Nepal celebrated its first “Safe Abortion Day” today. The celebration has actually #BustTheMyth regarding policy makers are not positive to abortion laws and policies. Also, it has #BustTheMyth on government officials not being positive to safe abortion law. The event was formally inaugurated by honorable health minister of Nepal Mr. Khag Raj Adhikhari. He shared his experience on abortion topic in parliament where few renown policy makers are still against abortion. The celebration has also brought all the partner organizations and stakeholder together with media to work together for betterment of the safe abortion laws and policies in Nepal.
The program was jointly organized by Family Health Division and partner organization like Sunaulo Parivar Nepal/ Marie Stopes International, Ipas Nepal, Centre For Reproductive Rights, Family Planning Association of Nepal, FWLD, action works, Beyond Beijing, Safe Motherhood Network Federation and Youth Action Nepal.
Youth Champion Advocacy Network Nepal also participated in the program. The slogan for the Safe Abortion Day 2015 address importance on family planning to avoid unwanted pregnancy and emphasis on safe abortion service if needed in safe and legal service sites.
Sharing about abortion scenario worldwide:
- estimated 22 million unsafe abortion every year
- nearly all unsafe abortion (98%) occur in developing countries
- 13% (47000) of the pregnancy related death is due to complication of unsafe abortion (WHO 2012)
- 5 million are estimated to suffer disability as a result of complications due to unsafe abortion
Safe Abortion program helps government focus on indicators like it helps to reduce MMR and morbidity and helps in creasing CPR and reduction of TFR. Preventing abortion related morbidity and mortality by increasing access to safe abortion services which leads to decrease in MMR. Likewise, preventing future unintended pregnancies by increasing access to post abortion modern contraceptive methods increase CPR and decrease TFR.
Nepal: From Law and Policies to Programs
- 2002- Abortion legalization
- 2003- Procedural Order & Safe Abortion Policy
- 2004- National Standards, protocol, guidelines, training materials and training centres and first SAS maternity hospital
- 2007- Introduction of CAC by nurses
- 2008- Introduction of 2nd trim services
- 2009- national MA scale up strategy
- 2011- National SAL implementation guideline
- 2015- Announcement of free service by government
Facts on Abortion- Current Status in Nepal
- 25% of pregnancies are unplanned in Nepal (NDHS 2011)
- Only 38% of women Know that abortion in Nepal is legal
- Knowledge is very low among no education (20%) and lowest wealth quintile (20%)
Safe Abortion Services: Achievements
- CAC service is available in government health facilities. CAC is available in all 75 districts at district and upper level health facilities. MA service at health post and primary health post level in 41 districts and second tri are available in 22 hospitals. In addition to Government, NGOs and certain private institutions are also providing safe abortion services.
- Safe abortion service was started in Nepal in 2004. Since then about 7 lakh fifty thousand benefited from safe abortion services. This saved many deaths of women and morbidity of women also reduce the cost of health services.
- A study was conducted in 2004, 2007 and 2010 to access the impact of abortion legalization. It was found that by 2010 the percentage of severe complications due to unsafe abortion decreased significantly post abortion legalization.
- As part of CAC, safe delivery sites also office family planning counseling and services to women after abortion. In Ipas supported 15 districts it was found that among the women who received safe abortion service, 80% use any kind of FP services.
- More than 2245 health care providers trained in SA care under NHTC
- 809 sites authorized for SA
- All 75 districts of Nepal has SA sites- even the most remote areas
- Abortion care is part of HMIS
- Over 7,00,000 Nepali women have received SA care services
- About 80% of women also received post abortion contraception
- Less than 2% experience complication
- Medical Abortion introduced in 2010 and available in 41 districts in PHC and HP level. (Data up to June 2014, FHD)
There still challenges that Nepal needs to over come like how to address few emerging issues such as abortion as method of contraception, use of emergency contraception as regular contraception particularly among adolescents, sex selective abortions. Another challenge is to provide free abortion services and further scaling up of program ensuring equity and quality. Similarly, we should ensure post abortion contraception particularly LARC and monitoring of free abortion services.