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.

 

Women with Disability and SRHR

The disability prevalence rate in Nepal is nearly 2% according to National Demographic Health Survey, 2011. It is nearly 1.7% when it comes to women. Disability is both a cause and a consequence of poverty, where persons with disabilities are not only economically disempowered, but socially and culturally disempowered and excluded.

Women and girls with disabilities face triple discrimination: by being female, having a disability and being amongst the poorest of the poor. They are often subjected to discrimination in accessing education, employment and health care and are at a greater risk of violence, injury, abuse, neglect or exploitation. They are often excluded from the social life of their communities and family. Women with disabilities are particularly disadvantaged due to the multiple forms of discrimination they experience. For example, disabled girls are the least prioritized in terms of access to school and education. Development activities such as income-generating programs for women are largely not accessible to women with disabilities and do not take active steps to include disabled women. Furthermore, girls and women who have a disability are more likely to become victims of physical and sexual abuse.

Approximately 15% of the population, nearly 1 billion people live with a disability. Of which, 80% live in developing countries- 19% of women and 12% of men. Various health related issues are leading to disability. People with a disability face many obstacles in their physical and social environments that prevent then from fully excising rights and participating in social, cultural and professional life as others in society do.

Women with disabilities have traditionally remained invisible in both disability and gender policies. Effective inclusion of women and girls with disabilities in development interventions requires specific strategies and mainstreaming strategies, often referred to as a twin track approach.

Women with Disabilities and their SRHR

Last week I met one of my friend who is also person with disability and she shared her experience on the assumption that disabled women are asexual. This has led women with disabilities a barrier to access reproductive health care, contraception, and sexuality information and social resistance to reproduction and mothering. Disabled women are at risk for a range of undesirable outcomes, including coercive sterilization. This remains me that persons with disabilities have the same sexual and reproductive health needs as other people. Yet they often face barriers to information and services. The ignorance and attitudes of society and individuals, including health care providers, raise most of these barriers, not the disabilities themselves.

Talking to her I remember an incident when I was traveling to Jumla. I met a mother of mentally retarded girl. Her concern was safety of her daughter. At home there is no one for her daughter to look after her 24 hours. She came to the headquarter of Jumla to inquiry about the female sterilization service to a girl with disability. 

The interim constitution of Nepal ensures equality, freedom, justice and dignity of all individuals and implicitly mandates an inclusive society for all including persons with disabilities.

The persons with disabilities are often overlooked or neglected. Many persons with disabilities are marginalized, they are deprived of freedom, and their human rights are violated. Persons with disabilities have been denied information about sexual and reproductive health. Furthermore, they have often been denied the right to establish relationships and to decide whether, when, and with whom to have a family. Many have been subjected to forced sterilizations, forced abortions or forced marriages. In crisis situations these risks are multiplied.

It is hard to estimate the exact number of persons with disabilities who are affected by the earthquake or died in Nepal by the 25^th April’s earthquake since there is no any system with government or any other agencies to track disability specific data at the time of emergency and post emergency situation. 

National Federation of the Disabled Nepal (NFDN), in coordination with its member organizations, has started collecting data of persons with disabilities who are affected by earthquake and have lost their lives. But due to the heavy destruction caused by disaster in district and lack of resource the data collection is getting a bit slow. So far, NFDN has updated the information of 1000 persons with disabilities. 930 out of that are affected in different ways and 30 have been killed. As per the information updated from different districts, the affected persons with disabilities are living on the following condition in the post quake situation.

Violence against persons with disabilities is intermingled by the fact that the victims may be physically or financially dependent on those who abuse them. When they come forward to report such abuse, the medical, legal and social service system are often unresponsive and inaccessible. They face many barriers to care and information about SRHR, GBV and abuse. There is a myth regarding persons with disabilities that they might not be sexually active has reinforce the obstacle toward accessing SRH services. However, research shows, the persons with disabilities are as sexually active a persons without disabilities. SRH services are often inaccessible to persons with disabilities for many reasons, including physical barriers, the lack of disability-related clinical services, and stigma and discrimination.

Attitudes of people differ from place to place and among different types of disability. The great majority of persons with disabilities face prejudice and stigma in their daily lives.Parents of children with disabilities often find themselves socially isolated. Stigma, poverty and lack of support systems take a toll on such families.

The most effective way to advocate for women with disabilities and their access to SRH services is to establish a dialogue with local organizations of and for persons with disabilities and other organizations working on behalf of persons with disabilities. “Nothing about us without us” is a key principle among persons with disabilities. The Convention on the Rights of Persons with Disabilities reflects this principle. It underscores the importance of including persons with disabilities at all stages of policy development, program planning, and implementation. Too often, persons with disabilities and organizations of persons with disabilities are consulted only after a policy or program has been designed. Persons with disabilities must be more than just recipients of SRH programs and resources. Policies and programs at all levels are consistently better when organizations of persons with disabilities take part in planning from the outset.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Connection Between SDGs and Safe Abortion

Sustainable Development Goals (SDGs) is a new road map to improve the lives of people throughout the world over the next 15 years. Sexual and Reproductive Health & Rights issues are currently featured on the SDG agenda expands their presence at both the global and national levels, by establishing SRHR specific indicators to measure progress toward the SDGs.

For the field of SRHR, the SDGs include several relevant goals and targets such as those related to health, education and gender quality. The goals and targets encompass many key aspects of SRHR, including access to SRHR services, comprehensive sexuality education, ensure reproductive rights, achieve gender equality as a matter of women’s and girl’s human rights, and the ability to make decisions about one’s own health. The SDGs are ambitious in their size and scope, consisting of 17 goals and 169 targets that are applicable to all countries equally, and take into account the economic, social and environmental challenges of our world.

The major component of SDGs SRHR related target is to advance women’s access to safe and legal abortion, in accordance with the new SDGs focused on health and gender equality.

SDGs Targets By 2030:

TARGET 3.1: By 2030, reduce the global maternal mortality ratio less than 70 per 100,000 live births: The 2030 target calls for a two-thirds reduction in maternal mortality, based on the latest estimate for the maternal mortality ratio globally, at 210 maternal deaths per 100,000 live births. This is well known facts that leasing cause of maternal deaths is unsafe abortion. A report by the United Nations Secretary-General in 2013 highlighted that numbers of unsafe abortion will continue to increase unless women’s access to safe abortion and contraceptives are questioned. Unsafe abortion is entirely preventable through ensuring women’s access to effective contraception together with safe and legal comprehensive abortion care in all regions, countries and among poor, young and vulnerable women. Nepal has announced free abortion service in 2015, and yet not implemented. This decision will definitely push the nation to achieve the target to reduce maternal mortality by 2030.

TARGET 3.5: By 2030, ensure universal access to sexual and reproductive healthcare services, including for family planning, information and education, and the integration of reproductive health into national strategies and programs: Contraception is an essential component of family planning and SRH that allows individuals to determine if and when to have a child.

Unmet need among the adolescent and young is particularly high for spacing with 37.5 and 23.3 percent respectively (NDHS 2011).

Ensuring that SRH services are made available along with other basic health care e.g.immunization services or treatment for TB may increase access to care and information, especially for disadvantaged populations, such as adolescents, people with disabilities and those living with HIV. Access of services especially SRH related is difficult due to geographical areas in Nepal. SGDs planning and implementation will help Nepal Government to identify geographical areas where and types of services for which availability is lagging can help better target resources and technical assistance.

Access to safe, legal abortion has been recognized by the global community as an essential intervention in a package of comprehensive sexuality and reproductive health services that should be available to all women regardless of age, ethnicity, gender identity, geographic location, marital status, race, religion, socio-economic status or migrant status. 

Improved SRHR knowledge can help young people make healthy, informed choices about their reproductive loves. Understanding levels of knowledge among adolescents can help identifying gaps in preparing young people for this important part of life.

“Only 38% of women know about abortion is legal in Nepal-NDHS 2011. Knowing the adolescent birthrate and whether those births were planned can help quantify challenges facing young people, including their unmet need for contraception and lack of access to education, information and services appropriate for them. For very young adolescents (ages 10-14), early childbearing can be a marker of forced marriage and abuse.”

And also adolescents in particular need universal access to youth-friendly and non-judgmental sexual and reproductive health services that respect their sexual and reproductive health and rights and their rights to confidentiality, privacy and informed consent.

TARGET 5.6: Gender Equality: Lack of gender quality affects almost every facet of life for women and girls around the world. Gender equality includes recognition of women’s autonomy and capacity to make informed and independent decisions about their sexuality and reproduction through laws and policies allowing access to safe and legal abortion. Women’s access to safe and legal abortion is as relevant to gender equality as women’s equal access to education, employment, adequate food and housing.

In order to protect women’s health and lives, it is critical to promote access to safe abortion and to reduce the incidence of and complications from unsafe abortion. Better data collection is necessary in this area to improve the medical and legal environment for providing safe abortion care and to reduce the stigma surrounding the procedure.

The success of key SDGs will depend in significant part on the extent to which important stakeholders-including governments, UN agencies and non-governmental organizations take seriously the specific SRHR targets and fully implement the relevant policies, services and programs to attain them. All the stakeholders should realize that the success of SDGs depend upon women’s & girl’s access to safe and legal abortion in all region equally.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Denial of Abortion Service in Nepal

In 2002, abortion was legalized in Nepal and made widely available. Abortion is permitted up to 12 weeks gestation on request and up to 18 weeks in cases of rape, incest, and health risks to the woman or fetus. Abortion services were established at most government hospitals, private hospitals, and non-governmental organization clinics. The government of Nepal has taken important steps to include abortion as a component of women’s reproductive health services, enabling nearly 800,000 women to obtain safe, legal services between 2004 and 2014. The government has recently announced that abortion services will be made available free of cost in the public facilities but this will take time to implement.

We, Nepali women are living in most privilege country where abortion is safe and legal. The government of Nepal has respected the women decision to have choices and decisions on their own body. Nepali women make their own decision to terminate their unwanted pregnancy on their own consent.  However in other countries like England, Wales or Scotland a woman must ask a doctor to make that decision to her. Similarly in the country where abortion law is restricted, Government takes decision for a woman whether she could or could not terminate her pregnancy. In most cases, women are denied of abortion services. This is the violation of Human Right.

For example, Northern Ireland where women are denied of abortion. In Ireland, abortion is all but outlawed. For decades, women have traveled to England to access abortion services. You can read an article where titled: Irish woman live-tweets journey for abortion from Ireland to England. Dr. Suchitra Dalvie talks about musings on women’s right to safe abortion questioning “Is it not a modern form of slavery to force a woman to have or continue a pregnancy she does not want? Should a woman’s reproductive function take priority over her own aspirations and desires and capacity to fulfill her own highest potential?

Talking about Nepal and the situation of denying abortion, people are shocked to know when I share them about denial of abortion services in unrestricted environment like Nepal. According to our National Demographic Health Survey (NDHS-2011), only 38 percent of women are aware that abortion is legal in Nepal. In addition, their knowledge of the specific circumstances under which abortion is legal is poor. For rural Nepali women, it is difficult to identify whether they are pregnant or not. Most of the women who reach health facilities for abortion service are of high gestation which means above 12 weeks. Most of our Government certified health facilities are authorized to provide comprehensive safe abortion service till 12 weeks of gestation.

One of the leading NGO in Nepal, Centre for Research on Environment, Health and Population Activities (CREHPA) had conducted a study in 2013 which aimed to examine how often women are being denied care, reasons for denial of legal abortion, options considered after denial, sources of information about illegal abortion, experiences seeking illegal abortion and complications experienced. The study showed that denial of legal abortion is common in Nepal. It is common among women from poor family and marginalized communities. Some of the reason for denial of abortion service could be:

1. High gestational age is the reason for denial of abortion as service providers hesitate to go against laws and they are not competent enough to terminate pregnancy of high gestation.
2. Most of the government health facilities are authorized to provide safe abortion services. However, women have been denied of the service due to absence of trained and skilled service providers. Most of the time lack of continuous supply of medical abortion in health facilities is another reason for denial. This has led women to buy unauthorized drugs over the counter which has led to complications among women.

The study has also explained that denial of abortion service has forced women to continue with their pregnancies. Evidence has suggested that children fare best when they are wanted and loved. Similarly, rejection of abortion is leading women to access illegal abortion by self inducing unauthorized drugs and going for traditional methods which can result in incomplete abortion or complications.

This means even if the law is liberal, in certain condition we are forcing women to seek illegal and unsafe abortion. I believe that abortion should be accessible in any gestation age. However, the abortion procedure should be safe which does not keep women at the risk to lose their lives.

Recommendation for improving women’s access to legal care:

1. High impact awareness campaign on pregnancy, abortion, abortion law and services available. For example: interactive radio programs, street dramas
2. Reduce stigma related to abortion.
3. Mobilizing Female Community Health Workers or community mobilizers door to door with interpersonal communication approach to orient people about early detection of pregnancy.
4. Train more providers at all levels to provide abortion and to refer appropriately
5. Promote free helpline numbers like Meri Saathi Free Helpline no. 16600119756 or 9801119756 in community level to call to get detail information on safe abortion, procedures, laws and service centres.
6. Introducing mobile health application like one initiated by Marie Stopes Nepal to registered through SMS and get instruction and information on using self induced medical abortion pills.