Working Together Towards Global Safe Abortion- 3rd IWAC

The conference is an international platform for global exchange, updates and sharing information on safe abortion as well as providing networking opportunities among committed health workers and SRHR safe abortion advocates. The theme of this congress was “Working together Towards Global Safe Abortion” recognizing that unsafe abortion still kills and disables thousands of women worldwide every day.   Highlights of the conference:

1. Conscientious objection: service providers should not deny the women access to abortion. (raised by Jon O’Brien and Dr. Choong from Malaysia).

2. Values clarification should be mainstreamed within medical education curriculum: To help future service providers understanding of the importance of women’s access to safe and legal abortion services and to enhance the quality service, non-judgmental service and maintaining privacy and confidentiality of clients.

3. “Trust Women”: The key to good medical abortion services (by Beverly Winikoff, Gynuity Health Projects.  

I came across the terminology “Conscientious Objection” during the refresher training organized for youth champions who had attended Youth Advocacy Institute organized by Asia Safe Abortion Partnership in 2014. Dr. sim-Poney Choong, Co-Chair, Reproductive Rights Advocacy Alliance Malaysia and a founder of Asia Safe Abortion Partnership said that it is a duty of a service provider to serve its client with non-judgmental attitude. He/she is not in the state of denial of service to its client because of his/her beliefs. If service providers do not perform abortion to a woman who needs, because it is against his/her beliefs then he/she is in wrong profession. Service providers before joining their profession as doctors or nurses take oath to serve every client. If they don’t, they are the reason for women seeking unsafe and illegal abortion resulting into complications and even death of women.

 Dr. Amar Jesani of the International Medical Journal of Ethics talked about abortion and how to handle ethical questions at Youth Advocacy Institute.

I agree that people come from different backgrounds and they have their own values and norms. However, when you serve nation as service provider on women’s health the important value is saving women’s lives rather objecting abortion service to them because it comes against own values. The best solution for this could be integrating Value Clarification Activities during the training for service providers on abortion. This helps to clear their values.

There was a presentation on trusting women by Beverly Winikoff- Gyunity Health Projects who talked about George Tiller, an American physician, an abortion provider and martyr for women’s right to choose. His motto was, ‘TRUST WOMEN’, an exhortation meant as moral and philosophical. It turns out that it is also very good policy and clinical advice. Her presentation spoke about medical abortion that has been made easier and more acceptable if women are included as major actors in the process and how many aspects of medical abortion treatment can be delegated directly to the woman with no loss of efficacy, safety or acceptability. Indeed, such a revamping of services seems to be more acceptable and preferable to many women.

An examination of what is required of medical abortion services using this lens raises the question of why the drugs are so often restricted to specialist services and to provision in clinics or hospitals only. Why shouldn’t medications for abortion be provided in pharmacies, like other safe and effective medicines? And why shouldn’t they be prescribed at the lowest level of the health care system that can use them effectively and safely- maybe by women themselves? This emphasized on trusting women and empowering them with information and self administrating the medical abortion pills.

Another interesting session was by Dr. Christian Fiala, MD, PhD Spezialist in Obstetrics and Gynaecology shouted asking question Why Is Abortion Illegal? What were the considerations and the intention of making it illegal in the first place? He, then clear the answer saying: monarchies, dictatorships and war leading countries wanted to increase their population and to have more soldiers. Care of children or women has never been a thought. It was only with democratic developments that people too, the freedom to vote for their political representatives and also wanted self-determination in the most intimate aspects of life: one’s sexuality and fertility. He also presented that respecting women implies to give the power to decide over all aspects of their reproductive choices. It also implies the duty for societies to rid of all remaining obstacles and patronizing restrictions.

10 Things You Should Know about Abortion Service in Nepal

This has been my tagline from my first blog post till today “Abortion is Safe and Legal in Nepal”. Nepal has passed its glorious 10 years and more after liberalizing abortion laws and respecting women’s rights to control their own body. It’s icing on the cake when recent national budget 2015/16 announced abortion service in government institutions being free of cost. Also, the NEW CONSTITUTION DRAFT of Nepal has “Guaranteed women’s right to reproductive health and has removed of the term BHRUN HATYA.”

The previous article 43(2) had stated…every women shall have right to safe-motherhood and reproductive right. Bhrun Hatya done on the basis of sexual identification will be punished. Now the new and current provision in the constitution draft in the very same article number i.e. 43(2) states EVERY WOMEN SHALL HAVE THE RIGHT TO SAFE MOTHERHOOD AND THE RIGHT TO REPRODUCTIVE HEALTH.

map-about-bigtext1Yes, it’s my body and I’d rather not have anyone telling me what to do with it. Motherhood is an especial feeling but women could not only be judge on the essence of pregnancy and delivering babies. Unwanted pregnancies can cause many issues and effect health of women as well. But even if the pregnancy is not caused by a rape or causing health issues on woman, my body is mine and i have full right to decide what I want. I know that this is very hard concept for many people to grasp but it’s just the way I feel.

Having said that I am a pro-choice and I support women’s right to safe abortion, I would like to share 10 things you should know about abortion service in Nepal.

  1. Legalization of Abortion:

You should be aware of legal conditions for safe and legal abortion in Nepal. There are legal conditions under which you can go ahead with abortion service in Nepal.

Abortion http://www.asap-asia.org/country-profile-nepal.html is legal in Nepal on the following grounds:

  • Up to 12 weeks of gestation for any women,
  • Up to 18 weeks of gestation if pregnancy results from rape or incest, and
  • At any time during pregnancy, with the advice of a medical practitioner or if the physical or mental health or life of the pregnant woman is at risk or if the fetus is deformed and incompatible with life

Abortion is punishable on the following conditions:

  • Sex selective abortion, and
  • Abortion without the consent of the pregnant woman

Sex selective abortion is big “NO”. This is  important for everyone and especially for young people to be aware of legality of abortion in Nepal. Young people are innocent and often they seek abortion service beyond legal limit. OR they are subject to family and society pressure to keep their pregnancy secret, pushing those who ultimately decide to seek abortion beyond legal limit. Because of this many young people have been denied of abortion. Therefore, awareness on safe and legal abortion among young people is must so that they go to abortion service centres within legal time frame. The denial of abortion service beyond legal limit has lead to unsafe abortion.

2. Abortion procedures:

In Nepal, as is true for most other countries of the developing world, women are rarely given the opportunity to voice their needs concerning health matters. But legalization of abortion in Nepal undoubtedly has empowered women and health status of women. Comprehensive Abortion Care Services is an additional powerful tool in addressing high maternal mortality.

There are two types of medical procedure that is used in Nepal: MVA-manual vacuum aspiration and MA- medical abortion. Medical abortion is performed within 9 weeks of gestation. Medical abortion is a method of using pills to end a pregnancy through a process similar to a miscarriage. Like vacuum aspiration, medical abortion is very safe and effective. It offers unique advantages. It provides a non-invasive method of ending an unwanted pregnancy that women can use in a range of settings, often in their homes.

Safe and legal abortion services providers should counsel its clients regarding the methods of medical procedure being available in the service centre. It is the choice of woman on going through medical procedure via MVA or MA.

3. Identify safe abortion service centres:

cac

Safe Abortion Logo

Comprehensive Abortion Care Services are made available through the private, non private, semi-governmental sectors to provide abortion services in under served areas and to marginalized populations. Government of Nepal has developed a safe abortion logo. It is a visual symbol to designate facilities offering safe abortion services that is prominently displayed at all abortion service sites. Through its extensive incorporation in safe abortion IEC materials and programs. the logo has been a widely recognized symbol of safe abortion in Nepal, particularly among vulnerable populations such as illiterate women. Perhaps have also used behavior change communication strategies- including evidence based community discussion groups and a serial radio drama to foster discussion about sexual health and to challenge commonly held negative beliefs and stigma around induced abortion.

Likewise, the Government of Nepal certifies the health facilities as well as health service providers with trained human resources (doctors, nurses, ANMs) to provide abortion services to women. Abortion service and care is now available in all 75 districts of Nepal, many of which are in remote, mountainous areas, reflecting the government’s emphasis on rapid decentralization.

4. Privacy and Confidentiality and Counseling:

Quality service is the integral part of abortion service centres and it is right of women to receive standard sexual and reproductive health service. Abortion is very sensitive issue to be talked and decide to go for the procedure. Before safe and legal abortion, counseling regarding abortion and its procedure is the most. Woman has right to choose the correct abortion procedures: MVA or MA. For this proper balanced counseling is the most. Similarly privacy and confidentiality is the most. There are evidence which states that young people and women do not prefer to visit their nearby health facilities for any sexual and reproductive health services as they might meet their relatives and friends or service providers might know their family. They prefer travelling far to next districts for even simple SRH service due to lack of privacy and confidentiality in their nearby health facility.

So it is necessary that health facilities and even service providers maintain privacy and confidentiality. If they do not, everyone has right to ask for and if not maintained legal action could be preferred.

5. Hotline service:

Meri Saathi Free Helpline In Nepal, there are limited hotline service centres which offer information on safe abortion: legality, procedures, dos and dons, queries, safe abortion services. But Marie Stopes Nepal offers range of sexual and reproductive health counseling over phone. They have trained and skilled counselors who are available six days a week and provide information on safe abortion. It is call Meri Saathi Free Helpline. You can dial 16600119756 or 9801119756 to get accurate information on abortion service centers. These numbers should be saved in your cell phone. In any emergency regarding sexual and reproductive health issues, the solution could be a dial away.

6. Abortion service centres- Youth Friendly 

All abortion service centres should be youth friendly. Safe and legal abortion is young people’s sexual and reproductive health rights. The service providers should be youth friendly. They should not have their personal values which hold them back when it comes to providing abortion service to young girls. Even the service centres need to be youth friendly with IEC materials being demonstrated, well received in the centre, non-judgmental, privacy and confidentiality.

7. Abortion and Consent:

This is an important topics to be discussed widely. When it comes to abortion and consent, most of the people think that consent from husband, boyfriend, family, etc is compulsory. But in our abortion law it is clear that “Only pregnant woman holds the right to choose to continue or discontinue the pregnancy.” This states that only pregnant woman’s consent is enough to get abortion service. If the pregnant woman is less than 16 years of age or not in a position to give consent (mentally incompetent), the nearest guardian or relative can give consent for abortion services.

8. Accessibility and Affordability:

Abortion should be accessible and affordable. As mentioned above abortion services in Nepal are available in all government institutes like Primary Health Care, Health post and Sub health post in all 75 districts. Service providers are trained to provide both MVA and MA services to women in urban as well as rural areas. Even various organizations like Ipas Nepal has been training Female Health Volunteers to aware community about safe and legal abortion services being available in their nearby health facilities. This is indeed good initiation to prevent unsafe abortion. The fee structure established for public-sector maternal health services set a standard fee of about Rs. 1000 for induced abortion. Although modest, this fee was in contrast to free provision of post-abortion care, delivery, pre-and post- natal cares, and long-acting contraceptives. The safe abortion policy does stipulate that services be provided free of charge to poor or otherwise marginalized women. With continuously advocacy by women’s health advocates, women’s right activists and health organizations “Abortion has been free of cost in government institutions”.

9. Post Abortion Family Planning counseling:

Safe abortion needs good quality abortion services incorporating counseling training human source, infection prevention practices and adequate logistic support. Abortion is also supported by contraceptive services to prevent further unwanted pregnancy. Post abortion family planning benefits individuals, families, communities in many ways: increased modern contraception use and decreased abortion, reduced maternal and child mortality, prevention of mother- to -child HIV transmission and new HIV infections. After abortion procedure, post abortion family planning counseling is the most.

10. You are a champion:

Now you are aware of all the abortion related information, you are indeed great messenger and champion who is responsible to relay accurate message on abortion being safe and legal in Nepal to other people in your circle. You are a Champion.

Youth Champions during Humanitarian Crisis

Youth Champions Nepal were planning for its country seminar to introduce itself among network working in dedication to young people’s sexual and reproductive health & rights when Nepal was struck by its worst earthquake in nearly a century on April 25, 2015. The earthquake destroyed nearly 600,000 and damaged almost 300,000 homes, and displaced some 2.8 million people. More than 8.800 people were killed, tens of thousands were injured. The people are still frightened by aftershocks and the devastation was compounded by number of powerful aftershocks.

Once the earthquake struck our cities, there was urgent need for food, water, shelter and other basic stuffs including first aid. There were numerous causalities reported in district hospitals. The first step of our Youth Champions Network in Nepal we distributed rice, dal, water, sugar, oils, traps & tents, etc. This is what we immediately understood about a humanitarian crisis of this nature. This was the first experience for us living in Kathmandu valley and dealing with natural disaster. But in-coordination with Asia Safe Abortion partnership we realized, there is also an urgent need to provide life-saving reproductive health services and to prevent and respond to gender based violence. Asia Safe Abortion Partnership allowed to use funds to prepare “Hygiene Kits” and distribute among women and girls being affected by earthquake.

“I am sharing about the situation in my community “Bhaktapur”. Since Bhaktapur is a very old and traditional city, most of the houses are made of mud and wood. The earthquake had destroyed most of the old and traditional homes of the Bhaktapur city. People are now staying in open places like field, party palaces, ground and even in dumping sites. We have been calling those places as “CAMPS”. As, the earth has decreased its vibration and we are getting after shocks which we are used to, people who have their house safe and fine to stay have returned to their places.


Among the people in the camps, there are limited tents, electricity, water and food. The people who have lost everything and do not have any alternatives are staying in the camps. As per our team’s observation, there are many pregnant women in the camps. In particular camp, there are 2- 3 women who are pregnant and 1-2 women who recently gave birth to their child. There are more than 25 campsites in Bhaktapur. Some of the places are unreachable as the pathways are closed due to destruction.

Since, there is no work at all and most of the people are emotionally challenged, alcohol has been the best alternatives to pass the time and means of entertainment in the camps. This is also affecting young women and they might be in risk of sexual abuse in coming days. Likewise, smoking among men has been tremendous which is in directly affecting pregnant women and women who just have delivered. As we have set-up our HELP DESK in Bhaktapur Hospitals, there are many changes regarding pregnancy after the devastating earthquake. I personally attended a couple, who were 3 months pregnant and came to visit hospital after the women started to feel the pain on her stomach as she jumped to escape from falling home. But the case was not serious.

Other remarkable affect on women’s health is there are physically and mentally been challenged by the situation. In one side, they have lost their near and dear ones and on other side they have lost their properties. In same time, there is overburden of the work to single women as they have lost their husband and now they suddenly have the responsibility of running the house. Other major effect is on sanitation. There are no proper toilets in CAMPs. Similarly scarcity of water, people are defecating wherever they like. There have been spread of many diseases and women have been the worse affected.

People in camps are mostly provided with raw noodles and biscuits. Proper nutritious food is not available to young women, pregnant women and women who have just delivered. Essential medication like TT, ANC/PNC, iron tab, etc. is also not available. There is a scarcity of contraceptives and we are unable to provide with much help, there are also women who had miscarriage during the situation but there is no care available for them. Health camps are being conducted by different organizations and medical teams have been mobilized but no one is focusing on women’s Sexual and Reproductive health.”- one of our Youth Champions Nepal

Likewise, our youth champions working in coordination with Bhaktapur Youth Information Centre were engaged in assessing pregnant women, lactating women, adolescent girls their SRH and VAW. By, there were many articles online as well in print media which had been reporting continuously about women and girls in crisis situations who face special perils. Pregnant women need ante-natal care, a clean, safe place to give birth and medical attention in the event of complications. new mothers need vital nutrients and postpartum care. And women and girls of all ages need protection from gender based violence, including sexual violence, which tragically follows in the wake of most humanitarian crisis.

“There is a drunken man in our tent. We are mostly girls and women in the tent and we don’t feel safe, him being around. I went and told the camp management committee but they told me to come and complain only if something happens, but won’t that be too late? It’s a day time, but he can do anything to us at night.” A young girl taking shelter in a temporary camp in Kamalbinayak, Bhaktapur.”- One of BYIF volunteers

One of our Youth Champions met Mrs. Sarita Fhutuwar of Balambau, Changunarayan. She is a mother of two daughter and now is pregnant of 8 months. She thought she would have a normal delivery as before but due to earthquake she is in deep thought and is not sure about her post pregnancy. Her house is also badly collapsed and now.lives outside the house in tent. This is the time where she (every pregnant women)has to be given especial care but situation is just the opposite. Keeping in mind her health and situation we BYIF supported her with.some supplements like horlicks, nuts and biscuits(which is enough until delivery). She was also assured that with help of FPAN we will refer her to hospital nearby for safe delivery. This has made her feel much secure and relief.

Then we released we need to come up with a kit that address immediate need of pregnant women, lactating women, adolescent girls and children. Youth Champions Nepal planned to develop hygiene kit with materials like maxi, sari, towel, soap, panties, comb, cream, mosquito coils, sanitary pads (home-made), socks, tooth paste, tooth brush, diapers, supplemental food for babies, torch, napkins, ear buds, nail cutters and more.


Nepal and Nepalese are rising from rubble. The crisis in Nepal is far from over. As Monsoon is here, it has been followed by landslides. Aftershocks are regular occurrences but monsoon has made it difficult for locals to clear all rubble. Meanwhile, human traffickers are targeting the region to abduct vulnerable women and girls. In many ways the dangers are as great as ever.