impact of your article. Instead of presenting data of abortion as terrifying issue, it would have been great if it was analyzed the difference between safe and unsafe abortions.

Even where abortion is legal millions of women across the world, especially young women, face barrier to access. In context of Nepal, many women, especially adolescents and women from rural Nepal cannot afford to access safe abortion. The geography of Nepal is another reason because of which women are deprived of safe abortion services. Unavailability of trained and certified service providers and continuous supply of Medical Abortion pills, women in many places in Nepal could not access safe abortion service. Stigmatizing abortion is discouraging trained service providers and capable human resources from providing safe abortion services. Even, volunteers like FCHVs are stigmatized for providing information on abortion. Marginalized populations like young persons with disabilities, women living with HIV, LGBTI and others are facing stigma and discrimination when seeking safe abortion services, resulting in denial of care or required authorization. Gestational limits, the need for parental consent for service is another barrier to accessing safe abortion services.

This article is an example that really hit me this month. I had discussion and argument on this. One of the people questioned me, “Why are you advocating and promoting abortion for young people? Why don’t you promote contraception instead? Excuse me! While more young women are using contraception in Nepal, there is till a tremendous unmet need for contraception and young women experience higher failure rates than older women. And I am not advocating for abortion, instead I am advocating for Safe & Legal Abortion. SIMPLE

Recently, I had received a call from Radio Station. The radio station is compiling data and information on abortion. They would like to know number of abortion cases. I replied them that I am not the person to talk about numbers on abortion. They should have visited to respective District Public Health Office and talked to concern department. She asked me what percentage of young girls seek abortion and what is the average age. Why these media people are more concern about the data on young girls accessing abortion. They concern and their queries is indeed stigmatizing young girls accessing safe abortion services. Instead for creating content that would provide wrong message to the community, it would be great if media could be sensible in this issue and support on preventing deaths due to unsafe abortion.

Please read this piece as well to get more incite on the articles publish on abortion by Youth Champion Advocacy Network Nepal.