Most of my blogs keep on reminding you about “ Abortion being legalized in Nepal” and it has been nearly 12 years. According to Health and Population Ministry of Nepal within 75 districts there are more than 600 safe abortion service sites and more than 1500 trained and certified health workers providing safe abortion services. MA and MVA are two methods in Nepal widely used for safe abortion under Legal conditions.
In Nepal even ANM (Auxiliary Nurse Midwifery) is eligible to provide Medical Abortion service after training provided by Government of Nepal. ANMs are certified to provide MA services upto 9 weeks of pregnancy. In rural Nepal, trained and certified ANM provides MA pills in most of the listed safe abortion sites. As being reproductive rights activists I really appreciate the action Nepal government is initiating regarding safe abortion and minimizing unsafe abortions.
Nepal has recognized that safe abortion is human right and has legalized it. But there are still unsafe abortion being prevalent in the country and unsafe abortion being reason of maternal mortality rate and serious complications. Abortion is not free as there is a general misconception that women will use it as an alternative to contraception. Now in Nepal there is a debate of getting abortion pills over the counter. Nepal Government has not certified any Medical stores to sell MA pills but in deed in rural Nepal you can get the MA pills in local medical stores/pharmacies.
There are two things in my mind. I want to support the initiation to get MA pills over the counter if the women gets proper counselling and instruction on how to use it. In other hand there are many cases of complications among women in rural areas who have taken MA pills from medical shops/ pharmacy. Another thing I observe barrier to women to get safe abortion service in Nepal is its geography where health facilities are not enough and not in reach to women as they have to travel long distance to access any medical cares. For those women the nearest point to seek health facility is local pharmacy shops. Realizing there is no option for those women visiting health posts for safe abortion MA pills over the counter with proper counseling is OK for me. But in Nepal its illegal to get MA pills in any Medical stores.
Recently I met this young women in Kailali and she was from rural area. She was brought to Sugarkhal Health Post by her in-laws
due to heavy bleeding. I got to interact with her and clicked her picture on her consent. She is just 25 years old and mother of two children: 9 years old daughter and 7 years old son. She told that her third pregnancy is unwanted. Her in-laws support her decision to abort her pregnancy. There was no health post near her village except a small medical shop. She bought a abortion pills packet to abort her 1 month pregnancy. Her mother- in-law told me that the packet comprised of 5 tablets and medical shop owner instructed to take the big tablet on first day and two tablets each on second and third day. On fourth day she started to bleed heavily and they took her to the health post which across the Karnali river. She was bought in a Stretcher ans was tied up as she was carried on a boat. Her in-law shared they had to pay more than thousand rupee for the abortion pill in medical shop whereas she could have easily paid Rs.500 in health post and abort her pregnancy without complication.
Even if Nepal has flexible law related to safe abortion the 2011 National Demographic Health Survey (NDHS) found that 62 per
cent of women in the country still do not know about the legal changes that took place ten years ago. For marginalized women access to safe abortion is needed as a back-up method for unplanned pregnancies, which unfortunately occur often due to the lack of access to contraception, or even in cases of contraceptive failure. The price for a safe abortion leads many women from marginalized communities to seek clandestine abortions. In most cases, clandestine abortions lead to complications that require trained medical assistance.
Even if Nepal has achieved a lot there is still too much work to be done for us to rest on our laurels. All stakeholders need to coordinate their efforts to make enjoyment of reproductive rights a reality for all women in Nepal. We are fully committed to continue engaging with the Government of Nepal to ensure the constitutional and legal protections for women’s reproductive rights in Nepal translate into real change for the health, lives, and rights of Nepali women.